Shireen: Podcasting from Dallas, Texas. I am Shireen, and this is a Yumlish podcast. Yumlish is working to empower you to take charge of your health through diet and exercise and reduce the risk of chronic conditions Like type two diabetes and heart disease. We hope to share a unique perspective and a culturally relevant approach to managing these chronic conditions.

Shireen: In today’s episode, Dr. Alana Biggers will be discussing how and why people develop high blood sugars, get diabetes, the different types of diabetes, and then the relationship between sleep and type two diabetes. Stay tuned.

Shireen: Dr. Alana Biggers is an internist and an assistant professor of medicine at the University of Illinois Chicago College of Medicine, where she received her MD. She has [an] interest in achieving health equity through health outcomes research. Dr. Biggers currently has an NIH grant for research to study the effects of mindfulness, meditation, and sleep on type II diabetes and heart disease risk in communities of color. Welcome, Dr.Biggers. 

Dr. Biggers: Thank you. Thank you for having me. 

Shireen: An absolute pleasure having you on. Dr. Biggers, I first wanna kick things off with understanding, why has this been your passion? Why study these interesting topics, interesting in my world, but why study these topics around Diabetes? What really led you to it?

Dr.Biggers: Yeah. Diabetes, [and] other chronic conditions as well. I do have a Master’s of Public Health in, chronic disease epidemiology, from Tulane University. I will say that when I first entered into the program, I had no idea what to expect. But it really just, it kind of changed my world and changed my lens in, you know, the disparities that I was seeing in different communities, it was able to give me the language behind there. I went to after I got my Master of Public Health, I did work at the CDC for about three years and then decided to move on to medicine because I had this passion to kind of combine population health with medicine. Oftentimes these two worlds work, you know, in silos. More so in the last, I will say, couple of decades, there’s been more of a push to, definitely merge the two worlds.

But I felt like that, it was a space that I really, could make an impact. For me, also in between that time between getting my Master of Public Health and going into medical school something [personal] happened to me. My father died from a stroke, so he was a presumably healthy man, had a Ph.D. in math, so very smart, you know, had health insurance. So, you know, all the reasons that you hear people saying that, oh chronic conditions are in different communities you know, like lack of access to healthcare, et cetera. He didn’t fit that bill. He even also worked out, he didn’t eat sweets. He did, you know, he was, he was a presumably healthy man, but one thing that he would not do and didn’t feel comfortable doing was actually going to see a physician. Like where my mom and you know, took us or herself to have annual visits. My dad didn’t do that at all. He was at, the university where he was teaching and had a headache, went to his office, and was found down. So had ended up having a stroke from undetected high blood pressure.

His blood pressure at the time that it happened was in the two hundreds, over one hundreds. Unfortunately, my dad did not survive. So, you know, I carried that with me and still carried that with me as well. Think about like, maybe if he had a physician that he could relate to that he felt comfortable with, that you know, maybe he would, would be, he would’ve been less reluctant to go to a doctor. We’re not talking about this today, but medical mistrust is a huge issue in different communities of color for reasons that are very legitimate historical reasons. I carried that passion with me too, going in and I feel like I want to be, I guess as an internist be used, and giving information to different communities, [and] different people, helping to empower them and really wanting to relate and connect and see whether or not, hopefully, I can make a difference in someone else’s life. You know, the way that, and unfortunately it didn’t happen for my father. That really does drive my passion for the work that I do. 

Shireen: That is so interesting and I am so sorry to hear that. And thank you for sharing that story. I’m sure it’s gotta be, it is painful, but at the same time it has a purpose around that work that you do is so mission-oriented to say that, this doesn’t need to happen. Yeah. Um, but, but thank you so much, for sharing that.

Dr. Biggers: I always tell my, my students, you know, that the work that we do as physicians only accounts for about 10% of somebody’s, health, their overall health. And, I feel like in my dad’s case, you know, he needed that 10%. Definitely, it like I said, drives me and hopefully, you know, wanna make a difference in someone else’s life. 

Shireen: As we, as we sort of look at this and, you know, for our conversation here today, we really wanna focus on, um, understanding diabetes in particular. And also just try to understand, especially around your research, which is very interesting. We’ll come to it in, just a minute. Can you help us understand, you know, just first let’s talk about understanding diabetes itself, right? Diabetes is usually a lifelong disease in which there are high levels of sugar in the blood. Help us understand how and why, does our blood have high levels of sugar, like what is even causing it to happen in the first.

Dr. Biggers: Yeah. Diabetes is a metabolic disorder. Your body is a well-oiled machine, right? You have your heart that’s pumping blood. You have your brain that is processing different, neurons throughout the day and senses and kind of bringing it together and allowing you to take action, et cetera. Then metabolism helps with creating energy for your muscles and for your movement. Right? So, with diabetes, your metabolism is impaired in that case. So, anytime you eat anything, your body breaks it down into nutrients that it can use. And like I said, it feeds the different organs in your body. Like your blood sugars will go up and then your pancreas, a particular creates a hormone called insulin. Insulin will help to bring those blood sugars down and also to help like, get the blood sugars into the different organs. But with type, well, with diabetes in general, that’s impaired. So whether or not it’s type I diabetes or type II diabetes. If your body is not producing insulin, then those blood sugars have nowhere to go. They’re in your blood and over time, that can cause damage to your organs and your body, whether it’s your heart, whether it’s your, your kidneys, brain, et cetera. So that’s a few basics all in diabetes.

Shireen: You mentioned the different types of diabetes. Can you help us understand the difference between type I and type II diabetes?

Dr. Biggers: Yeah. type I is an autoimmune, type of diabetes. Usually, someone is diagnosed in their childhood, whether or not it’s, whether they’re a baby or is it later on in life usually. Sometimes it can happen in adulthood, but typically it happens within, your early years of life. Your body is not making your pancreas in particular is not making any insulin. So you are dependent on insulin for the rest of your life. Yes, diet and exercise is always good for you. But regardless of you doing dire exercise, your pancreas is not making any insulin.

So you need to have insulin, lifelong insulin with type I diabetes. Type II diabetes, on the other hand, is acquired diabetes. Your pancreas is working fine and then, you know, things happen along the way. Whether it’s aging sometimes that can do it. You know, being overweight and we can talk about those types of risk factors too, but your pancreas is just not producing the same amount of insulin that it was before, is there’s a strain on it. So it’s causing some of the similar effects with, as type I diabetes, not being able to like process those, and break down those blood sugars for you. That is in the, a majority of people have type II diabetes.

Shireen: Okay. That’s helpful to know. Now in looking at type I and type II diabetes, you mentioned the most common one is type II diabetes. Can you help us understand why that type II, I guess is more common than type I? 

Dr. Biggers: Yeah, so type I again, it being autoimmune, the, it can run in families can be genetic. Whereas typeII diabetes, a lot of it honestly is driven by our higher rates of obesity. People gaining weight, it’s like I said, it could put a strain on your body, just, like even if you feel, if you’ve ever had weight and you’re like, oh, my knees don’t work as well anymore. So now you’re, you’re like having your pancreas try to work harder to process different foods that you’re eating and breaking down, sugars, et cetera. It’s just not working as efficiently as it is or as it was previously. So you’re just not being able to put out as much insulin and again, but most of the time it is driven by weight gain.

Shireen: Then how does diabetes affect across racial groups?

Dr. Biggers: Yeah. Unfortunately, it hits different communities of color differently. The American Indian Alaskan Natives, have higher rates of type II diabetes, followed by, non-Hispanic blacks, then Hispanic populations, [then] Asian population. You know, in that order. So, it is more prevalent like they were higher rates in different communities of color, and for multiple reasons, it’s very multifactorial. 

Shireen: Okay. Can you talk about some of those Factors? What, kind of factors are we talking about?

Dr. Biggers: Yeah, absolutely. Again, unfortunately, driven, a lot of it’s driven by rates of obesity. There are higher rates of obesity in certain communities of color as well. But then, is not just oh, you have to look at the bigger picture. I’ll just say that. So it’s not just like, Oh, well this population, there are higher rates of obesity so that’s why. But you, we, you know, I always ask a question of why, why is that happening? Right? So, again, very multifactorial. Neighborhoods you have to look at that. There are, unfortunately, communities of color are at higher risk for living in under-resourced neighborhoods. And that lends itself to, people not being as physically active, not having the green space, not having sidewalks, that type of thing. And in that case, that actually, puts them at higher risk for having higher rates of obesity, which again, can lead to the type II diabetes. There are other factors as well. Like if somebody in your family has it, you probably have a higher propensity of getting it yourself.

That’s, it’s not a, I don’t wanna say it’s definitely not a given. I actually have heard people say things like that. Like they’re not surprised, like, oh, well my father has it or my aunt has it. So, you know, it was a given, I was supposed to have it right. Yes, you were at higher risk for getting that, for getting diabetes, but that doesn’t mean that you have to get it. I just wanna put that out there as well too. In certain communities of color, there are. Of having what they call food deserts or food swamps, which,you know, where there are either, there’s access to foods, but they’re not of higher nutritional value. Again, adding to that, those rates of obesity too. Another one, believe it or not, is sleep health. Sleep health is, there’s a sleep disparity amongst communities of color compared to, other groups too. So not getting enough sleep, can lend itself to type II diabetes and, yeah, sort of type II diabetes.

Shireen: Perfect segway for me. Thank you for building that up Dr. Biggers. But perfect segway into, going into that next topic, which is, you’ve done some research on this relationship yourself. You’ve done this, research on this relationship between sleep and type II diabetes. Can you share with us what this relationship looks like? Why it’s important?

Dr. Biggers: Yeah. It’s one of those things that I feel like is emerging over several years in terms of the importance of sleep health. So you’re hearing it more so in the news, but many people don’t know that sleep health actually can impact your, risk for getting type II diabetes. As a nation, we’re not getting sleep. Enough sleep is anywhere between seven to nine hours a night as an adult. Of course the kiddos, they need more sleep. Go 18 and older, seven to nine hours is a recommended time. S sleep deprivation is people who get less than six hours of aleep at night. I have been guilty of it myself. They have seen in multiple studies that people who are not getting enough sleep are at higher risk for developing type II diabetes or, if they have type II diabetes, worsening diabetes too. Again, multifactorial, but one of the, leading thoughts is that not getting sleep deprivation, not getting enough sleep can actually increase like your cortisol levels.

That’s the stress hormone. It impairs your ability to process sugars again, right? So that they’ve seen in multiple studies that like after a night of sleep deprivation that people end up having their blood sugar levels are off. There are other studies that show that there’s an association between, low sleep or not getting enough sleep and in type II diabetes. So that’s where that connection comes into play. 

Shireen: That’s interesting. And so one, once that happens, so it’s, so what I’m hearing from you is the cortisol has to do with it, which has that impact on that ability? It’s almost like a ripple effect, right? Not enough sleep means that the impact on the sugar, which then, which means impact on the stress, which means an impact on sugar. So it’s, and so that’s why when we talk about these are all the different risk factors. It is really the culmination of this and then also the ripple, in fact, that each of these factors have on one another that can also lead to lead to that. So that’s, that’s an interesting point. Um, tell us more about this research. What do you, would you plan to gain out of it? 

Dr. Biggers: Yeah, just to, add to that too their communities of color are most affected by this sleep deprivation and poor sleep health too. They are at higher risk for having like non-standard working times, right? Working overnight shifts and being up all night or, you know, non-standard shifts. So you can see that again black, Latinx communities, they have higher rates of poor sleep health in general. So that could be a factor that’s contributing to type II diabetes. In my first study that I did, it was just an observational study looking at black and Latinx populations with type II diabetes and looking at their sleep health. So yes and needless to say that it, the sleep health wasn’t as good as we hoped it to be. In my current study, what I did was I wanted to in this time look at black populations with type II diabetes and seeing whether or not a mindfulness meditation intervention could actually improve their sleep and with the end goal of hopefully improving their type II diabetes.

Then type II is a risk factor for heart disease too and then thus, you know, improving their heart disease risk too. So their heart health overall. That’s what I’m hoping to see. There is literature in there that, looks at mindfulness meditation. There have been some association research but there has been some associations with mindfulness meditation, improving your A1C numbers for instance, many of the or most of the research actually is not done in communities of color. So, I thought it was important to focus on a black African American population for this. It’s a smaller study, so a small study, to get some data going forward.

These communities of color in general have kind of been largely left out of research that’s related to mindfulness meditation. And again, we could talk a long time about that as well. But there are different movements that you see about bringing mindfulness meditation. Because it has, you know, there are benefits to not just type II but to improving sleep, improving stress levels, improving, you know, feelings of pain that, you know, chronic pain that people feel too. Yeah, there’s again, it’s one of those emerging areas that have been going over, the last couple of decades and, I wanted to bring this type of intervention to this population.

Shireen: You know, Dr. Biggers, as you’re sort of mentioning the sleep element, it, you know, it’s hard, to not even see like a person who has diabetes, especially a person who’s newly diagnosed with diabetes Right. Trying to manage all of these different components of their lives and still trying to live their life.

Dr. Biggers: Yes.

Shireen: And live everything else that comes in it. What would you say to someone to say, Okay, how do I get my seven to nine hours of sleep, eat healthy and physical activity, and manage my stress, [and] mindfulness? What would you say to someone like that who says, life is complicated to begin with, now you’re gonna add all of these other things that I have to do for diabetes? What would you say to someone like that? 

Dr. Biggers: Yeah, and it’s like, I just got diagnosed with this and you’re throwing all these things at me. Yeah. I try to tell people to, you know, Rome wasn’t built in a day and that you know, take it one step at a time, honestly, start where you are. So I try, I give people my patients, just general information about diabetes, what their diagnosis could mean, et cetera. Of course, I give them the space to ask questions and to talk, et cetera. If you know leading giving people opportunities to meet with nutritionists and taking a class on diabetes, I think it’s helpful. But in those 20 minutes that you have with a patient, right? You try not to overwhelm them, but then you also try to instill in them that this is a time, you know, I want you to feel empowered, so start where you are. If you are a person who is, you know, I kind of go through like the foods, like, I’m like, are you a, you know, carb, you know person? If they don’t know what that means you know, whether or not it’s you know, bread or like potatoes, et cetera and if, or rice, you know if they tell me that.

I’m like, okay, well, you know, I’m not telling you to cut out completely, I’m gonna tell you to cut down significantly. We’re talking about portion control right now. And then like if it is rice, I’m going to ask you to do some type of rice. You know, white rice, like some rice substitute, right? Lke brown rice or quinoa or, something barley, something that is more of a complex carbs. So we go into that discussion too, like, what’s a complex carb? If somebody’s a potato person, I’m like, Okay, well, you know, a sweet potatoes, believe it or not. Not with the sugar in it though, you know, it’s a complex carb. Like red potatoes with keeping the skin on again, portion control, but you get more of the complex carbs if they’re a sweets person. Same conversation we’re cutting down significantly. We’re not going to cut out.

If you are like a soda pop person, um, you know, I’m telling you, water, water, water is your friend, we have discussions. And you wanna meet with them like more often too. So you don’t wanna just be like, all right, here you go, bye and then I’ll see you in three months and see what your new A1C is, right? Whether or not they need a two-week follow-up to check how their blood sugars are going, or if they need to see ’em back within six weeks just to see how things are going with everything. Yeah. So that’s how I try to approach it. So try not to overwhelm them.

You know, we, again, we also talk about like their physical activity if they’re not doing anything. All right. How about you just take a walk, you know, just a couple times a week or if there’s somebody who can’t get out or it’s super cold. Like I’m here in Chicago. super cold we talk about home exercises or if there’s somebody who they’re not very mobile, you can do some exercises in your chair. So I try to give people resources around that and also I do ask about their sleep health too. Like what’s, what’s challenging for them, right? If they’re a person who, it’s hard for them to go to sleep or they’re noticing that they’re snoring or something, you know, some type of sleep assessment, then okay, well then, maybe we need to have you get assessed by a sleep doctor and do a home sleep test.

 If there’s someone who watches TV and likes to have the lights on, we talk about sleep hygiene. You know, having, um, dark room, no TV on, you know, keeping that blue light filter on your pone, even though I know that’s a little, sometimes they say it works and or it doesn’t work as well as they say it should. But those are all measures to try to improve someone’s sleep health.

Shireen: Mm-hmm. I appreciate you going through that because it is also incredibly hard to find doctors like that, who are taking the time to explain those things, which is like a whole nother episode that we can do, have a conversation around. But, with that, for this episode, we are toward the end of time here on this episode. Dr. Biggers at this time, I would love for our listeners to know how they can connect with you, and just learn more about your work after this. 

Dr. Biggers: Yeah, absolutely. So you can connect with me, um, in different ways. Dr. Alana Biggers on Facebook, Dr. Alana Bigger is actually on Instagram as well. Twitter, is doc_prevention. I feel like that’s probably all, different ways you can connect with me. I’m still working on the website. I do have a website that we’re building as a landing page, so, when it becomes live, it is Dr.Alana bigger.com. 

Shireen: Love it. Thank you Dr. Biggers so much for coming on the episode and chatting with us. To our listeners who are listening out there, get over to our social media, find us on Facebook, find us on Instagram, Find the post for this particular podcast episode, and answer this quick question, How are you managing diabetes for yourself, for your family members? So get over to our social media. answer this quick question again, you can find us on Facebook at Yumlish, or you can find us on Instagram at Yumlish_. Get over there find this post for this podcast episode and answer this quick question there. Dr. Biggers, it was such an absolute pleasure having you on. Thank you so much. 

Dr. Biggers: Yes, thank you, and thank you for having me here.

Shireen: And thank you everyone for tuning in. Thank you for listening to the Yumlish Podcast. Make sure to follow us on social media at Yumlish_ on Instagram and Twitter and at Yumlish on Facebook and LinkedIn for tips about managing your diabetes and other chronic conditions, and to chat and connect with us about your journey and perspective. You can also visit our website, yumlish.com for more recipes, and advice, and to get involved with all of the exciting opportunities Yumlish has to offer. If you like this week’s show, make sure to subscribe so you can hear more from us every time we post. Thank you again, and we’ll see you next time. Remember, your health always comes first. Stay well.

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