Category Archives: nutrition

Now I have Type 2 diabetes what am I supposed to eat?

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It comes as no surprise that one of the first questions someone newly diagnosed with type 2 diabetes asks is “What am I supposed to eat?”.

Let’s face it you’ve probably heard over and over again that type 2 diabetes is a ‘disease of lifestyle’. And lifestyle commonly involves food. When it comes to the food choices we make there is a lot of emotional charge attached to that. For some, it may be the way that they have eaten since they were children and this is the only way they know how to eat. Food is a connecting force between us.

So, a common answer someone diagnosed with type 2 diabetes may receive about what to eat from their healthcare provider may sound something along the lines of ‘eat healthy portion sizes, increase fruits and vegetables, cut down on processed foods’. And all these answers are great recommendations.

You’d think it seems pretty easy right to go out there and, ‘eat healthy portions, increase your fruits and vegetables, and cut down on processed foods’. But we know that’s not really what happens.

A lot of people struggle with food choices. Perhaps that’s why we have such a growing epidemic of borderline diabetes and type 2 diabetes.

Over the course of my 20 plus years as a physician, I have encountered some really strange interpretations of what a ‘healthy diabetic diet’ means to different people. Let’s face it, the amount of information out there on the internet does not help either.

So when I address the topic of what to eat with anyone diagnosed with type 2 diabetes I start by helping them to normalize their experience. Take a deep breath. This is not a punishment for what you have done wrong. And yes, you can make a choice starting today to do things differently.

My invitation is to consider that diabetes eating is healthy eating.

I intend to give a TED talk with that title because it’s something I passionately believe. If everyone diagnosed with type 2 diabetes looked at this as a way their body was inviting them to eat healthier we wouldn’t have people walking around feeling victimized.

The great news is that by making these changes to how you eat, it is possible to halt the progression of borderline diabetes, type 2 diabetes and worsening metabolic health.

Change can be stressful. So I often start by advising you take simple small steps.

This will help bypass the gargantuan alarm signals to your primitive brain- the amygdala which ends up keeping you from making any change smack in the middle of your comfort zone.

So back to the question -where do you start?

The Mediterranean diet

The Mediterranean diet is a great starting point when it comes to making some healthy changes to what you eat. The traditional mediterranean diet attracted interest because people who were living on the Greek Island of Crete had less heart disease.

What makes up the Mediterranean diet

  • whole grains
  • fruits and vegetables
  • extra virgin olive oil
  • modest amounts of poultry, red meat and fish
  • nuts
  • legumes (beans, peas etc)
  • red wine

The Mediterranean diet has been extensively researched. Over 50 studies have shown that by eating this way there is an improvement in overall metabolic health parameters- reduced waist circumference, improvement in lipid profile, blood pressure, weight and blood sugar levels.

Functional Nutrition

Perhaps you want to go a step further and you want to develop an empowered relationship to food.

Food can be used as a powerful tool, to bring about healing. In functional medicine, we call this functional nutrition.

There are several food plans used in functional medicine, each targeting different results.

The cardiometabolic food plan is a step above the Mediterranean diet.

Features of the cardiometabolic food plan

  • low glycemic foods
  • personalized targeted calories
  • helps to balance blood sugars
  • high in fiber
  • low amount of simple sugars
  • a healthy balance of quality fats

One of the exciting aspects of the THRIVE group coaching program, will be working with clients on creating a personalized cardiometabolic food plan designed to optimize their metabolic health.

If you would like more information about joining the program, please send an email to info@doctoreno.com.

Some proven benefits of the ketogenic diet, but is it right for everyone?

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I recall when I first started hearing the buzz around going “keto” “ketogenic” ketolife” I was very skeptical. With the roll of my eyes I dismissed it as a soon to be done fad that would blow over. But it didn’t.

After my community talks, I’d have a few people stop by and ask my thoughts on going “keto”. Again, my response would be I thought it was just another fad and would pass away. And oh by the way if you happened to be someone living with type 2 diabetes, this probably was not for you!

How wrong I was on both counts especially the latter.  

Well you know the saying “what you resist persists”?  Keto has persisted. And now it’s becoming mainstream.

The ketogenic diet was developed almost a 100 years ago- in the 1920s- by a faith healer who was trying to help children with epilepsy. There was some success with this diet intevention at the time. However, when drugs were developed for the treatment of epilepsy it fell out of favor.

How does the ketogenic diet work?

The ketogenic diet works by converting the body’s source of predominant fuel from carbohydrates to fats which are the source of ketone bodies predominantly beta hydroxybutyrate. This leads to an increase in the production of energy source -ATP.  

The ketogenic diet is now being used to treat a host of diseases and conditions. In the article below I list some of the benefits of a ketogenic diet.

Improved insulin resistance and reduced inflammation

By utilizing fats as a source of fuel versus carbohydrates there is less need for insulin. This leads to less insulin resistance. Insulin resistance is the hallmark of type 2 diabetes. There is research showing the benefits of a ketogenic diet to reverse pre-diabetes or type 2 diabetes. Insulin resistance is also associated with more inflammation because of an increase in free radical production. Inflammation is linked to a host of chronic diseases such as auto-immune diseases, arthritis, thyroid disease, bowel disorders, mental and cognitive decline (type 3 diabetes). Less insulin resistance=less inflammation, which allows the body to heal.

Improved Fat Burning leading to weight loss
By definition, being in a state of ketosis means you’re burning fat for energy. If you have excess body fat, you’ll be able to burn it at a much more efficient rate. This trend can lead to weight loss. The advantage of using fat as fuel, is that you do not have as much hunger cravings as when you are using carbohydrates as a main source of fuel.

Mood stabilizing effects
A ketogenic diet changes the energy matrix of the body. In the brain, a ketogenic diet helps to modulate mood by not only a reduction in inflammation but also changes in monoamine oxidase levels, GABA transmission, as well as mitochondrial biogenesis.

Improved Energy
Increased energy from a ketogenic lifestyle is due to a combination of factors including less inflammation, upregulation of mitochondrial biogenesis, more ATP per molecule of ketone and more stable blood sugar.

Improved Mitochondrial Biogenesis &Anti-aging
Our bodies are trained to use glucose (sugar) as a natural source of energy.  Our mitochondria are the energy powerhouse of our bodies. With aging, we tend to have less efficient mitochondria. The ketogenic diet helps to stimulate new and stronger mitochondria. Because mitochondria have such a profound impact on energy production, inflammation levels and gene expression (and therefore an overall function of the body), promoting mitochondrial health can be of great benefit when it comes to anti-aging.

How do you know you’re in ketosis?

There are a number of kits on the market which can help you to detect when you are in ketosis. Kits that measure blood levels are more accurate than urine test strips.

How do you know if keto is right for you?

Despite it’s popularity a ketogenic diet may not be safe for everyone. Despite a plethora of websites offering do it yourself keto plans and diets, I highly recommend that you invest in working closely with a qualified healthcare professional who is well versed on what to look out for if you have any of the following conditions:

  • Type 2 diabetes
  • Very high blood triglycerides
  • Severe depression
  • Older adults
  • Cancer
  • Cognitive decline such as alzheimer’s type dementia
  • Certain gene snps such as ApoE4

The next thing to consider is – how long do you need to be on a ketogenic diet?

The reality is that maintaining ketosis for prolonged periods of time can be a challenge for most.

In summary, a ketogenic diet can be a useful tool for helping to improve metabolic health. Be sure to use it under the supervision of a qualified healthcare practitioner who will be able to customize it to your unique goals as well as determine a safe duration of therapy.

To your health and wellbeing,

Scientific citations

A low carbohydrate ,ketogenic diet to treat type 2 diabetes

Veech RL. The therapeutic implications of ketone bodies: the effects of ketone bodies in pathological conditions: ketosis, ketogenic diet, redox states, insulin resistance, and mitochondrial metabolism.

Peer-reviewed papers from Virta health on ketogenic diet and type 2 diabetes reversal

How fiber can help reach healthy blood sugar levels in type 2 diabetes

type 2 diabetesA friend of mine was recently sharing me how frustrated her husband was with his blood sugar levels. They seemed to fluctuate widely from high blood sugar levels to low blood sugar levels. He did not know how to react to this and had decided that he was not going to take his medications any longer. Naturally she was at her wits end when she reached out to me. How could she convince her husband that stopping his medications was not the way to deal with fluctuating blood sugars?

Fluctuating blood sugars are not unusual in type 2 diabetes. Whether you are a woman living with diabetes or you know someone living with diabetes, this can be very frustrating .

Let me start by normalizing this for you. You are not alone. There are many reasons why the blood sugars fluctuate. I will cover this topic in more detail in an upcoming article.  In addition to scheduling an appointment to see your healthcare provider, you may also need to make sensible lifestyle changes- to your diet and exercise regimen.

One of the ways things to tweak in diet to increase the amount of fiber. Fiber is a form of carbohydrate. Contrary to popular belief, not all carbohydrates are bad for you!

There are two kinds of fiber-soluble fiber and insoluble fiber. Insoluble fiber does not get absorbed from the intestinal tract. This kind of fiber helps to reduce constipation. Soluble fiber has many proven benefits. Soluble fiber gets absorbed into the bloodstream and so can help regulate blood sugars. It also helps to control cholesterol levels.

Soluble fiber can help to reduce the risk of stroke and heart disease by up to 50%. This is especially important for someone living with type 2 diabetes, where the risk of stroke and heart attacks is increased.

Another benefit of soluble fiber is that it help reduce hunger by maintaining a sense of fullness. This can be useful in weight management. When you feel full you tend to eat less. 

Research has proven that simply losing 10% of your body weight helps to prevent borderline diabetes from becoming full blown type 2 diabetes. Some examples of soluble fiber include psyllium, pectin and wheat dextrin and oat products.

So exactly how much fiber is enough?

 Women should eat about 25 g of fiber and men up to 38 g of fiber a day. With the ‘standard American diet’ we consume an average of 17 g fiber per day.   A study in the New England Journal of Medicine found that by increasing daily fiber up to 50 g, a person living with diabetes was able to achieve healthier blood sugar and cholesterol control.

Some ways that you can start to increase your fiber intake? 

 I usually recommend gradually increasing fiber in your diet. Remember this is a long-term change you are making to your lifestyle.  If you rapidly increase fiber, it may cause gas and abdominal bloating. Too much fiber could also cause constipation if you do not drink enough water.

 So here are some suggestions on ways to increase your fiber intake: 

  1. Create a list of fiber rich foods.  You can do research this online. Click on this link to research a variety of food sources that have high fiber content.
  2. Try experimenting with some new sources of fiber every day.
  3. Gradually increase your fiber intake by 5 g per day until you reach the goal.
  4. As you increase fiber intake also make sure to increase your water intake to reduce bloating and constipation.

Remember to be kind and patient with yourself. There is no quick fix to diabetes. Your goal is to achieve healthy blood sugars so that you reduce the complications associated with diabetes. Increasing the amount of fiber in your diet can be one of your most powerful tools in achieving healthy blood sugars. So start today to take simple small steps each and every day and don’t give up.

To your health and wellbeing,

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