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 2 diabetes and heart disease. We hope to share a unique perspective and a culturally relevant approach to managing these chronic conditions with you each week.

Shireen: In today’s episode, we’re speaking with Dr. Hensrud talking to us about the Mayo Clinic Diet; and answers your burning questions about artificial sweeteners and rice. As well as the paradox surrounding eat less, exercise more. Stay tuned. 

Dr. Hensrud: The Mayo Clinic Diet is more than a diet. It’s a lifestyle change program.

We combined the healthiest aspects of diet, with good, solid evidence supporting weight management, and that’s what makes up the Mayo Clinic diet. More specifically, it’s based on the concept of calorie density or energy density, that by consuming large amounts of vegetables and fruits, which have a lot of bulk and volume, but not a lot of calories, it can be easier to manage weight.

 In the other food groups, carbohydrates, protein, fats, we recommend healthy choices, though not real low fat or real low carb, but healthy fats and healthy carbs. 

At the center of our pyramid, the Mayo Clinic healthy weight pyramid is physical activity, and that’s part of it. We don’t count calories. That’s important. Calories count, but we deal in servings. With vegetables and fruits, in general, the more servings those people eat, the better is their weight. The better will be their diabetes, therefore, and the better we’ll be their health. And that’s why carbohydrate intake is important for people with diabetes.

In general, the greater the carbohydrate intake, the harder it is to manage glucose values or the more it will increase glucose value.

Number one, be kind to yourself. Don’t try and be perfect. Number two, just be mindful and (…) aware of what you’re eating, and don’t focus on what you can’t eat. But focus on having positive strategies that you can feel good about. And there are many of them. Watching portion size, asking yourself, am I, did I have enough or am I mindlessly eating?

Trying not to snack while we’re cooking. It all adds up, but if you want something, have it, [and ]enjoy it. But don’t throw in the towel and mindlessly eat. Rather than just sit around and watch TV all day and eat, maybe we could do some activity to make ourselves feel better, not just to manage the weight, but to feel better. Have a schedule or do it with a colleague or a friend, and you can both be accountable to each other, do family activities, have outdoor activities, [and] manage our individual factors, but do it in a way that isn’t drudgery. Come up with alternative behaviors and we can change our behavior and our tastes more than what we realize and still feel good in the process and improve our health and our diabetes.

Shireen: In today’s episode, Dr. Alana Biggers will be discussing how and why people develop high blood sugars that lead to diabetes and the relationship between sleep and Type 2 diabetes. Stay tuned.

Dr. Biggers: Many people don’t know that sleep health actually can impact your risk for getting type two diabetes. Sleep deprivation: not getting enough sleep can actually increase like your cortisol levels. That’s a stress hormone. So it impairs your ability to process sugars again.

Their communities of color are most affected by this, sleep deprivation, and poor sleep health too. They are at a higher risk for having like non-standard working times, right? Working overnight shifts and being up all night. That could be a factor that’s contributing to Type 2 diabetes.

American Indian, Alaskan Natives, they have higher rates of Type 2 diabetes followed by non-Hispanic blacks than Hispanic populations and Asian populations. A lot of it’s driven by rates of obesity. So, there are higher rates of obesity in certain communities of color as well.

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 sidewalk, that type of thing. Food deserts or food swaps, which there are either access to foods, but they’re not of higher nutritional value again.

In my current study, what I did was look at black populations with Type 2 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 2 diabetes. And then Type 2 diabetes is a risk factor for heart disease too. So that’s what I’m hoping to see.

Take it one step at a time. Honestly, start where you are. But in those 20 minutes that you have with a patient you try not to overwhelm them, but then you also try to instill in them that this is a time I want you to feel empowered. So start where you are.

Shireen: In today’s episode, we will be talking with Dr. Robert Eckel and we’ll be discussing cardiometabolic diseases like heart disease and diabetes, lifestyle changes, statins and valuing quality of diet over quantity. Stay tuned.

Dr. Eckel: Understanding of more so as to what people ultimately with obesity have consequences of obesity, and many of them develop diabetes and then ultimately developed cardiovascular disease. So the good cholesterols and HDL, that’s really something higher in women than men. And the bad cholesterols, the LDL cholesterol, which is ultimately the type of cholesterol that gets into the artery. Forms the plaque and results in heart attacks and strokes and death from cardiovascular disease.

So what about diet? Well, the dietary intake of cholesterol is not as important as the dietary intake of saturated fats. Those are the hard fats.

Number one is know your risk, and that includes how are you eating?

What’s the quality of your diet. Number two, what about activity? Are you sedentary or minimally active? And can you become more active? The third is avoiding tobacco, all forms of tobacco. The fourth is ultimately managing your weight. Now, the other things that we can do is we can manage our blood pressure, we can manage our glucose, we can manage our cholesterol, and ultimately sleep is another issue we need to consider.

It’s important to remind people that having a medium rare steak once in a while, or going to have fast food once a month is not something they need to confess. Ultimately, we can have some foods occasionally and not so much worry about that. It’s the overall dietary pattern we want to stress, not an individual food or an individual meal.

Shireen: In today’s episode, we sit down with Lisa Golden, who is a certified diabetes care and education specialist. We’ll be discussing the role of a diabetes care educator, the importance of regular eye exams for someone with diabetes, and signs and symptoms of diabetic eye disease. Stay tuned.

Lisa: Oh, diabetic eye disease often goes unrecognized. So a lot of people with Type 2 diabetes upon diagnosis with Type 2, they have some kind of diabetic retinopathy going on and with Type 1 it may take a couple of years, but then that’s the importance of annual exams. But basically it is damaged to the retina, it or any place in the eye. The most important thing to prevent diabetic eye disease is managing your diabetes.

Now, once you have some eye conditions, some of the most common things, I mean, cataracts, obviously cataract surgery, but sometimes there’s eyedrops that can be prescribed and they don’t necessarily improve your vision, but they can keep some things from happening to your eyes. There’s also some laser surgeries where they can go in and actually laser the parts of the eyes that are damaged.

Unfortunately, when they laser it, all it does is keep it from continuing to bleed or grow blood vessels in that area. Anti-VEGF medications. Now these are actually. Injections that go directly into the eyeball and um, they can improve vision to a certain extent. You have lost your vision due to diabetes.

Then you have a right to be angry at your diabetes. So we have to deal a lot with depression and diabetic distress is a very real condition that people deal with. And so that’s something that I work with people about is what exactly is going on? How do they feel about things? And let’s process those so that we can get back to.

Shireen: In today’s episode, we will be talking with Zakiya Jenkins, who owns and operates a fitness studio dedicated to helping people in her community be healthier. Zakiya will be discussing the importance of community coming together and creating a space for anyone to get healthy. Stay tuned.

Zakiya: Having people of color in health spaces is critical to our care and to being related to. You have to relate to the culture.

What I’m doing in the community is really the education piece. I’m not selling, I don’t have any waste trainers to sell. I don’t have any pills to sell. What I sell is a healthy lifestyle that you can do it, you have to do it. It’s life or death if you don’t make small changes.

But sometimes, honestly, we don’t know what those small changes are. You know, breaking generational curses, going to exercise. I offer free exercise classes Monday through Friday, 6:00 AM to 6:30. I can do what you can do it. That is the hardest thing is changing people mindsets. If you change a mind, you can change a life, but you have to change their mindset for the long haul that I’m just the ambassador of health.

Strive for progress, not perfection. Every day you get up, do something for your health. Take a walk. Take, do try something new, right? Do you might really like it. It’s a process, but you are worth it. People, you are worth the sacrifice, and you are worth the wait.

Shireen:  In today’s episode, we will be talking with Dr. Alka Kanaya about obesity and diabetes, and specifically the correlation between fatty liver, diabetes, heart disease, and her research that is focused on the South Asian community. Stay tuned.

Dr. Kanaya: So, what we know is there’s some really nice new studies that have been done that look at genetic risk of where we put fat and it looks like there are genes that do determine if you store fat mostly under the skin. So that’s the subcutaneous fat that you can pinch under your skin, or if the fat is more likely to go around the abdomen or in the different organs where it shouldn’t be.

And so what we’ve seen in South Asians is that there’s a higher predisposition of putting fat in the liver around the organs In the central area, the apple body shape is much more predominant in men and women of South Asian backgrounds.

Yeah, so we’ve been conducting the Masala study since 2010. It started out as a study that was being done at my institution, UC-San Francisco. And my co-PI is Dr. Numi Kadula and she’s at Northwestern University in Chicago. So both of our sites enrolled about 450-500 people. So we had 900 people in this cohort, and we’ve been following these people now for 12 years.

We’re actually seeing them back right now in a third exam visit. And we are really focusing on getting more diversity in the South Asians who are in the study. And, and this is a group of adults who are healthy community dwelling adults between age 40 and 85. Because we’re trying to figure out factors that lead to someone developing heart disease.

And then if they’re ever do get diagnosed with heart disease or a stroke or have any kind of procedures on their heart, we ask them about that and we try to determine what factors we had measured in them may have been causally related to them having a future stroke or heart problem.

And we found that people with, who had the highest amount of fat in their liver were more likely to develop diabetes, and we found that there’s certain aspects of their diet. People consuming less healthy plant-based foods we’re more likely to develop diabetes. So that’s what we’re trying to do is really understand the causative factors that lead to new development of disease so that we can intervene.

That’s the point of this study, is to find what are the modifiable factors that lead to disease so that we our communities, you know, thrive and do better and avoid those risk factors.

Shireen: Megan Robinson has been a registered dietician nutritionist since 1994 and has worked at the Children’s Hospital of Philadelphia for the past 20 years. She’s a board-certified sports dietician and certified diabetes educator. Specializing in sports nutrition and diabetes education.

Megan: [T]he number one concern that every athlete comes into camp with, and also in my practice at Children’s Hospital when I’m working with kids with Type 1 diabetes, who are also athletes, is hypoglycemia, low blood sugars.

Normally when we think about an intense exercise, adrenaline increases and that can cause the blood sugar to spike and go high. But more traditionally when somebody is going for a walk or a slow run or easy bike ride, the blood sugar more likely is going to go low. One of the things you have to understand with diabetes is that first thing in the morning you are more insulin resistant, meaning that your liver is making a little bit of extra sugar in the morning because of hormonal shifts as you wake up. And with diabetes what this means is that you tend to maybe wake up with a little bit of a higher blood sugar, but if you’re exercising, you’re going to less likely going to have a low blood sugar compared to later in the day.

But there’s ways to prevent that. I mean, we talk about nutrition and making sure you’re eating something after exercise to refuel your muscles. For the more recreational athlete, it’s more of just general health. getting in enough nutrition throughout the day. Now, if they are more of a competitive athlete, that’s where we really have to make sure that they are spreading out protein throughout the day, more evenly which helps with muscle recovery.

So I’m always thinking about where are you getting your protein from? Where are you getting your carbohydrates from? Are they coming from the grains? Are they coming from vegetables? Are they coming from fruit? And really focusing on fiber.

Shireen: In today’s episode, we will be talking with Dr. Janis Rozsler, who specializes in sexual health for people with diabetes. Most women and men who are diabetic start to suffer with problems in sexual of sexual nature because of diabetes, and Dr. Rozsler will be discussing what some of these problems are and how you can better manage it. Stay tuned.

Dr. Rozsler: Approximately half of all women and men with diabetes are experiencing some type of sexual complication. That means every other person a healthcare provider sees is having something. And the range of issues is quite great. But let’s take a look at sex. Sex is a physical activity. There’s always a risk of going low of blood sugar dropping because you are utilizing your blood sugar stores to do something just as if you were running a race.

During sex a lot of things can happen and it’s so important to communicate. Say look I have diabetes, I’m going to keep snacks by the bed in case I start to feel lightheaded or start to feel low. Please know the symptoms that I may come up with. We know that the higher a man’s A1C., the more likely he is to develop erection problems. And do everything you can, which would be making healthy food choices, being physically active, taking your medication is directed.

With women we don’t see, research does not show that there’s a strong connection between A1C and a woman’s development of sexual complication patients. What we do find with women is their sexual complications with, when they have diabetes, tends to be more related to emotional based issues.

If it’s bothering you, if you have questions, let your healthcare provider know at the beginning of the session that you want to make time for this. You know, there’s ways to get that information to kind of get that conversation going. But it’s best if the doctor or healthcare provider knows that the conversation’s going to happen so they can schedule that in.

Shireen: Today’s episode, Dr. Rupinder Deol will be discussing the reasons why re the country, especially in certain geographic areas, more than other minority groups. We will also discuss the role that healthcare physicians can take to better understand people of different backgrounds and provide care that is culturally competent. Stay tuned.

Dr. Deol: My research was mainly looking at the behaviors, beliefs, and how patient, how Asian Indians manage their diabetes. They knew about diabetes from a very young age because a lot of them had been caregivers to their grandparents, to their parents, administering their medications. So they took it for granted that one day they will get diabetes.

The statistics show that one in six Asian Indians in the United States have diabetes. Asian Indians have a 40% higher mortality rate compared to their white counterparts. Our genetics play a large part in this, and also one of the major factors is the truncal obesity that Asian Indians have. It’s also our lifestyle and it’s also stressors.

I found that Asian Indian women tend to lean more towards being vegetarian versus the men. The men tended to consume meat. The biggest thing they gave up was meat. Thinking that meat was the cause of their diabetes without realizing that all the other foods that we eat, for example, roti, rice, some of our how we prepare our sweets. Our major cause of diabetes.

And I think the first thing that really helps is the language, how you approach them. And I find a lot of them where they’re older, they’re an older generation, they don’t speak English very well. Acknowledge and accept the fact that they are vegetarian. There is some misunderstanding about carbs and calories because that’s what I found they mix that up too.

So there’s a lot of lack of education. So understanding that yes, there is that gap, that knowledge gap, and also accepting their beliefs. I think that’s a big part. That’s a big part that’s lacking in taking care of Asian Indians with diabetes, is that they, the providers don’t really understand their foods that they eat, and also the Ayurvedic principles are that why they’re eating those foods because that is a big part of Asian, of an Asian Indian. So that’s how I approach it. I acknowledge that first, and then we work from there.

Shireen: In today’s episode, we will be talking with Susan Wiener, an award-winning nutritionist on incorporating a healthy lifestyle to help maintain your diabetes. Susan will be giving some suggestions on how to start and keep a good exercise routine, eat healthy, and manage mental health along the way. Stay tuned.

Susan: A person with type one diabetes makes approximately 180 different health related decisions every day. Think about that. It’s 8,700 hours a year. Spent on self-management of diabetes and only 28 minutes a year with a provider. So change is huge. Even the most organized person who’s not stressed out will become overwhelmed sometimes and situationally disorganized with a disease, a chronic disease diagnosis, especially when a diabetes.

So to get to the point education and change. I believe that we first have to embrace the person with the lived condition of diabetes and say, please tell me about your journey with diabetes. And the mental and emotional health is the umbrella over all of this before anything can happen with change or education.

Not only does physical activity, both aerobic exercise like walking, swimming, cycling, dance, help with blood sugar levels, but so does strength training, exercise and anaerobic exercise as well. Find what you like and schedule it in small intervals and you’ll see that that’s going to be a big accomplishment and may motivate you, really motivate you to keep going with it when you feel those benefits and we talk about learning about different foods.

Sit back, practice active listening before we share anything. And that will hopefully start to put a person at ease because they may have seen another healthcare provider in the past, another clinician in the past that judge them or blame them, or they feel blamed for whatever reason with their diabetes.And that’s helps put them at ease. But this goes into language as well, rather than labeling a person as a diabetic. Ask them, how long have you had diabetes and body language can help put a person at ease and really help flatten that power differential. Because remember there was so few minutes per year that a healthcare professional is spending with a person and so many hours that they are spending caring for themselves.

We want to really build up all of the tools in their toolbox for self care and be available for guidance as needed.

Shireen: Thank you for listening to the Yumlish Podcast. Make sure to follow us on social media at Yumlish_ on Instagram and Twitter and @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, 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.

Connect with guests:

Dr. Hensrud

Mayo Clinic

Dr. Biggers

Instagram

Facebook

Twitter

LinkedIn

Dr. Eckel

Email

Lisa

LinkedIn

Zakiya

Website

Instagram

Facebook

Dr. Kanaya

Website

 Facebook

Twitter

Masala Study

Megan

Website

Instagram

LinkedIn

Facebook

Dr. Rozsler

Website

Twitter

LinkedIn

Dr. Deol

Website

Susan

Instagram

Twitter

LinkedIn