Managing Your Diabetes with Diet & Nutrition

This is Weekly Dose of Wellness, brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): Hello and welcome to the show. You're listening to Weekly Dose of Wellness. It's brought to you by MemorialCare Health System. I'm Deborah Howell, and today's guest is Dr. Kristine Arthur. Dr. Arthur is a board-certified internal medicine physician with MemorialCare Medical Group in Fountain Valley, California, who believes in treating the whole patient, not just focusing on one area. Dr. Arthur received her medical education at Loma Linda University and completed her internship and residency at St. Mary Medical Center in Long Beach. As part of her whole patient philosophy, she addresses issues such as diet, exercise, and lifestyle to try to manage conditions and prevent future illness. Welcome to you, Dr. Arthur.

Kristine Arthur, MD: Thank you. Glad to be here.

Deborah Howell (Host): Today we're going to be talking about managing diabetes through diet and nutrition. This is an astounding statistic. 23.6 million people, or 7.8% of the population of the U.S., have diabetes. Can you tell us about this disease? And I know there are two types.

Kristine Arthur, MD: Yes, there are two types and definitely a big difference between the two. Type one is usually diagnosed in childhood, and this is when the body does not make enough insulin. So, patients are actually insulin dependent. They have to use insulin every day in order to keep their sugars controlled. So even if they eat well, they have a great lifestyle, they keep their weight down, they will still need to use insulin. Type 2 is the type that we are most familiar with that we see around us more. This is usually diagnosed later in life, and it's a problem where the body is not able to manage sugars, and so the blood sugars are high most of the time. The insulin that we do produce just it doesn't work as efficiently as it should. And over time, sugar levels go up and insulin levels go down.

Deborah Howell (Host): Okay. So what are some of the risk factors for type 2 diabetes?

Kristine Arthur, MD: Well, there are some things that we can't control. So ethnic background, Hispanic, Latino Americans, African Americans, Asian Americans tend to have a higher rate. If you've had a history of gestational diabetes when you were pregnant, that's another risk factor. Your family history. But also things like obesity. So if your body mass index is over 30, that is definitely a risk factor. For people who are inactive, have a very sedentary lifestyle, that's a problem too. And then also if you have high cholesterol, high triglycerides, uncontrolled blood pressure, those are all risk factors as well.

Deborah Howell (Host): So we can't really cure it, but we can control it with diet and nutrition. Maybe you can give us some tips.

Kristine Arthur, MD: Yes. So this is one of my favorite topics just because there are so many things that we can do with diet and nutrition to improve diabetes dramatically, sometimes almost completely reverse it. One of the biggest things is to limit refined and processed carbohydrates in our diet. So the American diet, we have a lot of foods that aren't so great for us, snack foods and other things, stuff like white bread, crackers, pasta, noodles, candies, pastries, soda, even things that people might think are healthy like juice. These can all make our sugars go very high. If we instead choose whole grains, things like brown rice or wild rice, different types of grains like quinoa, instead of using white bread, using things like rye bread or spelt, this makes a big difference in how our sugars will respond and if they go up quickly after we eat. Another thing is trying to be sure that you add enough protein into the diet. So you want to have a balance of healthy carbohydrates with lean proteins and healthy fats at each meal. So, for instance, breakfast can be a tricky one because people, you know, most of our breakfast foods, people don't really think about it, but if they have cereal or oatmeal or toast and juice and fruit, they're getting a lot of carbohydrates, which will make the sugars go up. But if they can add some lean protein and healthy fat, maybe some scrambled egg whites, some peanut butter, this can balance sugars dramatically. So, adding protein like eggs and chicken, turkey, fish, lean meats, beans is a great way to balance out the sugars.

Deborah Howell (Host): You might be surprised how much better you feel rather than starting your day with a sugar bomb of, you know, cereal and a big glass of juice.

Kristine Arthur, MD: Mm-hmm. And it's true. People really feel that, you know, they're being healthy and there are, you know, they pick a breakfast cereal and a big glass of orange juice and some even whole grain toast, but they're missing out on getting enough protein or healthy fat in the morning and then, couple hours later, blood sugar drops and they're feeling tired and cranky and heading for another snack to try to get their sugars back up. So it's definitely important to balance that out at each meal. And some of the foods that people think, wow, those are fattening, I can't have those. For instance, nuts, they're a great snack because while they do have fats, it's a good type of fat. So not all fats are the same. So we try to encourage adding in healthy fats in regular small amounts to try to balance out the diet as well. And then you don't have to be hungry. You can always add in as much as you want of things like salads and leafy greens and other vegetables. And there is a tool that you can use, which is pretty simple if you have online access or you can buy a book at a bookstore to look up a glycemic index of different foods. And what this does is if you type in a food, look it up, it will show if it's low on the scale of a glycemic index or high. So if it's below 55, that means that when you eat it, your sugar doesn't spike up very rapidly. If it's close to 100, then it's really going to make your sugar spike. So not all foods are equal. For instance, with fruit, if you were to pick, say, apples or grapefruits or pears, they're relatively low on the scale, whereas... If you picked raisins, watermelon, cantaloupe, ripe bananas, your sugars will definitely go up more after eating those.

Deborah Howell (Host): Even pineapple, right?

Kristine Arthur, MD: Yeah, some of the tropical fruits can really do it. And something as simple as, you know, if someone comes in and says, well, I love oatmeal, I have instant oatmeal every morning, that will make your sugar go up much higher. If you just switched that to an old-fashioned oatmeal, that will make a difference right there.

Deborah Howell (Host): So easy to look at it. It's a little harder in practice, but it just takes doing and getting used to, and it's a little bit of a shift. And then if you add exercise, that can also help control diabetes.

Kristine Arthur, MD: Definitely, and you don't have to be a pro at it or a marathon runner. A small amount will make a difference. You know, when you do some type of moderate exercise, your muscles are going to use glucose to do that. So over time, this helps to bring your sugars down, but it also makes your insulin work better because this is a problem with diabetes is that the insulin is inefficient. So I've seen a huge difference in patients who simply added a 10-minute walk a little bit after their meals. They'll go out, walk around the block for 10 minutes, and they will see, they'll check their sugars before and after, that it does make a difference. And they're not, you know... necessarily young patients who can go out and run and do things there, you know, they're getting around and it's not running. They're doing sort of a brisk walk and it makes a big difference.

Deborah Howell (Host): And also just makes you feel better mentally.

Kristine Arthur, MD: Right, right. To get out and do something. And strength training is important too. So any kind of doing weights, lifting weights, anything like that will also help metabolize the sugars better. So the key is really just picking something that you like or that you're willing to do. It may be, it could be walking your dog. Maybe it's playing tennis. It does, it doesn't matter as long as you're getting out and staying physically active.

Deborah Howell (Host): Okay. Now, if you are diagnosed as having type 2 diabetes, what's the standard treatment?

Kristine Arthur, MD: Well, usually the first thing we would do is get you enrolled into a diabetic class so that you can understand what diabetes is, what the complications are, and the long-term goals. Often we'll have you see a dietician to go through your diet and figure out what changes you can make. We will set you up with a meter to start checking your sugars so that you can see what they are when you get up in the morning and after meals. And then usually we'll start people on an oral medication. As soon as people hear about diabetes, they always think, oh, no, insulin, insulin, insulin. But we don't start with insulin the vast majority of the time. It's usually medication, pills. that are, for most people, well-tolerated. There's many options. And usually, we can get people controlled with a combination of diet and pills, and they may never have to use insulin.

Deborah Howell (Host): Well, that's terrific news. I didn't know that. That's wonderful. Well, good. Well, you know, we have just about a minute left. So really quickly, prevention tips?

Kristine Arthur, MD: Prevention, just know your family history and maintain a healthy weight. Know what your BMI is, your body mass index. Make sure you're regularly doing some type of physical activity, no matter how small. Balance your diet out. Avoid those processed refined carbs and bad foods and snacks. Make sure your cholesterol and blood pressure are controlled. And just keep regular doctor's visits so you know all these numbers. You can see what your blood sugar fasting is. And your cholesterol and get your blood pressure checked. And those really are the main things that can make a huge difference.

Deborah Howell (Host): Very good information. Thank you so much, Dr. Arthur, for taking the time to talk to us today about diet and nutrition. They can definitely help manage diabetes. It's been lovely to have you on the show. I'm Deborah Howell. Join us again next time as we explore another weekly dose of wellness brought to you by MemorialCare Health System. Have yourself a fantastic day.