Integrative approach to DM2

As a family medicine PA, a lot of my job is discussing and managing chronic disease. Diabetes is a big one!

When I first started working, I was pretty adamant about counseling surrounding refined carbohydrates (eye roll). Now that I have a few years of experience under my belt, I would say the majority of my counseling is brainstorming what gets in the way of making healthful choices – ie stress, work, grief, anxiety, depression, poor sleep, child care to name just a few.

From a nutrition counseling standpoint, I typically ask about access to nutrient dense foods, take a 24 hour nutrition recall, inquire about adding sugar to beverages.

I’ll also aim to remove any guilt or shame from a diagnosis. There are SO many different factors that influence health and health behaviors beyond individual decisions. Policy making, genetics/family history and other predisposing factors, access to medical care, access to nutrient dense foods and/or transportation, environment, social circumstances are all incredibly important factors.

I will spend some time discussing the diagnosis of diabetes, usually noting elevated blood glucose as a result of the body not using insulin efficiently. This is typically measured using an A1c value or fasting blood glucose on a few separate occasions.

I also like to discuss the difference between carbohydrates and aim to avoid the demonization of carbohydrates. Carbohydrates are in no way “bad”! They’re actually an incredibly important source of fuel for your body.

  • Complex carbohydrates are long, complex chains. They take longer to break down and digest and allows for more gradual energy release. They are often found in whole grains and are a great source of fiber. Examples include: brown rice, quinoa, oats, oatmeal, wild rice, buckwheat, spelt, and some fruits/vegetables.
  • Simple carbohydrates are made up of shorter chains and digested quickly. They’re found in fruit, dairy, and some vegetables.
    • Refined carbohydrates are also simple carbohydrates – though those that are stripped of their fibers. This means when consumed on an empty stomach they cause big spikes in blood glucose followed by sharp declines. Examples include: added sugars in juice/soda, crackers, cookies, and other processed snack foods.
I always like to emphasize that no food is ever off limits. Noting a food as inherently “bad” often leads to a pattern of restriction and binging. Instead, all foods are okay and healthy. We aren’t robots and food is much more than simply input and output. Instead, it’s sustenance, nourishment, emotion, culture, community, joy, and so much more! And speaking of shame, sometimes medications are necessary to act as a bridge, or necessary for much longer term. Each individual person is different and has different healthcare needs!
Including my general recommendations for diabetes lifestyle care below.
General recommendations: 

NUTRITION:

  • Eat a well balanced meal at regular increments throughout the day. Try eating at similar times every day and avoid skipping meals.
  • Eat LOTS of non-starchy vegetables (cauliflower, broccoli, onions, zucchini, tomatoes, kale, spinach, lettuce, for example)
  • Aim to consume ample omega-3 fatty acids (salmon, avocado, nuts, seeds), and moderate amounts of protein at every meal.
  • Be mindful of the amounts of sugar, processed/fast foods, trans fats, and refined carbohydrates. This includes sugary beverages and adding sugars to items.
  • When choosing carbohydrates, aim for ones that have high fiber (sweet potatoes, brown rice, oats, beans, lentilsetc) rather than refined carbohydrates (white rice, bread, pasta, pizza, crackers, cookies)
  • Pair carbohydrates with sources of fiber, healthy fats and/or protein. This will help stabilize your blood sugar and prevent drastic spikes in blood glucose. This means eating vegetables and proteins before or with carbohydrates.
  • Another useful hack is consuming foods with vinegar prior to a carbohydrate dense meals. Trying adding a few tsp of apple cider vinegar to water or consume a salad/vegetables with vinaigrette prior to carbohydrates.
  • Think about gut health! The microbiome is extremely important for managing chronic disease.
  • Apply mindful eating at each meal, eating slowly and paying attention to hunger cues. More on mindful eating here.
  • Notice how you’re body FEELS after a meal. This will help determine which foods and combination of foods work best for you!

 

LIFESTYLE:

  • Focus on getting enough restful sleep, ~7-9 hours per night.
  • Do something every day that brings you joy! This will help manage stress, which has a profound impact on blood sugar. Stress is a major component to diabetes care. Check out my favorite ways to unwind here.
  • Move your body in a way you find enjoyable 3-5 times per week.
  • Try to go for a walk a few times throughout the day. Walking for 20 minutes after meals can help prevent spikes in blood sugar after eating.
  • Ask friends, family, peers, colleagues or your healthcare team for support!

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