Shireen: Welcome to the Yumlish Podcast 2020 Wrap-up where we'll be taking a walk down memory lane with some of our all time most listened to episodes from the past year. Throughout this episode, we'll be synthesizing tips from experts about how to simplify eating to manage diabetes, how stigmatizing plays a role in the condition will demonizing foods be helpful or hurtful to your diabetes management. And finally, we touch on food colonization and take a step back to look at the culture of modern day health care. Our first clip is from episode nine COVID-19 and eating for diabetes where we talked with author of The New York Times bestseller Eat to Beat Diabetes, Dr. William Lee, about expanding how we think about the development of type two diabetes and how we eat to manage and even reverse diabetes.

Dr. Lee: You can do almost everything with food starting with food. And if you think about type two diabetes, it doesn't just come out of the blue. It's really a situation that evolves over years of lifestyle. So you know, most of us when we're younger, you know, you go to college, you pull all nighters, and you go out and have a thunder your friend and carousing, look we can our bodies can take a lot of damage. But over time, just like driving your car really hard, not filling, not taking care of the oil pan, you're changing the oil, eventually, you'll actually get wear and tear. And so I would say diabetes is kind of a diet type two diabetes is kind of a wear and tear condition, let's not call it a disease, let's call it a condition. And it's something that the earlier we do something to prevent getting into that situation, the better it is obviously. So some of the basic things, you know, staying physically active. eating, eating in moderation, I think is a really important thing, whether you before you have diabetes, while you have diabetes, and after you actually reverse diabetes, I'll come back to that in a second. And so choosing the right foods to eat, so you're not really making a habit of choosing the wrong foods. So I gotta tell you disclose something to you, which is that I am not one of those doctors, who basically thinks that a healthy diet is about cutting everything out. But that eating healthy is about shame, guilt or fear. I think there's a lot of, of that around already in the healthy eating community. I think that this is what I used to always tell my patients, life is for the living, we should really enjoy what we do. And food is so important across different cultures to who we are our families, you know, our roots, you know, what we feel comfortable with. And so what I say is that, it's really important to be honest with yourself of who you are and what you like. And if you can start with what you already like. And choose from the basket, the breadbasket of what's healthy for you. This is like a cornucopia of fruits, vegetables, herbs, I mean, a whole bunch of things that are not just, by the way, not just veggies. There's a lot of different foods and in my book, Eat to Beat Disease. I talk about a lot that can help diabetes, they're all healthy types of foods is more than 200 of them. If you choose the ones that you relate to the most, when you start with that, then you're already ahead of the game, because you're choosing from the things that you like, I think that's number one. The very important approach number two, I mentioned this before as moderation, you know, eating you know, the adage that many of us grew up with, you know, sort of our, our moms and our grandmas, you know, hovering over a saying you got to eat more, you know, please have another one, you know, look how skinny you are, look, you need to eat more well intention. But I think that everything we know from research is, the less you eat, the better. And so take something you really like that's healthy for you. And what I tell people is you know, rather than pile your plate with it, I've got plenty of fruit. Take a start with a third, just take the you know, so whatever your eyes sees take only a third of is really practical. And they eat it slowly and your brain will actually teach you how to enjoy what you're eating. So you get this is why you got to start with what you want. Because then you have to get to savor it, the more time you get to savor your food, and the less you put on your plate, the faster you can get full with the things that you already enjoy. And then it becomes an experience that you actually like. I didn't mention anything yet about really the whole idea of the science behind this. But we know when you limit your calories, for example, when you choose the right foods, in fact, as you say, physically active, which is really important. As a matter of fact, you can many people, not all but many can take a situation like type two diabetes, and you can actually normalize or get closer to normal, or what your blood sugars are.

Shireen: From registered dietitian, Grace Rivers, we're talking about how to set up your plate for success in Episode 17.

Grace: When you're cooking sources, things like canola oil, or olive oil could be helpful, and decreasing the amount of meat that a person may be eating if you're a meat eater, that realizing that, that chicken breast does not need to weigh a half pound that you put on your plate. And it doesn't need to cover half of the plate, just covering only a quarter of the plate.

Shireen: Interesting. And so what, what do good combinations of healthy foods look like? 

Grace: Uh, well, let's say what if we just pictured an empty plate and has nothing on it. And if you start out by putting it again, if you're a meat eater, putting that kind of meat on the plate, and however much you're cutting, try to keep it to only a quarter of the plate. And patients have said, but what am I going to do to not be hungry. And this is where you add those fiber filled foods. And no, a staple in my kitchen is lentils. So I'm really looking at lagoons to help fill us up. And you can do this in the way of beings whether they're canned, or dried beans that you have soaked yourself and cooked. And peas, sweet peas, Black Eyed Peas that you get in there, all of those things fit in. And you, including those on your plate and getting some whole grains in there. Whether it's brown rice, if that takes too long for you to cook, then various minute rice, and store brands work just fine. And you can include that in. And certainly, let's try some fruits and veggies in there as well to help keep someone satisfied. I'm not a believer in being hungry. When you leave that meal, you should be very satisfied.

Shireen: Any recipe ideas that you can share with us?

Grace: The recipe ideas that, that I get when I am looking for just something different. I still refer people to going back on lentils. Many clients have said to me, I don't know what a lentil is. and lentils for those that don't know are just very small like little beans.

Shireen: Shifting our focus from nutrition in Episode 27 Combating Social Stigmas of Diabetes, Megan Munoz touches on how stigmatization impacts a diabetes diagnosis and how healthcare providers can help reduce these stigmas. 

And so why is this so important and talk about some of those things that are not behavior related that are in our environment that are in our sort of in our in our society in the you know where we are, they talk about how your risk of diabetes increases based on your zip code, which is just mind boggling. So and why is it so important to talk about some of those other risk factors?

Megan: I think it's twofold. One, of course, is because we need to set up social structures and those systems we need to create better access to health care. We need to create ways that people can get education and safety and own houses. So all of the things that we've heard lately from you know, great people who are trying to change the most pieces. The other side of it on the personal side for people with diabetes is to know it's, it's not your fault. Diabetes is really complicated. And when we focus just on, you did something wrong. It can really hinder people. I mean, I meet so many people that struggle to make changes to their diabetes health, because they just don't want to be labeled with the diagnosis. There's so much stigma around that. They don't want to be, you know, looked at by family members or other co workers, or even their medical provider as screwing up or doing something wrong, and that's why they have that diagnosis. So it can be very paralyzing. That could be a lot of self blame and a lot of guilt. And we need to break that down.

Shireen: And how do you address that?

Megan: You know, I think one of the things… I think really important, at least personally with me is talking to people about their personal risks for type two diabetes. So they usually come in and they say, Oh, well, you know, I, I've gained weight over the years and, and that's why I have diabetes. But once we start talking, they start recognizing, well, I was in the service, and I was exposed to Agent Orange. And I know that's a risk for diabetes, and I also have thyroid disease, and I know that's a risk for diabetes. So then we start looking at all these other pieces they're able to see, okay, you know, I understand that maybe I made some lifestyle choices that were not as helpful. But it's not the only piece. And there's other things and, and we that's one way we can move past. I think the other thing is we just having communication, even like for myself with other medical professionals, about reducing those stigmas. For example, we know, for people that come in to get diabetes training, we only see about 10% of the people and diabetes, self management training that get diagnosed with type two diabetes, excuse me, I should say. So somebody gets newly diagnosed, only 10% of those people are going to be coming to see someone like myself in a clinic or hospital setting. That's really bad. That's horrible stats. And I think a lot of it is because somebody comes to their medical provider, and a provider says, well eat better, move more, and I'll see you in three months. And diabetes is a chronic condition that requires lots of training and lots of support to really manage it well. And it's already got that stigma or the blame of you didn't do something, obviously, because you have diabetes, so fix it. And then you'll, you'll do well, there's not the, you know, diabetes, it's complicated. There's lots that you need to know, you might be doing some things great, you might be doing some things not so well go here, get some training, get some support, you can live a long, really healthy life with diabetes. So even from the get go, even across the medical world, some of the things that I do is just presenting on how we can be more person centered, focus on the person, making sure that we're trying to reduce the stigmas even within the medical world.

Shireen: At the end of October, we spoke to Shannon Leininger in Episode 32, the End of Demonizing Foods in Diabetes Care where we got a new perspective on how we frame foods and how all foods can fit into your diet. 

Shannon: So I think first of all, the thing we want to keep in mind is that it's what you're doing, really most of the time that matters. I like to tell my patients and just kind of use the example that if you know eating one less healthy meal or treat a week is not really going to do any harm. Because if we think about the opposite, think if you were only eating one healthy food, right, once a week, or one day a week, would that do any good? And the fact is, that wouldn't right? And so the opposite of that and eating one less healthy food per, per day or meal or week again, depending on the person is okay. You know, I try to think about foods more in terms of nutritional value, are they full of nutrients or not so much? Are they just full of empty calories, what we call as a food that, yes, it's giving us calories, which gives us energy, but not really give us, giving us any nutrition or kind of bang for your buck there. I also recommend thinking really about the consequences of eating a certain food before you actually consume it. I know it sounds silly, but you have to kind of think about what happens on the other side of this. By, eat this food isn't going to help me reach my goals again, whether that's improving my blood sugar or losing weight, or is it not going to get me there? And it's okay, there's going to be times where you choose the less healthy food for whatever reason and that's okay. Right But at least kind of having that internal dialogue with yourself to think about what what happens either way, right on the other side of this. There's no reason to demonize any foods. You know, some foods certainly offer more nutrition, but even the ones that aren't as healthy are still typically bringing something positive.

Shireen:  

In the episode Food Colonization and Fixing Food Oppression, Tamra Stevenson talks about the three E's of food colonization.

Tambra  

And so for me as I've come to learn food colonialism through my writings in, in my PhD program at American it helped me to understand one what is colonialism period? And how does that apply to the food system. And some of the best ways that I sum it up for many is the three E's we have the ratio, the erasing of what I call on with the work of Wanda, elevating the Hidden Figures of the food system. Some people will get the food and other women behind it and their corner currency, which flows into the exploitation of one thing about labor practices within the food system and not having fair wages across the supply chain. tends to happen. And then the third is the extraction. Just like those who search for tropical disease remedies and the Amazon, extracting the essence of the plant, that is what we tend to do when it comes to the food system extracting the essence of what we want and, and, and toss away all the other parts including the loop aspect. When you think about the 299, far at will kind of mindset and not true supporting both people, planet and profit in this triple bottom line mindset that we've seen in social entrepreneurship. And then the other components with colonialism is the divide and conquer strategy that you'll find dividing communities. Dividing a district as we'll see in DC, the numbers show a 20 year age gap between of life expectancy of my community of Anacostia and Ward eight compared to the other west of the Anacostia River, war two in three locations. And then you have the control the, controlling of just like anyone who is a game designer, you know that you control. What are the final outcomes in a super mario brother game, you think you have choices, but the choices were already predetermined. And so that is a control of the food supply and what options that you have. And then you also have beyond the divide and conquer control. You just have a just the capitalism that happens along with it.

Shireen:  

In our final fan favorite from December 3, Culture and Diet and Health Care, Sandra Arevalo magnifies an example of diabetes management and calls upon health care providers and patients alike to be better advocates for care.

Sandra  

How can I help you, like what's really going on? And he says, well, that Rosie's going to the pharmacy, I get the insulin, but I'm homeless, I don't trust supporting insulin. So at the same time, it's like if consistently, something is not going well, and you're trying and trying, you know, it's time also for the providers to look outside the box. If I keep raising the insulin a few times, and it's still not working, ask yourself like maybe something else, right? I mean, it makes sense. And that's what I mean, get to know your patients, you have to know, you know, I had an older case where this older lady, she would not get better, same issue, you just keep increasing the insulin and keep you know, switching medications around and you don't know what's going on and, and these lady will not get better. She's to us, like over 60 of the time. Well, Joseph was talking to her and asking, How can I help you, you know, I need you to get better help me help you, she was finally able to disclose Well, I'm getting the insulin and sending it to my son in Ecuador, because my son also has insulin, there is no insulin in Ecuador, and he cannot afford it over there. So I'd rather just inject myself just a tiny little bit on I sent the older insulin to me, it's so many stories that I have, yeah, I could say, you know, for all these stories, but it's like, it's a way to me that you're really gonna be able to help them. Because again, we are monitoring the person not really sees is not about the medication, the right medication, oftentimes it's not like that, and we have so many people, the poorly controlled diabetes, and we're not doing enough for them as providers, we're not doing enough for them. And then people themselves, you know, patients are not doing enough for themselves, because they should speak up. That's what I always say, it's like, why didn't you say this six months ago, you know, like, there are people who have already had an amputation, or it's when you're looking for help, and that's when you're opening your mouth, it's too late. So I also, you know, encourage all my patients like you need to do is that we know it, you know, unfortunately, the healthcare system nowadays is hard. It's not ideal. It's expensive, doctors have to see 18-20 patients a day. So you gotta move super fast. And you don't have all the time. But the thing is, you know, me myself when I go to the volts during the low 30s, like, Okay, so this is what we're gonna do. And this is the next treatment. This is your next appointment. Do you have any questions? And I get to ask one question that are like, okay, so nice to see you after the answer. And I'm like, wait, I have four more questions to ask, you know, and I'm right now not like I made them wait, and, you know, that is me. I will you know, it Okay. Then I'm in the healthcare system. I know how to talk and advocate for myself. So imagine how many people are out there that don't know how to do that. Even for my parents. I'm scared when they go to the doctor by themselves because I know they are not going to give the quality of care that they deserve.

Shireen:  

That's our 2020 Rep. and we hope you all enjoyed all of those clips in all of our episodes from our experts this past year. Stay tuned in 2021 for more experts like physical therapists and psychologists asked me to talk more about nutrition, chronic illness, and all things wellness.

Connect with our 2020 Wrap-up guests! 

Dr. Li

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Grace Rivers

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Megan Munoz

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Shannon Leininger

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Tambra Stevenson

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Sandra Arevalo

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