“Some people get caught up in the details of diet.”
Dr. Hensrud talks to us about the Mayo Clinic diet and answers your frequent questions about artificial sweeteners and rice, as well as the paradox around “eat less and exercise more”. Dr. Hensrud is a consultant in the Division of General Internal Medicine, Associate Professor of Preventive Medicine and Nutrition at the Mayo Clinic, and is medical editor of the Mayo Clinic Diet and the Mayo Clinic Diabetes Diet.
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, we’re speaking with Dr. Hensrud talking to us about the Mayo Clinic Diet; answers your burning questions about artificial sweeteners and rice, as well as the paradox surrounding eat less, exercise more. Stay tuned.
Shireen: Dr. Don Hensrud is a consultant in the division of General Internal Medicine Associate Professor of Preventive medicine and Nutrition at [The] Mayo Clinic, and he’s also the medical director of the Mayo Clinic Diet and the Mayo Clinic Diabetes Diet. Welcome, Dr. Hensrud.
Dr. Hensrud: Thank you. Happy to be here, Shireen.
Shireen: Such a pleasure having you on Dr. Hensrud. Let’s start things out by understanding what inspired you to write this first book, and did you see yourself becoming an author?
Dr. Hensrud: I didn’t. Some people aspired to that, but I followed my passion of becoming a physician; specifically helping people take care of themselves through healthy lifestyle habits. In that process, what I do in the office, I wanna do for people everywhere. And so in conjunction with Mayo Clinic, we’ve come out with a number of books, and the most recent, ones are the Mayo Clinic Diet. The third edition is coming out in January, Mayo Clinic Diabetes Diet, and TheMayo Clinic Diet Journal. So that’s a way of spreading what I do in the office to everybody, and that’s my true passion.
Shireen: Lovely. Hey, tell us a little bit more about these books.
Dr. Hensrud: The Mayo Clinic Diet is more than a diet. It’s a lifestyle change program. The reason we chose that term, was for two reasons; One is there have been so-called Mayo Clinic diets floating around since the 1940s, and none of them were associated with Mayo Clinic. In 2010, we put our flag in the sand and we said; this is the real Mayo Clinic diet. But the way people look for information on weight management is by using the term diet. Now, that’s a four-letter word. If people go on a diet, they usually go off a diet. We get people’s attention, but what it really is, it’s a lifestyle change program to help people adopt practical, realistic, and enjoyable habits that are sustainable; can improve their health and their diabetes, and help them feel better.
Shireen: Would you share with our listeners what makes the Mayo Clinic Diet [different] from some of the other diets that we hear about that could be fad diets as well? Can you tell us more about that?
Dr. Hensrud: We designed this around long term, this is not a here today, gone tomorrow fad diet. It’s evidence-based, which is important. As I said, it’s practical and it combines health with weight management, and that’s really important. Some diets will help you to lose weight. They may not be enjoyable, practical, or sustainable, and they may not improve your health. This is silly, but if someone ate 500 calories from jelly beans, they’d lose weight, but obviously, their health would not improve. 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.
So not real low fat or real low carb, but healthy fats and healthy carbs. At the center of our pyramid, “The Health Mayo Clinic healthy weight pyramid” is physical activity, and that’s part of it too. At the top of the pyramid is sweets and we realize nobody’s perfect; sometimes people go too far and they undertake a diet they can’t keep on for a long period of time. So we recognize that. We allow people a treat now and then if they follow the program overall.
Shireen: You mentioned it as practical, and you’ve also characterized it previously as “a common sense” approach. What really makes it that?
Dr.Hensrud: Some people get caught up in the details of diet. For example, blueberries are the healthiest source of antioxidants or the best source so, “How many blueberries should I eat?” Give me a break. All berries are good. And so we don’t get caught up in the weeds. We try [to] keep it high level. We don’t count calories, that’s important. Calories count, but we deal in servings, those servings of fruits, servings of vegetables, and servings of carbohydrates.
A serving is a specific amount of food and anyone who manages diabetes knows that they should watch their carbohydrate. We do this through servings that makes it easier. People don’t have to memorize calories, and if they’re out eating, they can look and estimate serving sizes with vegetables and fruits, there is not a limit on servings. People aren’t going to overdose on broccoli one of the most important things I see is, that people don’t eat enough of these things well enough vegetables, enough fruits. There’s a minimum amount of servings of vegetables and fruits. in general, the more servings of those people eat, the better is their weight.The better we’ll be [for] their diabetes, therefore, the better we’ll be [for]their health. As a side note, one of the things I hear from people is, I have diabetes, I should avoid fruit. A couple of points regarding that. One is we make a distinction as does, the American Diabetes Association and other groups between added sugars and natural sugars.
A piece of fruit does not have that much sugar or calories. In a small to medium piece, there may be 60 calories or so, and not a lot of sugar. There’s water, there’s fiber, there [are] nutrients, so it’s healthy. In addition there, because there aren’t many calories if people are eating more fruit instead of other foods that are higher in calories that can help them manage their weight and in general for most people, improve their diabetes. So that’s one of the things that I see is that people don’t realize there are healthy foods they should eat, that can help them manage their diabetes and their weight. Now, if they add fruit on top of everything they’re eating, that’s just extra calories. But if they’re eating it in place of other foods that may not be as healthy or have as have more calories, then that would be beneficial.
Shireen: Mm-hmm. I do wanna get into some of the foods in just a second. Let’s, now that you’re talking about diabetes, in particular, let’s talk about the blood sugar a little bit more. When our blood sugar goes up, is it measuring what was eaten the previous day or the current day? Can you talk about what that timeline looks like for [the] impact on immediate blood sugars? I just wanna connect that to A1C in just a second, but let’s start there first.
Dr. Hensrud: Yeah. So for somebody without diabetes, We use and, and with diabetes, we measure a fasting blood sugar in the morning because everything we see we’ve eaten is out of our system. That’s kind of a baseline as far as how our body handles glucose and maintains glucose levels. People without diabetes have a blood glucose level of 70 to 100 milligrams per deciliter in the morning. That’s normal. People with diabetes have a blood glucose level greater than 126. That’s the definition of diabetes.
A fasting blood glucose in the morning is kind of a baseline, and that’s what we do our measurements on to determine if somebody has diabetes. Now, when somebody without diabetes eats something, their blood glucose value goes up after they eat, depending on how much and what they eat. And then it comes down again relatively quickly. An hour [or] two, something like that. Somebody with diabetes may lose that initial regulation. The blood glucose may go up higher and it may stay up longer. So there are differences in the short-term way that people with diabetes metabolize food and carbohydrate and their blood glucose values, and how they react.
Shireen: I see. While we’re talking about monitoring blood sugar, levels, can you also talk about the evening blood sugar and what numbers one should look for?
Dr. Hensrud: Yeah, as I mentioned, people without diabetes, they can get their blood glucose values down, pretty good. Insulin works well to lower blood glucose. People with diabetes, on the other hand, as I’ve alluded to; their blood glucose may go up more during the day and stay up longer. So it’s a good idea to know what it is in the morning, what it is. Sometimes we’ll ask people to measure during the day or in the evening so we can adjust medications appropriately.
Shireen: Okay, now let’s get into some of the foods itself. Should we use artificial sweeteners? It’s a big question that we even get, here at Yumlish all the time. Should we use artificial sweeteners or real sugar in cooking and baking? Can you talk about that? And then I wanna get into some of the sweetener substitutes.
Dr. Hensrud: Yeah, so artificial sweeteners do not have any calories. They do not raise blood glucose values. And the important thing is the American Diabetes Association recognizes that it is safe and effective to use them in people with diabetes. It will not, they will not raise blood glucose values. There are a couple of caveats regarding that. If someone has a meal out that has a double cheeseburger, a large order of fries, and a diet soda with artificial sweeteners. That probably isn’t accomplishing what they wanna do. But if they lower their overall calorie intake by using them, it’s probably okay. One other point related to that is I see people sometimes and they’ll say, well, I, I drink, I, I don’t drink regular soda.
I drink large amounts of diet soda though, cuz it doesn’t have any calories evident. It doesn’t have any calories and it’s better than regular soda. But there is some data that people who consume large amounts, both adolescents and adults, may tend to weigh a little bit more. The product doesn’t have any calories. The general theory is though is might trick the brain into seeking other foods that are sweet, and those calories may contribute to a little bit of weight gain. What’s best is good old water, and I like mine, either carbonated or with a splash of a little flavoring in it that doesn’t have any calories.
Shireen: Is the sugar substitute Diva, for instance, okay, for managing diabetes.?
Dr. Hensrud: Yeah. It is natural and that’s been promoted it is an artificial sweetener. Yes, in the context of what I described before, I think it is okay, within those parameters.
Shireen: Okay. Is the same true for others like Splenda? I mean, we see a bunch of different types of sweeteners, artificial sweeteners out there.
Dr. Hensrud: Yeah. Some of those in general. Yes. What’s interesting though, years ago and this is many years ago, there was a concern about cancer, and that was kind of discredited some of the earlier studies. However, recently there has been some questions about the health effects. They are better than regular soda, and they are okay, but, it’s like anything else. I like to eat minimally processed foods and mostly plant products that kind of summarize nutrition and stick with real food, so to speak.
Shireen: Gotcha. All right, is unrefined natural sugar better than granulated cane sugar? Cuz even in sugar we’ve got a bunch of different [varieties] to pick from.
Dr. Hensrud: That’s right. And I hear the same thing about honey. Honey is healthier than regular sugar. Unfortunately, no difference in the health benefits are minuscule and all sugars contain the same amount of calories. It is important for people to watch their total sugar intake, whether natural or added. Again, the one caveat being with fruit because it comes in a good package and there isn’t as much sugar as what’s commonly believed. Let, let me expound on that a little bit. As I said, in a small to medium piece of fruit, there are about 60 calories. In a candy bar, there are 270 calories for some candy bars. So for the calories in a candy bar, you could eat a small peach apple pear an orange for that one candy bar. And that kind of puts it in perspective, I think.
Shireen: Let’s talk about some other different foods moving on from the sugars. Let’s get into rice. That’s a big one for me because I’m of South Asian descent, and I love my rice. What is the difference between white rice and brown rice?
Dr. Hensrud: The easiest way to look at that; is it’s similar to white bread and brown or whole grain. White rice has the fiber removed. It has some of the beneficial nutrients and fat removed similar to white flour. So brown rice has the fiber of more nutrients. It is healthier than white rice, but I realize that white rice is what a lot of people eat and it’s a change. But if people can get, sometimes people like the nutty taste, you know, our taste preferences can change. On the other hand, foods raise blood glucose values at different rates. And rice is one that despite brown or white, it’ll raise blood glucose a little bit. We have to watch the total amount. There’s a slight difference because of the fiber and the slower absorption of brown rice. It probably raises blood glucose a little bit less than white rice, but still, the total amount is important of how much we eat.
Shireen: Can you talk about the relational carb content there, and then specifically for someone with diabetes?
Dr. Hensrud: Carbohydrates are converted in our body into blood glucose, carbohydrates any kind of carbohydrates. Complex carbohydrates like starches in brown rice or starchy vegetables are broken down in the body and ultimately converted into blood glucose. In people who don’t have diabetes, they can handle that as we alluded to earlier, their insulin levels can and their insulin sensitivity can lower the blood glucose values. Insulin in the body in the blood lowers blood glucose in people with type 2 diabetes. They have enough insulin and usually, in fact, insulin levels may even be higher in people with type 2 diabetes, but they have what’s called insulin resistance. The insulin doesn’t work as well in the cells to lower blood glucose values.
Fat is not converted directly into blood glucose. Protein is only indirectly converted to blood glucose, and so carbohydrate in our diet is much more directly converted into blood glucose, 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 values. So carbohydrate is particularly important for people with diabetes on the long term. Let me switch gears a little bit.
Dr. Hensrud: Weight is important. Of the two factors, we can’t control for diabetes both are important age and genetics or family history, we can’t control those. You can’t choose your parents. We can’t do anything about that. And if somebody has a genetic predisposition to diabetes, that’s the cards they were dealt. Of the controllable factors, weight is by far the most important followed by physical activity and exercise, and followed by diet. Now I’m talking about the independent effects here because diet and physical activity relate to weight. But if somebody loses weight, especially early on in their diabetes, their blood glucose values will improve. So short term, it’s important to watch carbohydrate intake in people with diabetes that will immediately raise blood glucose long term. That’s why weight is so important, is that if people lose weight in general, their diabetes control will improve up to a certain point.
If they have advanced diabetes, they’ve had it for a long time. The pancreas kind of gives out and says, I’m tired. I can’t produce any more insulin, and it doesn’t work as well. And weight loss in people who’ve had diabetes for a long time may not work quite as well, but it’s still important to watch diet and physical activity, and weight to try and decrease the overall increase in blood glucose values.
Shireen: Mm-hmm. Okay. Another important topic to talk about, especially in December, is that the holidays are here, right? There’s a lot of overeating, binge eating, lot of calories, and sugary foods. Added sugar foods. Is there one, is there a magical time of day to eat some of these? Sugary foods with chocolates and all of that. And is binge eating bad foods and snacks better than eating all day long? I mean, is there, is there a win here anywhere?
Dr. Hensrud: So, this is a real timely and interesting topic. If you look in the medical literature, there was a classic study 20 years ago, and this was not among people with diabetes. This was among everybody. It showed that from mid-November until mid-January, We gain about 0.8 pounds, a little less than a pound or so. But the important factor is it stays on it’s cumulative. Another important factor was there was a wide variability some people don’t gain much. Other people gain more people who tend to weigh more tend to gain a little bit more weight.
So the holidays are a particular time, as we intuitively know for weight gain, not as much as what’s commonly believed for most people. There are ways of going about that. And similar to weight management overall, I think it’s really, really important how people approach this, their attitude or mindset and just in weight management, I see people just try and, oh, they just try. They focus on the goal weight and staying on a very rigid diet. They beat themselves up about weight. I’m a failure I haven’t done this. That’s not a good way to approach it. That’s not a good long-term success because sometimes the numbers on the scale are gonna stop changing. Then people often throw in the towel and gain all the way back again and more.
They ignore their successes. So around the holidays, what I tell people, number one, be kind to yourself. Don’t try and be perfect. Number two, just be mindful and be 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, enjoy it, but don’t throw in the towel and mindlessly eat. Another important point around the holidays is physical activity. And again, rather than just sit around and watch TV all day and eat, maybe we could do some activity to make 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. If you’re living in the north, go outside for a walk and look at the Christmas lights. If you live in a safe neighborhood or have a snowball fighter get, get some activity that’s fun. There are ways of going about this that don’t have to be drudgery and people can manage weight, they can enjoy the holidays and they can continue to, be healthy throughout the holiday season.
Shireen: So, the short answer is no, do not fit in any of the binge eating. There is no, no better time and day to do that, or time of year to do that.
Dr. Hensrud: Correct. You, answered it much, much more concisely than I did.
Shireen: Dr. Hensrud, you previously mentioned, and I quote, “effectively, managing weight is one of the biggest paradoxes I know. It sounds easy. Eat less, exercise more. But the factors that go into that seemingly simple statement are tremendously complex.” One, why do you call it a paradox? And really what factors do you think making losing weight just tremendously complex?
Dr. Hensrud: So you kind of outlined the paradox. It does sound easy. Eat less, exercise, more doc. People don’t need me to tell them that it’s how to do it that is the paradox. One thing, I talk to people about is, if you think about it, our inner brain tells us to eat a lot and take the shortcut. The reason why is a couple of hundred years ago, the person who ate the most and did the least activity is the one who survived. Everybody was doing, working in the fields and food was scarce. So there was a survival advantage in eating a lot and doing a little, our inner brain still tells us that I’m gonna survive if I eat a lot and do a little.
So we were hardwired to take the shortcut to eat high-calorie foods that taste good. We’ve gotta outsmart our Olympic brain. One example, a silly example of that is, when I go to a different floor here at the, at the Mayo Clinic, my inner brain tells me to push the elevator button every time. And I have a limit. I don’t walk up 20 stories. But instead of doing that, I’ll do the self-talk and I’ll say, take the deal, take the stairs instead of the elevator. If I do that multiple times during the day, I’ve increased my activity, I’ve burned some calories, and improved my health.
Dr. Hensrud: Another silly example of how we’ve done that in our lives. Is at the gas station. Used to be we had to walk into the gas station and pay for our gas. Now we just swipe at the pump and there are hundreds of examples of that in our lives. So that’s what I mean managing weight is managing the hundreds of factors that influence it, both on diet and on activity. And it’s an individual.
For some people, they exercise regularly. That’s not an issue. For other people it may be, or diet. Some people, like to munch at night when they’re watching TV or I can’t buy it pass by a fast food place without stopping. So we have to 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: One more question for you, Dr. Hensrud before we wrap up the episode here, are there any magical foods for weight?
Dr. Hensrud: Despite common belief, no. Tthere are no foods that have negative calories. For example, as I said earlier, though, there is in my view interpretation of the evidence and let me explain this a little bit different way. If it does, calories don’t fill us up. You don’t say, I’ve had 500 calories now in full. There are some foods that have a lot of calories in a small volume other foods have a lot more bulk and volume, but less calories. By focusing on those foods, we can still get enough to eat. We don’t have to feel deprived all the time, and we can lower our overall calorie intake so it, doesn’t have to be that much drudgery, so there are no magic foods but by shifting toward more low-energy, dense foods, it can help manage weight, it can taste good. There’s a lot of great ethnic food out there that’s plant-based and it can help improve our health and our diabetes.
Shireen: Lovely. Dr. Hensrud, I feel like this is a conversation we can keep having. I feel like we need to have a part two on this episode but with that we are toward the end of the episode here. Can you tell our listeners how they can connect with you, learn more about your work?
Dr. Hensrud: So, I’m at the Mayo Clinic a couple of ways. One is we have the website, Mayo clinic.org. We pride ourselves in providing evidence-based, but practical, and easy-to-understand information to people. There are tons of articles and information on our website. We have the book, The Mayo Clinic Diet, and the other book, The Mayo Clinic Diabetes Diet. You can get it on our website, you can get it online in various places. And we have the Mayo Clinic Diet Journal, and there’s a new cookbook that Mayo Clinic has come out with our executive wellness chef, Jen. She’s very practical, Cook, Smart, Eat Well. So there are a lot of resources for people, to take a deeper dive into this important subject.
Shireen: Lovely. And with that, we are toward the end of the episode. Dr. Hensrud, thank you so very much for your time.
Dr. Hensrud: Thank you. It’s been a real pleasure, Shireen.
Shireen: Thank you. And to our listeners, let’s continue the conversation. Go over to our Facebook, to our Instagram, find this podcast post, and comment below for the following question. Tell us if you’ve heard about the Mayo Clinic Diet before, how it has impacted your life. Uh, again, go over to that social media post again. Find us on Facebook, Instagram. Find this podcast post in common below to tell us how it has influenced the way that you eat. Dr. Hensrud. Thank you so much.
Dr. Hensrud: Thank you.
Shireen: Thank you for listening to the YumlisPodcast. Make sure to follow us on social media at Yumlis_ on Instagram and Twitter and atYumlish 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.
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