Diabetes is a tough disease to manage. In this episode, APU’s Dr. Bjorn Mercer talks to Dr. Jameelah Powell about the kinds of changes that can help individuals with diabetes function well.
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Dr. Bjorn Mercer: Hello, my name is Dr. Bjorn Mercer, and today we’re talking to Dr. Jameelah Powell Faculty in the School of Health Sciences. And our conversation today is about diabetic lifestyle changes. Welcome Jameelah.
Dr. Jameelah Powell: Hello and thank you for having me.
Dr. Bjorn Mercer: Of course, love having you on the podcast. So great topic, different ways in which we can hopefully impact diabetes if we happen to have it. And so, let’s start with the first way, which is how can we change our food and alcohol consumption?
Dr. Jameelah Powell: Well, food is going to be one of your biggest, I think modifiers when it comes to changing your lifestyles. I think it has the most effect and it’s something that you can control really easily. But I think with diabetics, the best thing that they can do is plan ahead. I think everybody needs to be mindful about what they’re putting in their bodies, but I think diabetics need to be especially mindful because there are certain ingredients that they should be on the lookout, sugar being the main one or glucose. And since almost everything we eat has glucose in it, you have to be mindful about how much of that you’re putting into your body.
So, what I always recommend for people is it doesn’t have to change your lifestyle so much, it just means you have to keep it in mind. You have to in the back of your mind know what am I going to be eating? Where am I going? What does my day look like? So, it’s something you should really be planning when you get up in the morning. You’re always going to have more of a challenge if you don’t have a snack with you or you don’t have your lunch, or you didn’t think about what you’re going to eat today because then you’re going to be in a bind. Your body’s going to say, I’m hungry and I need food now. And then you’re going to end up getting something that you probably, it’s probably not the best for you as I think most people do. I know sometimes when I don’t bring my snacks or if I don’t have trail mix in the car, I may end up in a drive-through getting fries and it’s not the best option for me. So, I think the first thing is to plan.
Dr. Bjorn Mercer: No and that’s absolutely wonderful. Food is one of those things where you do, you have to plan your intake. It sounds funny, but you really do. And when you are on the go, anything that you could typically buy that’s fast will be say, not always high calorie, but high fat, high salt. That’s why they’re so good. And those are the things that will obviously with a lot of sugar, and those are the things that will potentially spike your numbers or cause inflammatory with too much salt or whatever. What should you do with alcohol? Should you just cut it out completely or is it moderation?
Dr. Jameelah Powell: So, with all of these things, you should always be in communication with your doctor because I think it’s going to be different and unique for everybody. Just like eating food, sometimes things we can tolerate better than others. For alcohol, it’s going to lower your glucose, which is not a bad thing. However, if you aren’t eating and you just say exercise before that, it’s really going to make you tank in your glucose numbers. So, it’s not great. And what I think people really should be mindful of is that you can drink in moderation if you have diabetes, if it’s under control. And that’s the keyword, if you are not in control, if you’re not eating correctly, if you’re, let’s say skipping your medication or if you are not doing moderate exercise, then your levels, your glucose levels are going to be all over the place and there is no option for you with alcohol. But if you’re in control, your numbers look good, you’ve been maintaining good glucose levels, then I think alcohol is okay to have. And moderate is usually, I would say for somebody with diabetes, I would probably say maybe three a week, maybe three servings a week, which I think the norm for moderate drinking is one glass of wine or beer a day. That’s considered moderate for people without diabetes. So, if you do have diabetes, I would probably say maybe closer to three times a week.
Dr. Bjorn Mercer: And that totally makes sense. And when it comes to food, it really makes me think of people need to be mindful, man, honestly, we all need a dietician, we all need a nutritionist. We all need somebody to teach us about food. I think of my wife and I in our journey of understanding food and we didn’t really understand what kind of nutrition food has until well into adulthood and it seems so silly. These are things we should learn in our teenage years, what we put in, what’s the most nutritious eating, high nutrient rich foods as little salt as possible, but you need a little salt, the right fats, you need fats but not the wrong fat. All these different things that people get confused with. And just making food yourself. When you buy frozen food, not that it’s all bad, but it’s frozen for a while, or if you buy stuff that lasts in a bag for two years, there’s a reason why it lasts in a bag for two years. It’s not the best for your body.
Dr. Jameelah Powell: I think what you’re saying is really important because eating is actually complicated now. It’s not as simple because there’s so many options and I want to say there’s so many rules and it’s not one size fits all. So, I’ve been talking to people about diets that are anti-inflammatory. So, if you have issues with arthritis, your diet may look very different than if you have issues, let’s say with seizures or something like that. You may be looking at a diet that’s higher in fat. If you’re a diabetic, you’re looking for a diet that’s lower in carbs and lower in sugar. So, it’s really talking to your doctor and looking at what’s right for you because I can say for diabetics, it’s good to eat things that have complex carbs and not to eat things that have a lot of sugar in them. I may think drinking a glass of orange juice is good. You may see that and say that’s part of a healthy breakfast, but it’s not. It’s basically drinking sugar through a straw even though it comes from a fruit. So, it can be overwhelming. Even as a nurse, I feel like I don’t think there’s nothing I can eat. What can I actually eat?
Dr. Bjorn Mercer: And orange juice is one of those things, and not to get into marketing, but man, orange juice, they’ve done a good job of the marketing like, you should have orange juice or even milk. Typically, as adults we don’t need milk. We don’t need milk from cows, honestly. And yet somehow that message is still out there that we need some sort of milk, especially for kids. But this leads us to the next one is for how to hopefully manage diabetes better. How does exercise play a role in that?
Dr. Jameelah Powell: So, exercise is good for everybody, obviously what they recommend just in general, and this is including diabetics as well, you should be exercising at least 30 minutes a day. And really it’s most days. So, I would say at least five out of seven days you should be doing at least 30 minutes a day. But that’s just to keep your heart active. That doesn’t necessarily mean vigorous exercise where you could be on a treadmill or taking a hike or walking outside. 30 minutes could be you cleaning your house every day, that literally is 30 minutes of exercise. But I think with diabetes you want to do something a little bit more. So, I would say real physical activity, maybe at least three times a week. And exercise helps to reduce your glucose levels. So, it’s good because what it does is stable you out. It evens you out a little bit more.
And this is why all of those things work together, like eating correctly and then also making sure that you are physically active. All of that works to keep your levels down. So, there isn’t a lot of spiking. Something that I’m seeing in the schools, I work in the schools, and I’m seeing a lot more diabetics in the schools, younger and younger. I have a five-year-old now in the schools and she’s a diabetic and her levels are all over the place. I have a 13-year-old in middle school and her numbers are all over the place. And it’s scary because they’re so young, it’s harder to manage them because they don’t really have a good understanding of what eating right is and what’s exercise. This little five-year-old plays literally all the time. So, her sugars sometimes are hard to predict.
Dr. Bjorn Mercer: Yeah, no, that would be very difficult. Even just thinking about meals at schools, unfortunately they’re not the best. Again, and we’ve talked about this before, I’ve said it in our podcast, we live in a food forest, there’s more food than humans have ever had ever. And yet unfortunately so many people are unhealthy because food is so complex, just like you said. That leads us to the next one is how does stress management help with diabetes?
Dr. Jameelah Powell: So, stress is a good one. Stress and illness actually go hand in hand, so I’m going to talk about both of them a little bit. Stress actually raises our blood glucose in addition to a lot of our vital signs. When you are under stress, your heart rate goes up, your blood pressure goes up, stress is what they call a silent killer because there are things happening inside your body that you’re not aware of, but those mechanisms are actually destroying tissue, causing inflammation and things like that. So, I think when you have diabetes, you absolutely need to have ways to de-stress, to self-care. So, I would say one of the important things is to find a way either to meditate or to find a space to just be you, to be silent, to be quiet for a minute, to just sort of process things. Because if you’re going through the day in a consistent manner where you’re just moving and you’re not really taking time to breathe or taking time to relax, you really are… You can destroy your blood vessels on the inside, which makes that much worse if you have diabetes, much more challenging to control things like your blood glucose, but also things like heart disease, things like your cholesterol, all of that ties into diabetes.
Diabetes tends to go hand in hand with lots of other chronic diseases. So, it’s important that you manage it so that you don’t get affected by these other ailments or diseases that go along with it.
So, what I would suggest, exercise is one way to de-stress, which we just talked about. Even 30 minutes a day outside in your garden or mowing the lawn or trimming the trees, anything like that is considered exercise. Just take a walk. I say for people after dinner, just take a walk, a nice walk in the cool air helps digestion, it helps get the blood flowing and it helps your heart stay healthy. So, for stress, I always tell people it’s good if you can meditate, even if you’re doing two minutes a day, just time to process things. But exercise is one of the best de-stressors and it doesn’t have to be something crazy. I know people who are running marathons on their treadmill every day and that’s, it’s not necessary. I don’t care if you’re walking two miles an hour, one mile an hour, just walk, just get your body going. But stressing really does create a physiologic response in your body that is so unhealthy for everyone.
Dr. Bjorn Mercer: I completely agree. And it’s one of those things with stress where again, like where we live in the food forest, and as humans we’ve got more food than we ever have, but we also have stress. Even though we’re not being attacked by enemies, there’s so much stress in our lives about maintaining our jobs and our families and just there’s always things quote “attacking us”. And so, finding those really good habits and exercise of course, is one of the best. But hobbies, if you do art, if you do some sort of crafting, if you do music, all those things that allow you to slow the world down, to focus in your brain and to be with your own thoughts. Because if we run, run, run, run, run all day long, our mind is just zooming and that can create stress. And we have to be able to slow down. And so, by slowing down, you’re actually being productive because you’re refreshing your brain. It’s like when you clear a computer’s cache and cookies, you’re refreshing it. And by slowing down you’re helping your own body.
And so, the next thing we were going to talk about is medication. But you wanted to say something about stress reduction, correct?
Dr. Jameelah Powell: Yes. I thought that where you were going in that discussion about slowing the mind and just slowing down was right on target because that’s what I was thinking. Just slowing down. Sometimes we’re so busy that sometimes we aren’t paying attention to our bodies. And you mentioned hobbies and there are lots of things people can do that I think to just slow things down. Picking up an instrument or a coloring book. Sometimes I will, I have an adult coloring book, doesn’t really matter, that sometimes I just doodle in. Puzzles are a great way to concentrate on something else other than the busy world around you. Sometimes I even say listening to a podcast like this one, it’s good because it, you’re using a different sense. I think sometimes we need to really slow down, like you said, and really just focus on inside instead of the outside world.
Dr. Bjorn Mercer: I completely agree and we should honestly have a podcast about stress reduction and meditation because more people should meditate and that there’s a wide variety of different types of meditations out there. But to slow down and let your brain breathe and to let it calm down and to constantly not feel like it’s rushing and working and trying to be productive is actually a very important part of just existing and having a healthy life.
And so, the last part we want to talk about is medication. So, we talked about food and alcohol, exercise, stress management, things that we can do ourselves, but if we’re not able to truly get diabetes under control, the next thing of course is medication.
Dr. Jameelah Powell: I think medication is probably one of the other factors that’s important with diabetes management. If everything else is not working I think generally what health professionals like to do is start with diet and exercise. And usually that works pretty well to manage diabetes if you can get your weight down, if you can start eating the right things, all of those things. And I know personally of lots of people who have gotten off medication or who have decreased their A1C numbers. And I think that that’s important to remember. You don’t have to stay on medication. However, if medication is needed, then one of the most important things is insulin. And what I will say about insulin is you really do need to, in addition to being proactive, like I said about your diet, you have to be proactive about your insulin because insulin basically immediately decreases your glucose levels.
And so, you need to be mindful of are you about to exercise? Because exercise decreases your glucose levels. You need to be mindful of are you not going to be eating for a while because that means you won’t have any glucose. So, there are certain times that you should be giving yourself this insulin, but it all needs to work hand in hand with your day and your life and your lifestyle. So, if you know that Mondays, Wednesdays, and Fridays you exercise at the gym and you’re on that treadmill or you’re pumping iron for an hour, then you need to be mindful, what does that look like for me? Does that mean I need to dial back my insulin? Does that mean I need to eat an extra energy bar before I work out so that my levels are controlled? So, what I would tell people usually is if you have a set lifestyle that you’re exercising and you’re eating a certain way, make sure you’re checking in with your doctor. You can actually create a regimen of insulin therapy because for some people their body responds to insulin a little bit more quickly than others. So, it’s important.
With my students, I notice that if she’s going to go play PE, then I need to be mindful that her glucose is going to drop. So, she needs to eat a little bit more. So, if she’s not going to eat her entire lunch, I may say, well, okay, eat another apple for me before you go out and play. So, things like that, you have to be aware that medication is really going to decrease your glucose. And it’s going to work much faster. So, it’s immediate.
Dr. Bjorn Mercer: And that’s great because medication shouldn’t be the first thing you do. Not that it should be the last thing, but all the food, the exercise, the stress should all be worked on. And then medication is part of a healthcare plan. But I think as with many things, it shouldn’t always be the first thing that people go to as you consult with your doctor.
Dr. Jameelah Powell: Absolutely. I think those things that we’ve mentioned, those are things that you can do on your own, you can modify those, you can change those, you can manage those on your own. And I would say the majority of the times it is very helpful, and you actually don’t have to start medication, but you do have to be committed to that process. I know people that are like, “I’m not going to do that. I’m not just giving the medication”, which is fine, but I will say even when you’re on medication, you still have to modify some of those lifestyle changes even with the medication because insulin is a pretty dangerous substance. It’s not something that you can just use anytime you… It has to be controlled. It has to be managed properly because you can injure yourself if you give yourself too much or if you give yourself too little. So, it still is important to not completely just rely on the medication you need to take into count everything that’s happening.
Dr. Bjorn Mercer: Excellent and absolutely wonderful conversation today. Any final words?
Dr. Jameelah Powell: I would say just eat right, whatever that means for you, because I know that’s a very generic statement, but I honestly tell people, as you said, dietician is probably the best bet. Talk to your dietician, find out what your other chronic issues are. Cause you may also have issues with high blood pressure, in which case there are some things you just need to stay away, period. If you have arthritis, there may be a certain diet for you. So, you want to make sure that you are eating foods that are right for you, not just because you have diabetes, but also you as a person and what your body looks like on the inside. So, I would recommend probably seeing a dietician first, like you said.
Dr. Bjorn Mercer: Excellent, absolutely wonderful conversation today. And today we are speaking with Dr. Jameelah Powell about the diabetic lifestyle changes. And of course, my name is Dr. Bjorn Mercer. And thank you for listening.