Managing Diabetes & Carb Counting

By: Rosanne Rust, MS, RDN, LDN —

Diabetes affects approximately 30.3 million Americans, or 9.4% of the population, according to 2015 data from the American Diabetes Association. Of that 30 million, approximately 1.25 million American children and adults have type 1 diabetes, and another one million have pre-diabetes. It’s estimated that 1 million Americans are diagnosed with diabetes every year.

November is recognized in the United States Diabetes Month. November 14th is recognized around the globe as World Diabetes Day. And these statistics most certainly deserve attention when considering both the prevention and treatment of Type 1 and Type 2 diabetes. Read on to learn more about diabetes, and how carb counting can be used as a tool.

Diabetes Terms at a Glance

Pre-DiabetesAlso called impaired glucose tolerance, pre-diabetes is diagnosed when blood glucose levels are higher than optimal but not high enough to be diabetes. People with pre-diabetes are at higher risk for developing type 2 diabetes, and for heart disease and stroke.Type 1 DiabetesType 1 diabetes is usually, but not always, diagnosed in childhood. It is diagnosed when blood glucose and hemoglobin A1C (average blood sugar over the past 2 to 3 months) results are above normal range. In addition to high blood glucose levels in type 1 diabetes, there is also a lack of insulin produced in the body. Type 1 diabetes requires injecting insulin (using syringes, pens, or an insulin pump) and measuring blood sugar levels (using a glucometer or a wearable device called a Continuous Glucose Monitor (CGM)).Type 2 DiabetesType 2 diabetes occurs when blood sugars are consistently high, due to either insulin resistance or poor insulin response in the body. Type 2 diabetes typically presented in middle aged or older adults, but we are now seeing it diagnosed more in younger people. It sometimes requires insulin, but often is managed with oral medication, diet and lifestyle interventions. Measuring blood sugar levels is also essential for managing Type 2 Diabetes, although it is typically done so less frequently compared to Type 1.

Risk Factors

Risk factors for Type 2 diabetes include family history, being overweight, having high blood pressure, age (being over 45), and metabolic syndrome (overweight, low HDL, high triglycerides). A strong family history of diabetes increases risk as well. The good news is that both types of diabetes can be treated and controlled with lifestyle choices and medication.

Education and Treatment

Certified Diabetes Educators (CDE) are trained to help people with diabetes lead healthy lives by creating a blood sugar management plan and helping them stay on track with it. Registered Nurses and Registered Dietitians often pursue this credential. CDEs have comprehensive knowledge about diabetes prevention, pre-diabetes, diabetes, and diabetes management.

Once diagnosed, it’s recommended that patients meet with a dietitian and CDE who will review the physiology of the disease and its potential complications. They will also educate the patient about lifestyle change, diet, and blood glucose monitoring.

How Many Carbs?

Carbohydrates (carbs) have been blamed for weight gain and diabetes over the past few years, creating confusion over this important nutrient. In many cases, some individuals are avoiding carbohydrates for no reason. Carbohydrates provide energy and many carbohydrate foods deliver important vitamins, minerals, and fiber. In addition – these foods add flavor, texture, and enjoyment to the diet.

How many carbohydrates do people need? This depends on multiple factors and should be prescribed by the CDE. A 140 pound woman requires fewer carbs than a 200 pound man. Carbohydrate needs are calculated based on total energy needs required to maintain a healthy body weight. Depending on the person, their medical and diet history, and their weight and activity level, the carbohydrate prescription may be 40-50% of total recommended calories. For someone requiring 1,800 calories, this would be about 200-225 grams a day. For someone needing 2,200 calories, carbohydrate limits would be 250-275 grams per day. Ideally, these carbs are spaced out through the day (at about 15-65 grams per snack or meal), and also planned to match activity and glucose tolerance.

Carbohydrate Counting

Carbohydrate counting (or carb counting) is a dietary strategy to help people with diabetes track their carbohydrate intake to keep blood sugar levels optimal. It involves tracking the grams of carbohydrates consumed through meals and snacks through the day. A registered dietitian (RDN) can determine how many carbohydrates are needed in the diet depending on calorie needs and activity levels. An RDN or CDE will also help patients plan the amounts needed at each meal or snack.

Carbohydrates are one of three macronutrients found in foods and beverages. The other two are protein and fat. Carbohydrates include sugars (simple carbs) and starches (complex carbs). Carbohydrates are found in many foods including breads, cereal, grains, pasta, fruit, vegetables, milk, yogurt, and of course sweets (candy, sugar-sweetened beverages, baked goods and desserts).  Foods such as whole grains, fresh fruits and vegetables are considered complex carbohydrates and contain more nutrients, but since carbohydrates increase blood sugar more rapidly than foods high in protein or and fat, it’s important for those with diabetes to keep track of all of them. Unless a patient is experiencing hypoglycemia, it is usually recommended that simple carbohydrates are avoided for the most part due to their higher glycemic effect.

Managing the amount of carbohydrates consumed at every meal results in better blood sugar management. Many types of foods containing carbohydrate can be included in the meal plan (such as special occasion foods). A unit (or carb-counting serving size) of carbohydrate is generally considered to be 15 grams, and a meal plan may limit carbs to 30-45 grams per meal, or 15-30 grams per snack.

How do Sweeteners Fit?

People with diabetes can still enjoy some foods containing sugar, but they have to be carefully planned into the diet. Overall, high sugar foods and beverages should be strictly limited (this is especially true with sugary drinks, since liquid sugar raises blood sugar levels rapidly). Low- and no-calorie sweeteners (LNCS) can help add sweetness to the diet without the unwanted glycemic effects of caloric sweeteners. For instance, aspartame has no effect on blood sugar, nor on body weight.

Substituting non-caloric sweeteners for caloric ones can also make the diet plan more enjoyable. These include diet soda in place of regular, lemonade or other drinks sweetened with aspartame or another LNCS, light yogurt, sugar free frozen treats, or sugar free pudding. LNCS can also be used to sweeten tea or coffee.

Since LNCS don’t add to the total carbohydrate content of the food or beverage, they can be a very helpful tool for people with diabetes. A newly diagnosed patient who previously enjoyed drinking regular soda or sweet tea will be delighted to hear they can substitute a diet soda or a tea sweetened with a LNCS that can be integrated into blood sugar management programs.


Carbohydrate management is a key component of blood glucose management, and, therefore, it’s important that all carbohydrates are accounted for in a patient’s meal plan. Be sure to refer newly diagnosed patients to a registered dietitian and CDE so your patient will have a blood sugar and meal plan management strategy.  In addition, continue to encourage patients to touch base with their educator whenever they are struggling with their blood sugar levels. Keep in mind, achieving a desirable weight and including daily physical activity also play key roles in diabetes management. The more enjoyable and feasible a diet plan is, the more likely your patients will be able to adopt and adhere to it.

Rosanne Rust MS, RDN, LDN is a registered, licensed dietitian-nutritionist with over 25 years experience. Rosanne is a paid contributor to As a Nutrition Communications Consultant  she delivers clear messages helping you understand the science of nutrition so you can enjoy eating for better health. Rosanne is the co-author of several books, including DASH Diet For Dummies® and the The Glycemic Index Cookbook For Dummies®. A wife, and mother of 3 boys, she practices what she preaches, enjoying regular exercise, good food and festive entertaining. Follow her on Twitter @RustNutrition.

Low and No Calorie Sweeteners in Diabetes Management

Neva Cochran, MS, RDN, LD –

November is a time to focus attention on diabetes, its prevention and treatment. About 30.3 million people or 9.4% of the U.S. population are living with diabetes while an estimated 84.1 million Americans 18 years or older have prediabetes.

Diet is an essential component of diabetes management. According to the position paper of the Academy of Nutrition and Dietetics: The Role of Medical Nutrition Therapy and Registered Dietitian Nutritionists in the Prevention and Treatment of Prediabetes and Type 2 Diabetes, “medical nutrition therapy (MNT) provided by registered dietitian nutritionists (RDNs) is effective in improving medical outcomes and quality of life, and is cost-effective. MNT provided by RDNs is also successful and essential to preventing progression of prediabetes and obesity to type 2 diabetes.” (1)

While most individuals with diabetes have a moderate intake of about 45% of calories as carbohydrate, research on the ideal amount of carbohydrate for those with diabetes is still inconclusive. Monitoring carbohydrate intake and blood glucose is essential for maintaining glucose control. (2) Ideally, eating fewer foods with refined carbohydrates and added sugars and more carbohydrates from vegetables, fruits, dairy and whole grains is preferred.

What the Science Says

The American Diabetes Association supports the use of LNCS, stating “they may have the potential to reduce overall calorie and carbohydrate intake if substituted for caloric (sugar) sweeteners and without compensation by intake of additional calories from other food sources. Nonnutritive sweeteners are generally safe to use within the defined acceptable daily intake levels.” (2)

An international scientific panel of health experts met in Lisbon, Portugal in July 2017 to develop a consensus on the use of low- and no-calorie sweeteners (LNCS) as substitutes for sugars and other caloric sweeteners. By analyzing the evidence related to the role of LNCS, their goal was to develop a useful, evidence-based reference to help reduce sugar consumption consistent with current international public health recommendations. They concluded that replacing caloric sweeteners with LNCS in weight loss plans might aid in weight loss. In addition, their use in diabetes management may contribute to better glycemic although results have been modest. The panel proposed that foods and beverages with LNCS could be included in dietary guidelines as alternatives to products sweetened with free sugars. (3)

In a 2013 scientific review of the role of LNCS in diabetes, the authors noted that research finds LNCS play an important role in diabetes prevention and management. Because added sugars are a source of increased carbohydrate intake, using LNCS is a safe and easy way to reduce carbohydrate consumption for those with type 2 diabetes so they can better manage blood glucose levels and lose weight. Substituting sugars with LCNS allows more flexibility in accommodating their health goals and personal dietary preferences. (4)

What a RD, CDE Recommends

In a recent article (5) by registered dietitian and certified diabetes educator, Kathy Warwick, she outlines the nutritional management of diabetes throughout the lifecycle. According to Warwick, there are a number of eating patterns that are acceptable for the management of type 2 diabetes. Nutrition therapy for adults involves meal planning that takes carbohydrates, fats, and protein into consideration. The amount of carbohydrate in meals can vary from 39% to 57% of energy without negatively affecting glucose control. As far as LNCS use, she suggests that FDA-approved nonnutritive sweeteners may be helpful for weight reduction and are safe to use within the acceptable daily intake range.

What Diabetes Organizations Advise

Leading diabetes centers and organizations all support the inclusion of LNCS as part of a healthful eating plan for diabetes management.

Sugar substitutes can be very useful to people with diabetes according to Gillian Arathuzik, RD, CDE with the Joslin Diabetes Center. In an article on the Joslin website, she recommends using either aspartame or sucralose in moderation depending on a person’s taste preference. (6)

Likewise, the American Diabetes Association confirms the safety and usefulness of LNCS for people with diabetes on their website. They support use of foods and drinks with LNCS as another option that may help curb cravings for something sweet. (7)

Finally, the American Association of Diabetes Educators has two LNCS tip sheets available on their website, one with frequently asked questions (8) and the other featuring a chart listing the amount of sweetener packets and cans of diet soda that can be consumed without exceeding the Acceptable Daily Intake. (9)

In summary, scientists, dietitians and noted diabetes organizations all support the use of low and no calorie sweeteners in moderation as part of a nutrient-rich eating plan for those living with diabetes. As health professionals it is reassuring to have options to recommend to clients to increase eating enjoyment and manage diabetes.


  1. Position of the Academy of Nutrition and Dietetics: The Role of Medical Nutrition Therapy and Registered Dietitian Nutritionists in the Prevention and Treatment of Prediabetes and Type 2 DiabetesJ Acad Nutr Diet 118:343, 2018
  2. Lifestyle Management: Standards of Medical Care in Diabetes – 2018Diabetes Care 41(Suppl. 1):S38, 2018
  3. Ibero–American Consensus on Low- and No-Calorie Sweeteners: Safety, Nutritional Aspects and Benefits in Food and BeveragesNutrients 10 818, 2018
  4. The Role of Low-calorie Sweeteners in DiabetesUS Endocrinology 9:13, 2013
  5. Diabetes Management & Nutrition Guide: Diabetes Nutrition Throughout the LifecycleToday’s Dietitian 20:33, 2018
  6. The ABC’s of Sugar Substitutes” Joslin Diabetes Center website accessed 10-18-18
  7. Low-Calorie Sweeteners” American Diabetes Association website accessed 10-18-18
  8. Translation of Research to Help Answer Patient Questions About Sweeteners” American Association of Diabetes Educators website accessed 10-18-18
  9. Acceptable Daily Intake (ADI) in Packs of Sweetener Compared to Cans of Diet Soda” American Association of Diabetes Educators website accessed 10-18-18

Neva Cochran, MS, RDN, LD is a registered dietitian nutritionist based in Dallas. She serves as a nutrition communications consultant to a variety of food and nutrition organizations, including the Calorie Control Council. She is passionate about promoting fact-based food and nutrition information to help people enjoy nutritious eating. Follow her on Twitter @NevaRDLD and check out her blog at

What Steps Can I Take to Prevent or Manage Diabetes Through Diet?

Blood glucose is primarily impacted by the carbohydrates in the foods and beverages consumed. Here are some steps to help prevent and manage diabetes through the diet.

  • As a first step, understand what carbohydrates are and where they are most commonly found.
  • Next, learn how to count carbohydrates. This entails counting the number of grams of carbohydrates in a meal and matching that to your dose of insulin.
  • More broadly, understand how to make sense of Nutrition Facts labels and make informed dietary decisions.
  • Strategize and execute your eating plans. This could mean looking up recipes with nutrition information needed to count carbohydrates, meal planning to help time your meals to keep blood sugars balanced, or seeking out smart substitutions to prevent blood glucose spikes, such as replacing sweetened foods and beverages with low- and no-sugar alternatives.
  • The inclusion of naturally high fiber or fiber-enriched foods in your diet could aid in the management of blood glucose levels, as they have been shown to slow the absorption of carbohydrates. As a result, the rise in post-meal glucose and insulin levels are minimized.
  • Take advantage of online tools such as CCC’s Food Calorie Calculator, which allows users to choose from thousands of foods and brands, and see nutrition facts including calories and carbohydrates.
  • Understand that there are more options than ever before for foods and beverages often labeled as “lite”, “reduced-calorie”, “reduced-sugar”, or “diet” that can help you minimize spikes in blood glucose levels. Those products are typically sweetened with low- or no-calorie sweeteners (LNCS). Learn more about utilize LNCS to manage diabetes here.

Back to School Healthy Eating Tips for the Whole Family

By: Jessica Levinson, MS, RDN, CDN —The kids are back in school, after-school activities are in full swing, and before you know it the holiday season will be here. It’s not so easy to get a healthy meal on the table when there’s so much going on in the household, especially when you’re shuttling the kids around town.

Early mornings and late nights at soccer practice and dance class may lead your family to stop for take out more often than you’d like, which means your family is likely eating larger portion sizes and more calories, sodium, saturated fat, and sugar than they would be if eating home cooked meals. But that doesn’t have to be the case. With a little bit of planning, cooking at home can become a reality. If you spend some time over the weekend planning for the week ahead, it will be much easier to implement this change for the family.

For breakfast, stock the fridge with hard-boiled eggs and individual containers of low-fat yogurt or cottage cheese. Don’t be afraid of fruit-flavored yogurts that are made with sweeteners – the nutritional benefits of yogurt (i.e. calcium, vitamin D, protein) are worth a few extra calories and increased palatability, especially for kids. You can even prepare smoothies the night before and quickly re-blend in the morning. This Blueberry Pomegranate Smoothie is a good source of protein and antioxidants and the pretty color will certainly excite the kids first thing in the morning.

Whole grain frozen waffles or pancakes spread with nut butter and topped with fresh fruit are another quick and easy breakfast the kids will love. You can also make a batch of egg muffins over the weekend, store them in the freezer, and defrost in the microwave in the morning. Overnight oats are another popular timesaving breakfast option.

If you’re packing lunch for the kids or yourself, keep it simple and balanced by filling bento-style lunchboxes with a protein, whole grain, vegetables, and fruit. Or put reheated leftover pasta dishes or hearty soups like lentil or chicken noodle in a thermos, which will keep it warm until lunchtime. Think outside the box when it comes to sandwiches – use romaine lettuce leaves as a sandwich wrap or use two cucumber rounds as the “bread” for mini sandwich bites. Fill them with tuna, chicken, or salmon salad. And don’t forget to pack a bottle of water to stay hydrated without the extra calories of soda or juice.

Eating dinner as a family is the biggest challenge of all for many families. To ease the burden, start with a small goal of cooking at home once or twice a week and work up to more as the schedule permits. Remember the MyPlate graphic when choosing what to make: lean protein, whole grains, vegetables, healthy fats, and a serving of dairy is all you need. Make big batches of soups and stews, which can be frozen and saved for a busy weeknight when you don’t have time to cook.

Get more recipes and tips in this guide to back to school meal planning.

Jessica Levinson, MS, RDN, CDN is a registered dietitian nutritionist and culinary nutrition expert. She has extensive experience as a recipe developer, writer, editor, and speaker. She is the co-author of We Can Cook: Introduce Your Child to the Joy of Cooking with 75 Simple Recipes and Activities (Barron’s, 2011), past columnist for the Culinary Corner column in Today’s Dietitian Magazine, and maintains a popular blog at Jessica is an active member of the Academy of Nutrition and Dietetics (AND) and various Dietetic Practice Groups of the AND, including Nutrition Entrepreneurs, Food and Culinary Professionals, and Dietitians in Business and Communications. Follow her out on Twitter, Facebook, Instagram, and Pinterest.

Eat Together, Eat Better

By: Jill Weisenberger, MS, RDN, CDE, FAND —

Yes, it’s true! When families eat together, they eat better. Specifically, kids who eat with their families eat more fruits and vegetables. Plus, they’re more likely to be at a healthful weight and less likely to engage in disordered eating. But that’s not all. Meal time is an important time for the entire family to connect. Research tells us that when teens eat regularly with their families, the teens are at lower risk of using drugs, have better mental health and feel more connected at home. Kids tend to do better in school too!

As hard as it was to put a family dinner on the table most nights, I wouldn’t have traded this important time for anything. It brought my family closer together, and it helped shape my girls’ values. They also learned about good basic nutrition. Today they know that fruits and vegetables are part of a balanced meal, that they should eat only until they are no longer hungry, and that it’s fun to try new foods and recipes.

Have More Family Meals

  • Get everyone onboard. Talk to your family about the obstacles that get in the way of having more family meals. For some families, it’s as simple as clearing the kitchen table of papers and mail.
  • Be organized. Plan a meal and shop for groceries.
  • Make it fun. Keep the TV off. Have a theme night now and then. Try Taco Tuesday, or have an indoor picnic on the floor. Practice using chopsticks with Asian food, and light candles for a fancy meal.
  • Strike up a conversation. Once a week or so, ask everyone to be prepared to share the highlight of their day, or a worry, a wish they have for the future, or something funny that happened.
  • Get everyone involved. Plan the menu together, or let family members take turns picking recipes. Let older kids shop for groceries and younger ones set the table or count out the right number of forks, napkins or ingredients for a recipe.

Collect Recipes

You may already have favorite recipes passed down through the generations. If you do, keep adding to this collection. If not, start collecting right away. Here are a few that your family is sure to love.

Sharing a meal together is a sure way to bring your family closer together and to instill good eating habits. It’s worth the effort. I promise.

Jill Weisenberger, MS, RDN, CDE, FAND has worked as both a nutrition counselor and a diabetes educator in the hospital and research settings, and now in private practice in Newport News, VA. Jill is the author of Diabetes Weight Loss – Week by Week and two upcoming books, The Overworked Person’s Guide to Better Nutrition and 21 Things You Need to Know about Diabetes and Your Heart. She is a member of the Academy of Nutrition and Dietetics, the American Association of Diabetes Educators and the American Diabetes Association. Jill is a paid advisor for the Calorie Control Council. Follow Jill on Twitter @NutritionJill and find more at

Seasonal Recipes


Stevia provides a low-calorie alternative to sugar for every season, celebration or special occasion. Whether you’re baking cookies for Santa, beating the summer heat, watching the big game, indulging trick-or-treaters or plotting a delicious surprise for your Valentine, consider staying healthy with these seasonal recipes made with stevia. For a collection of everyday recipes, click here.

Happy New Year with Stevia
Valentine’s Day with Stevia
Mardi Gras with Stevia
St. Patrick’s Day with Stevia
Easter Recipes with Stevia
Kentucky Derby with Stevia
Cinco de Mayo with Stevia
Fourth of July with Stevia
Back to School with Stevia
Football Season Recipes
Halloween with Stevia
Thanksgiving with Stevia
Hanukkah with Stevia
Christmas Cheer

For more recipes, check out Stevia Benefits on Pinterest.

September is National Childhood Obesity Awareness Month

Each month of the year has it’s own health observations to bring light to the wellness issues that impact our society.  With children going back to school, this September is National Childhood Obesity Awareness Month. Growing obesity rates affect not only adults, but children and adolescents, too. Currently one out every five children in the United States is obese, according to the Center for Disease Control and Prevention. Unfortunately with increasing obesity rates we also see an increase in related health conditions such as heart disease, Type 2 Diabetes, asthma and sleep apnea among children. Not only are obese children at a higher risk to become obese adults; but the risk factors associated with weight are more likely to be severe.  These children also have a higher risk of being the target of bullying, having lower self-esteem and potential depression and behavioral issues.
Continue reading “September is National Childhood Obesity Awareness Month”

5 Ways to Stay Hydrated All Year Long

Hydration is something we think about often during the hot summer months when we’re noticeably thirsty and sweaty, but as the temperature starts to drop from fall into winter, we’re less likely to hydrate as much as we should.  Dehydration, which can lead to constipation, kidney stones, and mood changes, is a concern all year long but may be less on our minds during the cooler months.

The Institute of Medicine recommendation for daily total water intake, which includes beverages and food, is 2.7 liters (91 ounces) for women and 3.7 liters (125 ounces) for men.1 According to a 2013 study, U.S. adults drank an average of 39 ounces of water daily – 60 to 70 percent less than what is recommended.2

Clearly, we need to be doing a better job at hydrating ourselves, no matter what the season. Here are five ways to stay hydrated all year long.

Keep it front and center.

Whether you carry around a reusable water bottle or you keep your favorite cup on your desk, make sure it’s constantly filled and easy to drink from. Some people find they drink more from a straw than an open top or a sport cap bottle – find what works for you and stick with it.

All beverages count and so does food.

Many people think only plain water counts toward daily water intake, but that’s not the case. Juice, coffee or tea, beer or wine, or a diet soda all increase your water intake. Based on the current evidence, caffeinated and alcoholic beverage consumption contribute to fluid intake and do not increase appreciable fluid loss.

However, it’s important to consider the calories that beverages contribute to your dietary intake. Fluid intake can contribute a wide range of calories to your intake. For example, plain or carbonated water contribute zero calories while an 8 oz serving of a full calorie beverage can exceed 100 calories.

Food also adds to daily water intake, with water-rich fruits and vegetables contributing the most. Tomatoes, watermelon, cucumbers, strawberries, and broccoli are all at least 90 percent water by weight. Sounds like the makings of a hydrating salad! Soup is also a great way to boost your fluid intake and stay warm during colder months.

Make it taste good.

Plain water is the purest, most natural form of hydration, but it’s not so easy to drink nearly 100 ounces – about 12 cups – of water every single day. Luckily there are many delicious ways to boost the flavor of our drinks without adding calories and sugar. Try adding sliced cucumbers, limes, or the tops of strawberries to your glass of water. You can even get a water bottle with an infuser to take your “spa water” (as I like to call it) on the go. Or add a drop or two of a liquid water enhancer for a flavor boost. Look for ones made with low- and no-calorie sweeteners like stevia.

Keep it room temperature.

One of the reasons so many people reduce their water intake in the fall and winter is the cold temperatures. You’re not looking to quench your thirst as much when it’s snowing out and an ice cold drink is the last thing you want when you need to warm up. To help with this problem, keep your water bottle at room temperature and rely on warm beverages like coffee and tea to increase your fluid intake and stay warm. Just be mindful what you add to those hot beverages and stick with low-fat dairy and low- or no-calorie sweeteners to keep calories and added sugar in check.

Enjoy your favorite beverages.

No matter what season it is, there’s no reason not to drink what you love. Even higher calorie beverages can be part of a healthy, balanced, and well-hydrated diet, as long as you take some measures to make them healthier. For example, start your morning with a protein-rich drink like this Blueberry Pomegranate Smoothie and this winter warm up with a cup of Cinnamon Hot Chocolate made with low-fat milk, unsweetened cocoa, and a stevia sweetener.


  1. Institute of Medicine. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Institute of Medicine Panel on Dietary Reference Intakes for Electrolytes and Water, Standing Committee on the Scientific Evaluation of Dietary Reference Intakes Washington, D.C. National Academies Press 2005.
  2. Drewnowski A, Rehm CD, Constant F. Water and beverage consumption among adults in the United States: cross-sectional study using data from NHANES 2005–2010. BMC Public Health. 2013;13(1):1068.


Jessica Levinson, MS, RDN, CDN is a registered dietitian nutritionist and culinary nutrition expert. She has extensive experience as a recipe developer, writer, editor, and speaker. She is the co-author of We Can Cook: Introduce Your Child to the Joy of Cooking with 75 Simple Recipes and Activities (Barron’s, 2011), past columnist for the Culinary Corner column in Today’s Dietitian Magazine, and maintains a popular blog at Jessica is an active member of the Academy of Nutrition and Dietetics (AND) and various Dietetic Practice Groups of the AND, including Nutrition Entrepreneurs, Food and Culinary Professionals, and Dietitians in Business and Communications. Follow her out on Twitter, Facebook, Instagram, and Pinterest.

The Power of a Morning Ritual

Though clients come to me for diet advice, they typically need much more than just guidance on what to eat. Because it’s so hard to develop good eating and lifestyle habits, we talk a lot about forming and breaking habits and nurturing the proper mindset. I’ve discovered that setting a good tone for the day helps to both attain a positive attitude and to stay intentional throughout the day. That’s why I talk to my clients about establishing a morning ritual.

Ritual versus Routine

A ritual is not the same thing as a routine. A morning routine might involve exercising, showering, dressing, reading the paper and eating breakfast. Because we’ve done it so many times before, we know what to do and in what order without having to do much thinking. A ritual may involve these same mundane chores, but a ritual takes on a meaning beyond getting a task completed. Rather, the focus is on the process of the task or an appreciation of its side benefit. With a ritual you have the added value of feeling energized, focused, grounded, clear headed or some other additional benefit beyond completing something on your to-do list. Some common morning rituals include meditation, exercise, journaling, yoga, reciting affirmations and setting daily intentions, such as a remaining patient with a difficult coworker, experimenting with a new stevia recipe and following through on your plan to snack only on fruit.

I found a meaningful morning ritual a long time ago and have continued with some version of it for well over two decades. Instead of rushing out the door or upstairs to my home office, I gift myself time to sip my coffee while having a meaningful conversation with my husband. I spend time thinking about my goals for the day and their potential obstacles and simply center myself for what might be in store. An important part of my morning ritual is my jog. It has become my meditation with the consistent steady sounds of my footsteps and my breath. By the time I’m home from jogging, I have set my intentions and feel mentally prepared for my day.

5 Steps to Forming a Morning Ritual

There are many ways to go about forming a meaningful ritual. These 5 steps are just one way I help clients find their ideal way to start the day centered and intentional.

  1. Commit a few extra minutes. You may want to get up a little earlier or save time by setting out your clothes and breakfast dishes the night before. Acknowledge that this is important time. There’s no reason to feel guilty for giving yourself the gift of not rushing to start your daily chores. By letting family members know that you’ve set aside time for yourself, they can help you protect that time.
  2. Chose a morning ritual to try out. Scan your past activities to identify ones you’ve enjoyed and found meaningful. Or consider something brand new that’s intrigued you. Would you like to meditate, read poetry, walk in nature, journal about your thoughts or goals? Pick any one thing to start. Be creative and open to new things. If something interests you, go for it. It’s okay if it’s not someone else’s idea of a morning ritual.
  3. Determine the time. Consider your schedule to pick an appropriate time. Some people will prefer to engage in their activity shortly after waking up. Others will want to wait until kids have gone to school or a spouse is out for a run.
  4. Experiment for at least a few days. Like with most health and wellness habits, it takes time to work your way through your new ritual to find what you like and what works. Stick with something for a few days and tweak as necessary. It’s okay to experiment with a few rituals until you find something doable and meaningful.
  5. Be consistent. Keep at it and guard your ritual. If you’re short on time one day, that’s okay. Just do what you can. If you wish for 30 minutes, but have only 10 – or even less – modify your ritual for the time you have. That consistency will help you maintain your ritual long term.

These tips work equally well to help you start an exercise routine. If that interests you, just try it. Months down the road, you may find that it’s become part of your morning ritual too. Cheers to a beautiful start to your day!


Jill Weisenberger, MS, RDN, CDE, CHWC, FAND has worked as both a nutrition counselor and a diabetes educator in the hospital and research settings, and now in private practice in Newport News, VA. Jill is the author of Diabetes Weight Loss – Week by Week and two upcoming books, The Overworked Person’s Guide to Better Nutrition and 21 Things You Need to Know about Diabetes and Your Heart. She is a member of the Academy of Nutrition and Dietetics, the American Association of Diabetes Educators and the American Diabetes Association. Jill is a paid contributor to Follow Jill on Twitter @NutritionJill and find more at

How to Make Recipes Your Own: Pumpkin Edition

Some people cannot wait until the calendar turns from August to September, just so they can enjoy a variety of seasonal pumpkin food and drink offerings for the rest of the year!  Some folks don’t enjoy pumpkin-spice everything, but I, for one, am totally team pumpkin. I love the nostalgia related to the taste and smell of pumpkin. Even though the season is winding down, I still try to use pumpkin year round. Pumpkin is low in calories, but rich in fiber, vitamin A and other essential vitamins – making it a great addition to a healthy diet.

While the opportunity to try new pumpkin recipes is abundant this time of year, the down side is that many of these foods can be high in sugar, calories, and fat. But fear not pumpkin lovers – we can still evolve our recipes to enjoy healthier versions of the season’s favorites (And really, any time of year is the right time to take control of your diet and adapt recipes).

To celebrate the closing of pumpkin season, I have taken a popular pumpkin recipe to showcase how you can adapt recipes to fit into your healthy diet.

Pumpkin Zucchini Bread

I love fruit and vegetable breads. They can be versatile as a dessert or as a quick breakfast – and they are easy to alter into healthier versions.  I decided to modify a recipe for pumpkin zucchini bread, which allows for bonus vegetables! The adapted recipe comes from Taste of Home’s Pumpkin Zucchini Bread.

My Adaptions to the Recipe:

  • I decided to add whole wheat flour to the recipe to add in more fiber and grains to the bread. I used 1.5 cups all-purpose flour and then 1.5 cups of whole white wheat flour.  (Note: You can completely substitute out the all-purpose flour for the wheat flour for a heartier, denser, and higher fiber bread.)
  • I also substituted ½ cup canola oil (with added omega-3) and ½ cup unsweetened applesauce for the 1 cup of butter. I love using unsweetened applesauce in breads as a partial fat substitute because not only does it cut fat and calories, but it adds in moisture for good texture.
  • The change that had the biggest impact was replacing the 1 cup of white sugar and  1 cup of brown sugar with 1 cup of stevia for baking.  Stevia for baking is not a zero calorie replacement, but a reduced calorie blend of cane sugar and stevia. This product facilitates the browning, taste, and texture which come from sugar in baking while significantly reducing the calories.

The Final Product

The final product was delicious! My adaptions resulted in a tasty, moist bread that I ate for breakfast the whole week. Nutritionally, the changes I made reduced the calories from 176 per slice down to 123 calories per slice, cut fat from 9g to 6.7g, and reduced sugar from 13g down to 3.9g per slice. That is a 9g reduction in sugar in just one slice!

This is just one example of how simple changes can be made to turn a typically high-calorie, high-fat and high-sugar food into something more nutritious. What is one of your favorite recipe adaptations?


Carolyn ReynaudCarolyn Reynaud, MS, RD, LD is a licensed registered dietitian and a paid contributor to She received her BS in nutrition from Michigan State University and her Masters and Certificate in Public Health from Georgia State University. She has experience working in several avenues of health care including corporate wellness, clinical disease management, research, and health promotion. She has been working as a health coach specialist for close to 6 years, where she counsels patients on preventative healthcare and helps them meet their health goals. Follow her on Twitter @ReynaudCari.