Transcription:

Bill Klaproth (Host): Over time, diabetes can damage the heart, blood vessels, eyes, kidneys, and nerves, so adopting a healthy lifestyle is very important in day-to-day management of the disease. Here to talk with us about popular diets and managing your diabetes is Katy McDermott, outpatient dietician and diabetes educator at Marin General Hospital. Katy, thank you so much for your time today. First off, can you give us general nutrition guidelines for diabetes management?

Katy McDermott, RD, CDE (Guest): Traditional diet that's recommended is about 50% of it should be carbohydrates, and 20% to 25% should be protein, and 30% should be coming from fat. That's the typical recommendation.

Bill: So that's a typical recommendation for somebody with diabetes.

Katy: Correct.

Bill: So then what are some of the popular diets people are following when trying to control their blood sugars?

Katy: Yes. More recently the most popular one I get asked often is about the Ketogenic diet, along with the Paleo diet, and then we always fall back on Mediterranean diet and so ultimately what I try to work with our patients is what's their ultimate goal? Is it weight loss? Blood sugar control? So it's very difficult with some of these popular diets because they're very restrictive. Especially with Ketogenic diet, majority of it's coming from fats and less carbohydrates, and so patients see dramatic results of weight loss, good blood sugar control initially because they've eliminated a lot of the carbohydrates which can elevate people's blood sugars if they're eating processed carbs and things that will elevate their blood sugars. But long-term, these diets aren't always the easiest to follow, and so it's difficult for patients to accept that idea because they see immediate results, but long-term it's still restrictive.

Bill: So can we do a quick pros and cons of these three? Just give me a quick overview of the Ketogenic, Paleo, and Mediterranean, pros and cons of each. So let's start with the Ketogenic diet.

Katy: Sure. With the Ketogenic diet, the pros would be for a lot of our patients within the first week or so they see pretty significant weight loss because they've dropped carbohydrates. Most recommendations are saying maybe twenty grams of carbohydrates a day, and the average person is consuming at least 200 grams or more of carbohydrates a day, so it's pretty significant. So they see rapid weight loss because carbohydrates will help us stay hydrated and retain water, so a lot of the initial weight loss is coming from water.

So  many times our patients see that as a pro. For some of our patients, I don't know if it's always a pro, but  many of them are like, "Yay, okay I get to eat a lot of protein." it's kind of an open door for them to feel like they can eat more protein than what's truly recommended.

And those are some things that people are looking at right now. They've also shown that there's a positive with, Alzheimer's, and memory, because initially the Ketogenic diet is recommended for patients with seizures.

Bill: And then what are the cons?

Katy: The cons would be, just some things to think about in all diabetes management when people are changing things is that if they're on insulin, or they're taking some other oral medication called sulfonylureas, is when they're changing their carbohydrates pretty drastically, like this diet, they need to be very aware of low blood sugars, and so patients might not be aware of all those things, especially if they've not talked to their primary care provider, endocrinologist, or diabetes educator. So those would be one of the definite cons.

And also again, it's very restrictive, and so I find just in the years I've worked with patients, is these restrictive diets give immediate results but they're not taught how to implement long-term, and if it's something that they can't follow long-term, what can they follow?

Bill: And how about Paleo? Pros of the Paleo diet?

Katy: Sure. So the pros of the Paleo diet, it can get rid of a lot of processed carbs, um which is super helpful because the processed carbs would be like white rice, white bread, a lot of the, uh, snacky foods like chips, crackers. And so it gets patients the more wholesome foods, they're encouraged to cook more, lots of fruits and vegetables. so again, patients find that their blood sugar is improved, they find weight loss.

For some of our patients that have diabetes, they also have celiac's disease, and so this can be positive because they do eliminate a lot of grains that have gluten in them, so this can be a positive, diet for them that is very easy to follow. It's very structured. Also for some of our patients it can get them into looking at whole foods, and avoiding a lot of these processed carbs.

Bill: And how about the cons?

Katy: The cons patients have to look out further if they have, kidney disease, which many of our diabetes patients can be, at risk of, along with cardiac disease. it's just higher amounts of protein. Eliminate a lot of the carbohydrates that can give them a lot of fiber, and so a lot of our patients don't understand when they follow these diets, that they're still encouraged to eat a lot of fruits and vegetables. And so I think a lot of people forget about that, they can have constipation. It’s just really an emphasis on more wholesome foods, and people sometimes take it as a vehicle to eat more unhealthy foods like hamburgers.  Obviously no bun, but a hamburger with cheese and bacon, as a way to say they're following Paleo or Ketogenic.

Bill: Right and I hear a lot about this one, this seems to be the diet du jour, if you will. What are the pros of the Mediterranean diet?

Katy: Yeah, so Mediterranean diet has been around for a long time. The pros, again it's focused on more wholesome foods, lots of high fiber whole grains, fruits and vegetables. It's not as restrictive as Paleo and Ketogenic, very much aware of healthy fats, lots of olive oil, and really the base is more plants. And I think, in looking at the Paleo, they do encourage lots of vegetables and fruits but they're also restrictive with certain fruits, where the Mediterranean diet is less restrictive with that. and so I find in the end, you know when patients ask what kind of diet to follow, we kind of encourage them- not that it's a diet, but it's a healthy eating pattern that really supports a lot of what we encourage of high fiber foods, having more of a balance with protein and healthy fats that people can really relate to. It encourages good blood sugars too, in the end.

Bill: And is there a con to the Mediterranean diet?

Katy: I would say when I propose it to patients, is really if they're coming in thinking they want to follow something like Ketogenic or the Paleo, they kind of view it as, "Oh wow, that's really higher in carbs than I expected of what you would recommend me having." and so again, then we would go through what our recommendations would be for carbohydrates, for pre-diabetes and diabetes, and it really fits that model, and also again long-term trying to tell patients that it's an easier diet to follow, and really we talk about long-term goals and not be so restrictive.

Bill: Okay, last question. You just touched on this, your recommendations. What is the best way to eat healthy when you have pre-diabetes or type II diabetes?

Katy: we try to take it from a very basic approach with a lot of our patients because things can get very complicated in talking about healthy eating. So I really look at the healthy plate, and show patients that ultimately when we're looking at the healthy plate, we look at half of our plate should be vegetables, the other half of our plate should be cut into fourths, a fourth of it coming from whole grains, and starches, and carbohydrates, and the other fourth should be coming from lean protein.

And so it's really coming back to the basic ideas and try not to be restrictive with certain food groups, and really encourage when they're choosing carbohydrates, specifically the grain, because we count carbohydrates also as grains, fruits, and milk and yogurt. But also coming back to the grains, it's really focusing on wholesome foods, high fiber foods like quinoa beans, lentils, uh, winter squashes, things that have a lot more fiber versus a lot of the processed foods that we're encouraging people to stay away from.

I always like to encourage- coming back to what Michael Pollan says is, "Eat food, not too much, mostly plants." So again, just coming back to the idea of eating real food again.

Bill: And I like how you put that, look at the plate half vegetables, quarter of the plate whole grains, quarter of the plate lean proteins. I think that's really good. Katy, thank you so much for your time today. For more information, visit www.MarinGeneral.org. That's www.MarinGeneral.org. This is The Healing Podcast, brought to you by Marin General Hospital. I'm Bill Klaproth, thanks for listening.