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Managing Type 2 Diabetes with Healthy Eating

How do MIT Medical patients use Nutrition services? What resources are available to those seeking nutrition consultations?

What role do nutrition and diet play in managing diabetes?

Switching to a healthier diet can clearly do a lot to improve one’s health, but it does require discipline and it can be easy to fall back on “comfort foods” that may not be very healthy.

Anna Jasonides, RD, LD, is here to explain the importance of good nutrition when managing your diabetes.
Managing Type 2 Diabetes with Healthy Eating
Featured Speaker:
Anna Jasonides, RD., LD
Anna Jasonides has been helping patients with their diet and nutrition for more than 25 years. She joined the MIT Medical community in 1997, and has also taught classes in nutrition and diet therapy at Bunker Hill Community College. She works with patients to help with healthy food choices and learn behavior modification around food.


Learn more about Anna Jasonides
Transcription:

Melanie Cole (Host):  Switching to a healthier diet can do a lot to improve your health but it does require discipline. If you suffer from diabetes, it might be even more difficult to maintain that healthy lifestyle and make those good choices. My guest today is Anna Jasonides. She's a registered dietitian/nutritionist at MIT Medical. Welcome to the show, Anna. What role does nutrition and diet play in the management of diabetes?

Anna Jasonides (Guest):  It is the foundation of the treatment and prevention.

Melanie:  So what do you tell people every single day? If they have been told they have pre-diabetes or that they do have Type II diabetes, what do you tell them about beginning to eat healthy and make those good choices?

Anna:  Well, first I listen to what they're eating currently. I ask them what they have in mind of what things they can do, what they've already read, what they already know. So, I listen to that because many times, people know exactly what they should do. So, I use that as a springboard to grow on. If they don't know, basically, we talk about weight loss first, if they're overweight, because that can dramatically improve your diabetes status.  Then, we talk about as part of the weight loss, probably the biggest nutrient to decrease are all carbohydrates. So, it's the quantity we're trying to decrease more than just the type. That is secondary.

Melanie:  Okay, so let's talk about carbohydrates because carbs have gotten this name, this bad rap, but there are such good carbohydrates for us:  fruits and vegetables and certain types of good grains. So, what do you tell them are the sort of good ones that they're allowed to eat and the ones that they need to stay away from?

Anna:  So, the carbohydrates are good if we want to use that language, would be in the grain department. I would say the whole grain. But that is not a license to eat as much of the whole grain as you want. So, yes, brown rice is healthier than white rice and you can't eat more of it and that is what most people think. They say, "Oh, I eat whole wheat bread and I eat brown rice and I eat quinoa"--which is another healthy carbohydrate--and they think they can eat three cups. You cannot. So, that is a very important part of the prevention and the treatment is you need to keep your carbohydrates on the lower side, given our American standards now. Yes, whole grains would be the better ones. Whole fruit as opposed to juice is another way to express a better carbohydrate. When it comes to vegetables, most vegetables, I'm going to say the non-starchy ones are pretty low in carbohydrates so those can become kind of free. I tell people "Don't count your string beans and don't count your broccoli." People don't get overweight because they had too much broccoli.

Melanie:  Hear, hear! They certainly don't and a carrot or a tomato really never caused anyone to get diabetes, but it can be confusing when people do hear that word and, as you say, some things have more sugar in them than others. Certain fruits and of course, juices and smoothies and things like that.

Anna:  Yes.

Melanie:  So, how do they keep track as they're eating? Do you have them journal and then keep track of their blood glucose levels? What do you tell them to do?

Anna:  I do those two things, but I get really specific, if people are willing to allow me to get specific and I might recommend that your average female who has Type II Diabetes, you know, middle aged, and is a little bit overweight, I would recommend that she have 30-45 grams of carbohydrates per meal, and that's assuming three meals a day and that's it. So, I get really specific. So then, I'd show them a list of carbohydrates and the carbohydrate content of particular foods and the particular portions so they can kind of get things organized and count better. So, I have people count their carbohydrates.

Melanie:  And that is so important. Do proteins or fats play a role in diabetes management?

Anna:  Yes, they do and, for most people, if you have Type II Diabetes--and 90% of Type II diabetics are overweight--so you have to reduce that portion size, too. People aren't sure. They don't want to hear that, but it's the truth. We Americans eat a lot of protein, and that's another buzzword; everybody wants to eat more protein and well, not really. It depends who you are. Most of us need to decrease the portion of our steak and even our chicken breasts, because you can't eat 12 ounces of chicken and say you're necessarily being healthy. You’ve got too many calories.

Melanie:   What role do you tell them exercise plays in maintaining that blood glucose level?

Anna:  It is a very important role and it is very effective. Exercise can reduce your blood sugar almost immediately. Like, if you took your blood sugar before you went for a walk and then after you went for a walk, you would see it drop, as a general rule. So, it's very, very important. Activity--I don't even like to call it exercise because people's faces cringe. I just say movement, physical activity, and it can be a walk and you can break it up three times a day. In fact, there was a study that said that that was even more effective instead of doing 30 minutes in one stint, you could do 3 10-minute stints and even better.

Melanie:  I think, when you deal with people who have Type II diabetes, Anna, if you've had someone with Type I, they've been dealing with this for most of their life but when you get someone newly diagnosed, all of this seems to be more of a surprise or a shock. So, how do you get them ingrained into this to explain to them how really, truly important it is that they maintain this and manage it?

Anna:  Well, I do it slowly. You know, we try to make a few changes. We get the foundations, sort of the basic, educational stuff, and then we talk about "Okay. Well, what changes can you make? What will this mean for your daily routine, your daily food choices?" And so, we start small. You know, small changes lead to big changes. That's how I would approach that.

Melanie:  Can patients who take insulin to manage their diabetes become non-insulin dependent if they adopt these healthier habits or lose weight?

Anna:  If you're Type II, possible; Type I? No. Never.

Melanie:  No, but Type II.

Anna:  Yes. Yes.

Melanie:  It's possible to change the medications that you're on and/or become non-insulin dependent.

Anna:  Yes. Yes. There is some good and strong evidence to show that you can delay the onset of diabetes with diet and exercise. There are very, very good studies that have shown that and if you lose weight and you manage to eat less and you exercise, you could get your medication discontinued. We see that often.

Melanie:  Really? Really, that's great information. It gives people so much hope that if they adopt these healthier choices, that they can actually reverse the process of their disease. How does MIT Medical use the nutrition services there?

Anna:  Well, they're basically referred from their physicians but they can also just ask for a referral and they don't have to be sick to see me. So, you could have diabetes, or you could say "Oh, I want to prevent diabetes," and that's how they could use me.

Melanie:  So then, what about people who just want to use you to help lose weight? What do you tell them about getting that under control and starting a good, healthy--not necessarily diabetic--but a good healthy food choice lifestyle?

Anna:  What do I tell them? Well, it starts with an assessment. I don't have a canned procedure here but I try to make it specific to them. It's definitely going to revolve around fewer calories. This is how one is going to lose weight, so we need less calories. We think about, with the patient, how can they do that in the course of their day with their habits? Where do they eat? What do they order? What do they drink? So, we try to look at what they're doing now to make it realistic. Instead of sort of a canned thing like "eat less and move more" because it's hard to take that into your life. I try to get specific but it will mean, yes, you have to eat less and you need fewer calories. There's no magic bullet. There's no combination of foods that's going to burn your fat, despite what the internet tells us. There's no time of day that you're going to do this or do that. I wish there were, but there's not.

Melanie:  There certainly isn't. It can be so confusing. In just the last few minutes here, Anna--and it's great information--just wrap it up for us about the nutrition services at MIT Medical and what you really want people to know about healthy eating.

Anna:  Well, I want them to get the facts about healthy eating because I think there are way too many mystery things out there and advertisements on the internet and "good foods/bad foods". I really think they should get the facts and I think that they should hear it from a registered dietitian/nutritionist. I think we have a broad eye of what's out there, what the studies have shown, what works, what doesn't work. So, I would say that would be important.

Melanie:  Thank you so much for being with us again, Anna. It's just great to have you on. You're listening to Conversations with MIT Medical and for more information, you can go to medical.mit.edu. That's medical.mit.edu. This is Melanie Cole, thanks so much for listening.