Shireen: Shannon Leininger is a registered dietician, certified Diabetes Care and Education Specialist and certified Health Education Specialist practicing in Las Vegas, Nevada. She has more than 10 years of experience in the field of dietetics and is passionate about helping people manage and improve their health with lifestyle changes. Welcome, Shannon.

Shannon: Thank you. Good morning. I'm so happy to be here. 

Shireen: Well, glad to have you on. So Shannon diving right in what led you to work within nutrition as a registered dietician, especially as a diabetes educator?

Shannon: Yeah, you know, it's kind of interesting, I had a little bit of a roundabout way of getting here, actually. I, I'm from Missouri originally, and I went to school at the University of Missouri and kind of was one of those I don't know, what I want to do is biology major for a little bit. And then was literally thumbing through the course catalog and kind of found this nutrition and fitness degree around. Well, that sounds interesting. I like health and that kind of stuff. And so I ended up getting a degree in nutrition and fitness. And I didn't, at that time become a dietitian, because I thought that dietitians only worked in hospitals. And I knew that that was not what I wanted to do. So did the nutrition and fitness saying and after that was kind of like, okay, now what and so randomly had gone to Las Vegas for spring break, and thought, Oh, I could live here. So I looked into the grad program here, moved out here and went to grad school. So I had my graduate degree in health education, health promotion. And when I finished that, then I thought, gosh, I've been in school a long time, maybe I'll do something fun. So I got a job, actually, at a restaurant on the strip. So I was a waitress for seven years, which was fantastic. I met great people and made good money, but also a few years and realized, this is probably not what I want to do forever. So that I was doing some continuing education for my certified Health Education Specialist credential. And when I was doing those, I kind of felt myself gravitating towards all of the nutrition related credits, I just was really interested in learning about how the foods we eat can influence are to risk for disease and make us feel better, and just overall the impact of nutrition on our livelihood. So I looked into the program at u and v here in Las Vegas and went back to school for nutrition, this time with a specific focus to be a registered dietician. So I was doing that and then working at night and finished my degree. And from there, I knew, right from the get go, I wanted to get into diabetes, not only is it just a huge issue, right with so many folks that are dealing with it, but I really am drawn to that, because it's one of those conditions that lifestyle plays such an important role in managing prevention and treatment, you know, so I love being a part of that, and being able to help people learn more about how they can adjust their lifestyle and modify their behaviors to help manage that condition.

Shireen: And in one of your approaches, you speak about how not to demonize foods. So what does it mean to demonize foods?

Shannon: You know, when we use that term, it's really any food that's been labeled bad. And I'm kind of using air quotes there, you know, for a certain reason, usually it's health related. It could be anything that's white. So we've maybe heard that before, or foods that are too high and fat, or in a much broader sense. Sometimes we hear about any foods that are carbohydrates in general, which is a very general term, but, and those have been demonized as well. And this is really kind of problematic, because when we start to label foods as good or bad, we start to associate value with that. One thing that we talk even with children about is we don't want to talk about good foods and bad foods, because we don't want to use that as a reward, right? We don't want to get ice cream for good behavior and feel like having to eat broccoli is a punishment. And so when we assign that value, it really kind of takes away from the quality of the food and the purpose of eating it. So we want to get back to trying to neutralize food. And so that's why when we demonize them, that's the exact opposite of that of that, right? So instead of looking at it as good or bad, we can just look at foods as are they more nutrient dense? Right? What kind of nutrition? vitamins, minerals, fiber, protein, healthy fats, what am I going to get out of this compared to a food that's maybe less nutrient dense, all foods are able to fit into our lifestyle, right? So it's not about having to eliminate any certain types of foods. Rather, we want to try to choose healthier choices most of the time.

Shireen: Makes sense, and what are some other foods that you commonly hear about that that have been demonized?

Shannon: Oh, gosh, so I would say probably the most popular ones that I hear from patients versus that to not eat anything white. And the second would be sometimes fruit in general as a broad category, but also specifically I feel like bananas and grapes and pineapple get picked on for some reason. And these are the ones that people come in the most often and say gosh, well I've completely cut out white rice or Well, I know I'm not supposed to eat grapes anymore. And I just, you know, when you think about that statement, it's, just seems kind of ridiculous to think that someone can't ever eat grapes again, just because they've been diagnosed with diabetes. And so my job and what I really try to, you know, stress with my patients is that that's, that's not true, right? We do need to learn how to eat them unhealthy amounts, but by no means is any food or certainly any food group going to be completely off limits.

Shireen: So the problem is not really eliminating, we shouldn't really eliminate the foods. The problem is the portion correct?

Shannon: Yeah, I always say let's think about healthier choices and unhealthier amounts, right? So there's, again, there's nothing that's off limits, but we, we might need to learn how to eat them a little bit more moderately. And that can mean different things for different people, right? I've got some folks that come in, and they're having ice cream every single night. So we… Okay, well, maybe that's not going to get you to your goals, whether that's managing blood sugar, or blood pressure or losing weight. So what can we do to still incorporate ice cream, since that's something you enjoy, but maybe in a healthier way? So instead of every night, maybe it's every other night? Or in a big bowl? Maybe we're using a smaller bowl, right? And it's all about those small steps to get them to that stage of better health. 

Shireen: Make sense? So one of the common things that you touched upon this just a second ago that we hear from physicians, especially after diabetes diagnosis is, you know, quote, cut out carbs than anything white. What is wrong with that statement? And how would you qualify that?

Shannon: Yeah, you know, again, when people come in and say that I just kind of shake my head a little bit, it just seems silly when I would first say, Well, okay, well, garlic, and there's white onions and mushrooms are white, do we need to eliminate those. So it's just such a blanket statement. And I get what physicians are trying to imply there. But it's just misleading. And you know, people kind of take that to heart. And since there's no chance, or the physicians haven't really qualified, what exactly that means. People take that literally right, and they come in and just thinking they can't do anything white, so or eat any kind of carbohydrates hydrates in general. I don't know if it's, you know, for obviously, you know, for many physicians, they're short on time with patients, right. And so maybe it's just easier to give a sort of blanket statement like that, and they don't have the time that then I have as a luxury to get into more detail and education with patients. I don't know if some of them are misinformed, you know, who knows, but regardless, what I really think would be a better way to qualify that would say, Okay, let's try to limit your intake of refined carbohydrates, things such as white bread, or white rice. And the reason for that is we know those are lacking in fiber compared to their whole wheat counterparts. So whole wheat bread or brown rice. And we know that fiber is an important part of, obviously, we know with our digestive system, but from a blood sugar perspective, fiber is really important because it helps to slow down the absorption of foods, thus slowing down the rise in blood sugar. So including foods that have more fiber is a good way to help prevent blood sugar from spiking, it also contributes to satiety. So we feel fuller longer. You know, in addition to that, suggesting that folks completely cut out carbohydrates, it's just really not feasible for a lot of people. You know, the fact is, a lot of us enjoy eating carbohydrates, you know, and so certainly, they might be able to eliminate them or really cut back on them for a short time. But most people and in my experience, at least find that they want to start including carbohydrates back into their lifestyle at some point, I think, you know, for me, I can better serve my patients by educating them on how to include healthier types of carbohydrates and healthier amounts, rather than just telling them not to eat them, you know, otherwise, if they eliminate them, and eventually go back to eating them. The problem there is they haven't really learned how to eat them healthier, they've just learned not to eat them. So oftentimes, they go back to doing exactly what they were doing before, which may include less healthy choices and less healthy amounts.

Shireen: How does one eat better, I guess without demonizing the food?

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 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 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? Is it 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 a 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, right? Maybe you're at a wedding or some kind of celebration, and there's cake. Okay, well, that's a happy, joyous occasion and cake might be part of that. That's okay. Maybe you're having a bad day, and there are certain foods that bring comfort. Are those always the most nutritious choices? Of course not. But there's no reason that we can't enjoy them, right? There's a variety of reasons that we eat, and enjoy foods. When we get to the point where we're choosing maybe those that are less healthy more often. That's where we want to kind of maybe take a step back and think, Okay, well, again, what are my goals? And what kinds of foods should I be choosing more often, to help me reach that? Mm hmm. The other good news too, is that, typically when people start to eat better, right, when they're fueling their body appropriately, and choosing foods that are more nutrient dense, they feel better, you know, they're seeing better blood sugar results. And so that kind of feedback is hard to beat in terms of wanting, or in terms of motivating people to continue with a certain behavior, gosh, I have more energy, sleeping better, my blood sugar readings are down, all those things are reinforcing. So it helps the person become more motivated to continue doing what they're doing.

Shireen: But it also takes a while to get there, right? You have to be eating well, for a longer period of time to be able to see those results, too.

Shannon: Oh, yes and no, I mean, certainly for looking at longer term measures, like a Wednesday, yeah, that might take a few months. But certainly within a week, you know, I've seen blood sugar numbers drop, I've seen people feel better, just from making better choices, whether that was cutting back on the refined carbs, choosing healthier amounts, eating more vegetables, moving their body more, all those kinds of things, really can have some short term benefits, which is great. So it's not like you need to wait a few months to really see the results, right.

Shireen: You talked about, just a second ago, about you know, if you're going to a party, and you there's this cake there, you know, you can indulge a little bit. Again, I would imagine that portion control would be, you know, best suited. There's like, you can't go all out on the cake, either. You just have to kind of manage that. Right?

Shannon: Yeah and that's okay. And I think too, it's important to, we've all been there, right, where we've over and over and thought afterwards, oh, gosh, you know, why did I do that or felt too full? Or knew that wasn't the healthiest choice? And at that point, you know, I think probably the natural reaction is guilty. No, I shouldn't have done that. And which is understandable. But also that's not really productive. Instead, I would say, okay, that's done. We can't change it. So let's look forward to the next time that that might happen. The next time I'm in that situation, what would I maybe do differently? What would be a different choice I would make so that I don't feel this way again, the next time I'm encountered with us, right? It's no reason to think that you can't enjoy cake, right? Not saying to go eat, you know, a huge slice or half the cake. But certainly learning to enjoy that a little bit more mindfully where you're enjoying every bite, rather than kind of shoveling stuff down your throat and not really thinking about what you're doing. But that can help you enjoy smaller amounts, right, but still get pleasure out of eating it.

Shireen: So here's the, here's the million dollar question, though. Why does, not the nutritious dense food right? The opposite, right? So why do those foods taste so much better than the broccolis and the lettuce and the kale in the spinach? Why is that? 

Shannon: Because life isn't fair? I don't know. Here's the facts, right? Sugar tastes good. That tastes good. And you know, when we look at broccoli, it's got hardly any sugar and no fat, you know. And so it's hard to compare that if we're looking at something like cake or a brownie, of course, that is going to taste more pleasurable, right? Not to say broccoli can't taste good, you know, and sometimes it's about finding a preparation method or a certain seasoning blend, but that you prefer that works for you. If that means it's a little bit of ranch with your broccoli, great, go for it. And I think to some of that's associated with kind of triggers, right, for reasons that we eat certain foods or occasions that we would eat certain foods. And that's why nutrition is so interesting to me, because there's so many factors that play into this, right? Whether it's actual hunger, its emotional cues, its social cues, right? If we're going to a function, then we expect there to be certain types of foods. And so, again, it's not about we can't enjoy those types of foods and you're right with the sugar in the fat. It's hard to compete with those. But at the end of the day, too, it's about thinking about Well, again, what am I trying to accomplish here, right and which of these foods are going to get me there? Which should I be eating in more quantities?

Shireen: Which leads me to the next question, which is, you know, what does it mean to meet patients where they are?

Shannon: You know, I think it's really important to have a tailored and individualized approach. I don't ever approach any two patients the same, because even though I might have two patients that both are newly diagnosed with diabetes, they're coming in with completely different experiences, preferences, budgets, schedules, and all these things are going to influence their food choices. So for me to expect the same, you know, same meal plan to work for every single person is just actually kind of ridiculous. So we have to really think about where they are in the sense of what's their knowledge about diabetes coming into this, what are they willing to change? What's their motivation to change? Right? Some folks, maybe aren't that motivated to make any changes, either because they feel fine, or they don't understand perhaps the consequences of, of having uncontrolled diabetes. So thinking about Okay, where are you at now? And that's really one of the first things I do is tell me about your current habits, whether it's exercise, sleep, stress management, eating, right, where are you at now. And what I really enjoy doing, too, is educating folks on the physiology of diabetes. I've got some patients that have had diabetes for 20 years, and they come in and I'll say, Okay, tell me what you know about diabetes. And they look at me pretty blank face, I'm, you know, something with my blood sugar is what I'll hear often. So I really enjoyed that opportunity to educate them. Once they understand what's happening in their body with regards to diabetes, it's, you can almost see the light bulb go off. Just makes so much more sense. Oh, okay. That's why maybe need to moderate my carbohydrate intake. That's why exercise is so important. Oh, that's how Metformin is working in my body, you know, helping them understand that is critical, because often then, once they understand why we're saying all these things, why we want you to choose healthier carbohydrates, they're much more likely to implement that. And what that looks like for, for different people is gonna vary, right? I've got some Hispanic patients that will come in, and they've been eating five tortillas, a heaping amount of rice and beans at every meal their whole life almost right. And so for them to come in and for a doctor to tell them, okay, you have to cut out carbohydrates. I mean, that's, it's crazy, right? And they come in, legit upset about that, which is, understandably so it's part of their culture. It's what they've known, it's what they enjoy. And so for me, okay, let's talk about why that might not be the best option, right. But again, we don't need to eliminate the carbohydrates. So think about how we can have them in a healthier amount. And for that patient, it might mean okay, instead of five tortillas, I'm gonna have four. Okay, that's fantastic, right? Because that's a step in the right direction, kind of working with them and getting some, some small steps towards behavior change is critical. They're much more likely to comply with that in the long term. And that's really our goal, right? We don't want anything they're going to do just for a few months, we want something they can do for life.

Shireen: Like that. So with that, Shannon, we're toward the end of the episode, unfortunately. How can our listeners connect with you and learn more about your work?

Shannon: Yeah, absolutely. So I do, mentioned before, I have a private practice in Las Vegas. So I see patients on a one on one setting. Typically, I do have a Facebook page, you can look up which is the well nutrition. And my website is www dot live well, nutrition Lv as in Las vegas.com. From there, I do have an email list. It's called the live well loop. So I offer weekly tips, healthy recipes, and then from there, they can certainly find contact information if they'd like to reach out further. 

Shireen: That's perfect. Well, thank you so much for your time, Shannon. Truly appreciate it. 

Shannon: Of course. Thanks so much for having me.

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