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Deborah Howell (Host): Hello and welcome to the show. You’re listening to Weekly Dose of Wellness. It’s brought to you by MemorialCare Health System. I’m Deborah Howell, and today’s guest is Dr. Kristine Arthur. Dr. Arthur is a board certified internal medicine physician with MemorialCare Medical Group in Fountain Valley, California who believes in treating the whole patient, not just focusing on one area. Dr. Arthur received her medical education at Loma Linda University and completed her internship and residency at St. Mary Medical Center in Long Beach. As a part of her whole patient philosophy, she addresses issues such as diet, exercise, and lifestyle to try to manage conditions and prevent future illness. Welcome to you, Dr. Arthur.

Dr. Kristine Arthur (Guest): Thank you. Glad to be here.

Deborah: Today, we’re going to be talking about managing diabetes through diet and nutrition. This is an astounding statistic: 23.6 million people or 7.8 percent of the population of the U.S. has diabetes. Can you tell us about this disease? I know there are two types.

Dr. Arthur: Yes. There are two types and definitely a big difference between the two. Type 1 is usually diagnosed in childhood, and this is when the body does not make enough insulin. Patients are actually insulin-dependent. They have to use insulin every day in order to keep their sugars controlled. So even if they eat well, they have a great lifestyle, they keep their weight down, they still will need to use insulin.

Deborah: Okay.

Dr. Arthur: Type 2 is the type that we are most familiar with that we see around us more. This is usually diagnosed later in life, and it’s a problem where the body is not able to manage sugars, and so the blood sugars are high most of the time. The insulin that we do produce doesn’t work as efficiently as it should, and over time, sugar levels go up and insulin levels go down.

Deborah: Okay. So, what are some of the risk factors for type 2 diabetes?

Dr. Arthur: Well, there are some things that we can't control. So ethnic background, Hispanic, Latino Americans, African Americans, Asian Americans tend to have a higher rate. If you’ve had a history of gestational diabetes when you were pregnant, that’s another risk factor, your family history, but also things like obesity. So if your body mass index is over 30, that is definitely a risk factor. For people who are inactive, have a very sedentary lifestyle, that’s a problem too. And then also, if you have high cholesterol, high triglycerides, uncontrolled blood pressure, those are all risk factors as well.

Deborah: So we can't really cure it, but we can control it with diet and nutrition. Maybe you can give us some tips.

Dr. Arthur: Yes. This is one of my favorite topics just because there are so many things that we can do with diet and nutrition to improve diabetes dramatically, sometimes almost completely reverse it. One of the biggest things is to limit refined and processed carbohydrates in our diet. The American diet, we have a lot of foods that aren’t so great for us, snack foods and other things, stuff like white bread, crackers, pasta, noodles, candies, pastries, soda, even things that people might think are healthy, like juice, these can all make our sugars go very high. If we instead use whole grains, things like brown rice or wild rice, different types of grains, like quinoa, instead of using white bread, using things like rye bread or spelt, this makes a big difference in how our sugars will respond and if they go up quickly after we eat. Another thing is trying to be sure that you add enough protein into the diet. So you want to have a balance of healthy carbohydrates with lean proteins and healthy fats at each meal. So, for instance, breakfast can be a tricky one. Most of our breakfast food, people don’t really think about it, but if they have cereal or oatmeal or toast then juice and fruit, they're getting a lot of carbohydrates, which will make the sugars go up. But if they can add some lean protein and healthy fat, maybe some scrambled egg whites, some peanut butter, this can balance sugars dramatically. So, adding protein, like eggs and chicken, turkey, fish, lean meats, beans, is a great way to balance out the sugars.

Deborah: You might be surprised how much better you feel rather than starting you day with a sugar bomb of cereal and a big glass of juice.

Dr. Arthur: Yes, and it’s true. People really feel that they're being healthy. They pick a breakfast cereal and a big glass of orange juice and some even whole grain toast, but they're missing out on getting enough protein or healthy fat in the morning. And then, a couple of hours later, blood sugar drops, and they're feeling tired and cranky and heading for another snack to try to get their sugars back up.

Deborah: Right.

Dr. Arthur: So it’s definitely important to balance that out at each meal. And some of the foods that people think, “Wow, those are fattening. I can't have those,” for instance, nuts, they're a great snack, because while they do have fat, it’s a good type of fat. So, not all fat’s the same. So we try to encourage adding in healthy fats in regular small amounts to try to balance out the diet as well. You don’t have to be hungry. You can always add in as much as you want of things like salads and leafy greens and other vegetables. And there is a tool that you can use. It’s pretty simple if you have online access—or you can buy a book at the bookstore—to look up a glycemic index of different foods.

Deborah: Okay.

Dr. Arthur: What this does is if you type in a food, look it up, it will show if it’s low on the scale of a glycemic index or high. So, if it’s below 55, that means that when you eat it, your sugar doesn’t spike up very rapidly. If it’s close to 100, then it’s really going to make your sugar spike. So, not all foods are equal. For instance, with fruits, if you are to pick, say, apples or grapefruits or pears, they're relatively low on the scale, whereas if you picked raisins, watermelon, cantaloupe, ripe bananas, your sugars will definitely go up more after eating those.

Deborah: Even pineapple, right?

Dr. Arthur: Yes. Some of the tropical fruits can really do it. If someone comes in and says, “Well, I love oatmeal. I have instant oatmeal every morning,” that will make your sugar go up much higher. If you just switched that to an old-fashioned oatmeal, that will make a difference right there.

Deborah: Yes. So easy to look at, but it’s a little harder in practice. But it just takes doing and getting used to, and it’s a little bit of a shift. And then if you add exercise, that can also help control diabetes.

Dr. Arthur: Definitely. You don’t have to be a pro at it or a marathon runner. A small amount will make a difference. When you do some type of moderate exercise, your muscles are going to use glucose to do that. So, over time, this helps to bring your sugars down, but it also makes your insulin work better. Because the problem with diabetes is the insulin is inefficient. So I've seen a huge difference in patients who simply added a 10-minute walk. A little bit after their meals, they’ll go out, walk around the block for 10 minutes, and they will check their sugars before and after, that it does make a difference. And they're not necessarily young patients who can go out and run and do things there. They're getting around, and it’s not running. They’re doing sort of a brisk walk, and it makes a big difference.

Deborah: And it also just makes you feel better mentally.

Dr. Arthur: Right, to get out and do something. And strength training is important too. So, any kind of lifting weights, anything like that will also help metabolize the sugars better. So the key is really just picking something that you like or that you're willing to do. It could be walking your dog, maybe it’s playing tennis, it doesn’t matter as long as you're getting out and staying physically active.

Deborah: Okay. Now, if you are diagnosed as having type 2 diabetes, what’s the standard treatment?

Dr. Arthur: Well, usually, the first thing we would do is get you enrolled into a diabetic class so that you can understand what diabetes is, what the complications are, and the long-term goals. Often we’ll have you see a dietician to go through your diet and figure out what changes you can make. We will set you up with a meter to start checking your sugars so that you can see what they are when you get up in the morning and after meals. And then, usually we’ll start people on an oral medication. As soon as you will hear about diabetes, they always think, “Oh no, insulin, insulin, insulin.”

Deborah: Right.

Dr. Arthur: But we don’t start with insulin the vast majority of the time. It’s usually medication pills that are, for most people, well-tolerated. There are many options. Usually, we can get people controlled with a combination of diet and pills, and they may never have to use insulin.

Deborah: Well, that’s terrific news. I didn’t know that. That’s wonderful. Well, good. We have just about a minute left, so really quickly, prevention tips.

Dr. Arthur: Prevention, just know your family history and maintain a healthy weight, know what your BMI is, your body mass index. Make sure you're regularly doing some type of physical activity, no matter how small. Balance your diet out, avoid those processed refined carbs and bad foods and snacks. Make sure your cholesterol and blood pressure are controlled, and just keep regular doctors visit, so you know all these numbers, you can see what your blood sugar fasting is and your cholesterol and get your blood pressure checked. Those really are the main things that can make a huge difference.

Deborah: Very good information. Thank you so much, Dr. Arthur, for taking the time to talk to us today about diet and nutrition. They can definitely help manage diabetes. It’s been lovely to have you on the show.

Dr. Arthur: Sure. Thank you.

Deborah: I'm Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness brought to you by MemorialCare Health System. Have yourself a fantastic day.