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Diabetes: Managing Your Nutrition

Good nutrition is important for everyone, and it requires particular attention for those with diabetes. Samantha Lalush, Registered Dietitian, discusses how to manage diabetes with your dietary choices.
Diabetes: Managing Your Nutrition
Samantha Lalush, RD
Samantha Lalush, RD is a Registered Dietitian.

Prakash Chandran (Host): Good nutrition is an important part of any healthy lifestyle and it’s especially important when you have diabetes. Today, we’ll learn how nutrition can help you manage blood sugar throughout your lifetime. And we’ll be speaking with Samantha Lalush, a Registered Dietician at Sierra Vista Regional Medical Center.

This is Healthy Conversations, the podcast from Sierra Vista Regional Medical Center. I’m Prakash Chandran. Now Samantha, good nutrition can mean so many things to so many people. But what does it mean for someone that has diabetes?

Samantha Lalush, RD (Guest): Diabetes is a management of blood sugars and of the nutrition is one of the things that are very important given that we have to eat everyday and carbohydrates are the foods that when we eat them, they turn into blood sugar. Which is what we need to manage when we have diabetes.

Host: So, I’m going to ask a pretty basic question just because I don’t know all the details here. Are we saying we are managing like an excess of sugar? Because I’ve also heard that if you take in too little sugar that can be a problem as well.

Samantha: Yeah so, a lot of people focused just on sugar when they should actually be focusing on carbohydrates. Sugars are part of the carbohydrate umbrella, so it’s not just sugar we need to focus on; it’s just overall carbohydrate consumption. And to address your second point, there is now a whole movement of very low carb diets, keto diets being one of them which is kind of the other extreme and I think the jury is still out. Some people really like keto diets, for others, it’s too extreme. There’s not enough research on it either. So, there’s just a lot of misinformation in terms of nutrition and that’s where hopefully I can help, or any Registered Dietician out there can help.

Host: Okay, got it. So, I’m glad you made that clarification between sugars and carbohydrates because I believe if I’m correct me if I’m wrong, those carbohydrates I guess convert into glucose which the blood treats as that sugar. So, if you eat a lot of bread and pasta; that is essentially overloading your system with that glucose or an over sugar high, right?

Samantha: Exactly. So, when we eat carbohydrates, our body breaks them down as sugar and then your pancreas produces a hormone called insulin which is in charge of putting that sugar away for energy. It opens the door for that sugar to get into your cells so your cells can use it for energy. The problem is when somebody has diabetes, they are either insulin resistant or they are not making enough insulin so that sugar stays in your blood instead of going to your cells.

Host: I got it. And the differences between type 1 and type 2 diabetes is there a change in diet based on which one you have?

Samantha: So, with type 1 diabetes, your pancreas isn’t making any insulin. So, that’s where you need to inject insulin and it does help to limit carbs but it’s not because of lifestyle that you get type 1 diabetes. That’s more of an autoimmune disease. However, type 2 diabetes is more linked to lifestyle choices and lifestyle physical activity and diet.

So, it can be better controlled with diet. That’s one of the first things we talk about for new type 2 diabetes patients.

Host: Okay, and so let’s talk a little bit especially around type 2 as you mentioned; let’s talk about the foods that they should be eating regularly. What does good nutrition look like for someone with type 2 diabetes?

Samantha: I mean, it’s not about eliminating all carbohydrates from your diet. It’s choosing some carbohydrates that are better than others. So, you want to choose higher fiber carbohydrates like whole grains, so brown rice, oatmeal, quinoa, whole wheat bread versus their white counterpart just because they have more fiber and fiber can help with blood sugars as well as vegetables, always some proteins and a lot of people have the misconception that you can’t eat fruit when you have diabetes. It’s not that you can’t eat fruit, you just need to limit the amount of fruit you are eating.

Host: And are there certain like macro limits that you tell people to obey like you should try to stay under for example, 100 carbs a day? Are there any rules of thumbs that people can follow?

Samantha: It’s individual to be honest. It’s based on weightloss goals, level of physical activity. So, everybody is different. Also on how their blood sugars have been managed. I think a low carb diet is considered under 100 grams of carbs a day but it’s just everybody is different. So, like I said, I think it’s more individualized.

Host: Got it. Okay. And I’ve always also been curious about like the time of day that a diabetic should or shouldn’t eat. Can you talk a little bit about that?

Samantha: I think it’s just what works for you. I find that for some people that skip breakfast, they do end up eating larger portions later in the day or making not as good a choice on what to eat because they are so hungry. So, eating I would say at least the three meals a day is important. There is not enough evidence on how late you should eat at night from what I’ve read. But I don’t usually recommend eating too late because for most people, they’ll eat dinner, sit down and go to bed so they are not really using all that energy they are eating at night.

The other thing that I get asked a lot about is snacking. Should I snack, should I have more snacks? I think it depends if you’re not hungry, I don’t see the need to snack. But if it will prevent you from eating a bigger portion later; then maybe a snack is necessary.

Host: Got it. So, it’s really about that portion control and doing so at small increments throughout the day, wouldn’t you say?

Samantha: Yes, definitely.

Host: Okay. So one of the things that you mentioned earlier was the ketogenic diet and I can just imagine that someone potentially with type 2 diabetes that has been living a life or they have been takin in a lot of carbs all of the sudden hears about it, they see their friends and all the results they are getting and they want to go to this extreme version from the carbohydrates they were taking in to I mean effectively none. Like what do you say to those people and can that be dangerous?

Samantha: What I would tell patients, there’s a good side to keto and a not so good side to keto. I find that when patients come talk to me and tell me they are on a keto diet; what they struggle with the most is being able to sustain it. It doesn’t seem to be very sustainable because it’s so extreme. So, they’ll initially lose a lot of weight but then if they get off the keto diet, they gain all that weight back and sometimes more than what they originally started at.

However, on the flip side, I find that what keto is teaching people is to eat less carbs. I don’t necessarily agree with how extreme keto diet is. But I think overall, we do eat a lot of carbohydrates in general. So, those are kind of my two versions of keto.

Host: Well that’s because they are delicious. Right Samantha.

Samantha: I guess so.

Host: I think the key thing that you said there was is it sustainable. That sustainability part of it is important because like you said, they might lose a lot of weight initially but it’s something that it was a real tax that they put on their body and it’s not something that they are going to keep up for the rest of their life so they might just regress to their old ways. Is that something you see often?

Samantha: I do see that often and my other concern with keto is eating so much protein and so much fat. What is that doing for your cardiovascular health?

Host: Yeah, absolutely. So, as we wrap up here, is there anything that you wish more diabetic patients knew before they came to see you?

Samantha: I wish that they would all come to see a Registered Dietician either when they first get diagnosed or just because I find – I have seen many patients that have had diabetes for many years, and they have actually never spoken with a dietician before.

Host: Yeah, so it doesn’t sound like it’s something that a doctor might immediately prescribe. So, I think for all of us listening, we have to understand that if we are diagnosed or if we are at risk that diet is such an important part of what makes you, I guess more diabetic or kind of express more of these symptoms so it’s really important to see a Registered Dietician, right?

Samantha: Yes, and even for patients that are prediabetic; so that means your blood sugar is high but not high enough to be diagnosed with diabetes; and there’s so much that can be done with diet and exercise when you get the diagnosis of prediabetes. So, that’s another big one that a lot of people don’t talk about.

Host: All right Samantha, I really appreciate your time today. that’s Samantha Lalush, a Registered Dietician at Sierra Vista Regional Medical Center. Thanks for checking out this episode of Healthy Conversations. For a referral to Samantha Lalush, or another provider, call the Sierra Vista Regional Medical Center and Twin Cities Community Hospital physician referral line at 866-966-3580.

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