Q&A with Dietitian Emily

Dr Jedha, Host 

Hello and welcome back to episode 34 and another Q&A session where we cover questions submitted by you, which is always so fun, and joining me for today’s Q&A is Emily. Welcome back, Emily.

Emily, DMP Dietitian, Guest 01:13

Thanks for having me join you today for another interesting exploration of our listeners’ questions.

Dr Jedha, Host 01:19

Yes, I can’t wait, and we’ve got some really meaty topics to dig into today, as usual, of course, but it’s been a while since we heard from you, Emily, about the Farm to School Project and, if you’re new to the podcast, aside from working with DMP, Emily currently works as a dietitian nutritionist for K-12 schools and back in episode 10, we talked about how she got awarded 95K in grant funding to improve the school meal program to help our kids eat better, and Emily’s been implementing such an awesome program where the kids get access to more farm to school meals through a variety of taste tests, and I believe there was a salad bar going to be implemented, and all of this is to help the kids develop an appreciation for healthy food. So I thought, Emily, I just wanted to ask, because I haven’t heard about it how is the program going?

Emily, DMP Dietitian, Guest 02:15

Well, first let me just say it’s been so much fun and such an honor to be working with this grant. We did launch our salad bar, so you have a good memory. We launched that at our middle and high school back in January of 2024, and the students absolutely loved this new meal choice. We were able to rotate the different salad toppings and the students enjoyed being able to personalize their meal choice. Through this grant, we’ve also been able to provide more nutrition education in the classroom which, as you know, is so important for teaching those lifelong healthy habits and helping to decrease risk of chronic disease down the road.

Dr Jedha, Host 02:55

Wow, that’s so exciting. So they’ve basically been able to go over to the salad bar, make their own salads and personalize their meal. That must be so much fun for them.

Emily, DMP Dietitian, Guest 03:10

It is, and I never I really didn’t imagine it would be as popular as it was. But both our middle school students so our sixth, seventh and eighth graders and our high school students a little bit older, they love it. We have staff coming down and they’re even picking the salad over some of their unhealthy favorites, but it just shows that they love being able to customize it and that kids are looking for more healthy options.

Dr Jedha, Host 03:29

Yeah, and just having that access to it to be able to try those things is really what this program’s all about, Because if they didn’t have access to that, they wouldn’t get these experiences to know that, hey, yeah, those healthy foods are just so yummy.

Emily, DMP Dietitian, Guest 03:50

And it’s to that point we’ve had the opportunity to put some local food on the salad bar. So for one week when spinach was growing in our part of the country, we were able to put local spinach as a salad topping. We have local radishes. So just another awesome part of the grant and the salad bar is that we’re able to use seasonal items and things that are really fresh and really nutrient rich because they’re coming from right here in our area of the country.

Dr Jedha, Host 04:12

That’s so good, and also having that nutrition education in the classroom just to solidify what they’re seeing as well, would be an awesome addition.

Emily, DMP Dietitian, Guest 04:22

Yeah, it’s such an important part of their day. I mean, there’s so much we want to teach our students in math and reading and writing, but nutrition education really should be up there in the conversation, because if we don’t, we’re going to have a really unhealthy future generation. So I’d like to think that we’re making our small impact on having a healthier future.

Dr Jedha, Host 04:43

Definitely, really, nutrition. It should be a core curriculum item in every school, shouldn’t it?

Emily, DMP Dietitian, Guest 04:49

Absolutely. We’ll get there. Slowly but surely. We’re doing our part in our school district, so I’m proud of that.

Dr Jedha, Host 04:55

Yeah, awesome, such an important program for our kids. So thanks for sharing an update on that, Emily. It’s really great. And before we get started, just a reminder to everyone listening that there will be more Q&A sessions in future. So if you have a question you want answered, you can send us a voice message or email at Type2DiabetesTalk.com. Okay, let’s dig into the first question. I’ve got a question from Lisa coming out first and she asked I am suffering with a foot ulcer, will the T2Diet program help me heal faster?

Emily, DMP Dietitian, Guest 05:37

Well, Lisa, the T2Diet program, with its focus on quality nutrition to regulate blood sugar, could definitely play a supportive role in your healing journey, because it is so effective in supporting people to get their blood sugar levels stable, and that’s key. High blood sugar levels can impair the body’s ability to heal and increase the risk of infection, which is definitely something you want to avoid. With a foot ulcer, and also, with a quality nutrition plan, this can help in reducing inflammation in the body. Plus, by focusing on nutrient-dense foods within your carb limit, you can provide your body with the vitamins, minerals and other nutrients it needs to support the healing process. Do you want to add anything to that, Jedha?

Dr Jedha, Host 06:24

All of what you said is true and great and, yes, definitely the program can help with improving your overall health and healing faster too, and I just want to point out that it’s important to remember that, while your diet plays a crucial role in managing diabetes and supporting wound healing, the care of a foot ulcer, it is a serious issue that involves a comprehensive approach and that should also involve others in your healthcare team, like your doctor and your podiatrist, for example.

Emily, DMP Dietitian, Guest 06:55

Yes, and thank you for that important reminder. Foot ulcers are definitely something that needs to be taken seriously, and the best thing that our listeners can do is always strive to keep their blood sugar levels in a healthy range, but if something does come up with your feet, go to your doctor and get medical advice right away. All right, our next question is from Betty. She asked I’m having a terrible time understanding fats and foods saturated, animal-derived, polyunsaturated, etc. Sometimes the label lists saturated fats without listing the other types, and the total fats exceed the saturated fats. For example, the saturated fats might be two and a half grams, fats are nine grams. What is the breakdown of those other fats? I’m totally confused.

Dr Jedha, Host 07:46

Betty, you’re definitely not alone in feeling a bit bewildered by the world of fats in foods and also with food labels. So the subject of fats is a topic that can get pretty complex, but it’s pretty simple as well, especially when it comes to labels. So let’s just break it down together. When you look at a food label and you see different types of fats listed, you’re essentially looking at the building blocks of the food’s fat content, and fats in our diet come in several main types saturated and unsaturated, which includes both polyunsaturated and monounsaturated fats, and then there’s trans fats. So when you mentioned seeing a label earlier with saturated fats 2.5 grams and total fats 9 grams, you’re observing that the food contains 2.5 grams of saturated fats out of the total 9 grams of fats. So the difference in this case 6.5 grams, would be made up of unsaturated fats, which could be either polyunsaturated or monounsaturated fats. So saturated fats on food labels are a requirement, but unsaturated fats aren’t.

09:05

Betty, I hope this clears up some confusion around fats on food labels and don’t hesitate to reach out if you have more questions. All right, we’ve got a question from Riaz up next Emily, who asked I take metformin 1000 milligrams twice a day and insulin, 15 in the morning and 15 before dinner every day, and still my postprandial is 175. Please advise me.

Emily, DMP Dietitian, Guest 09:35

Riaz, thanks for sharing your current treatment and your concerns about your postprandial blood sugar levels. Here are a few things that you can consider. First, I’d recommend that you review your diet and nutrition, because what you eat has a direct impact on your blood sugar levels. So working to refine your diet to better support blood sugar control could be one important key for you here. It could also be beneficial to review your current medication with your doctor. Sometimes a slight adjustment in the dosage or even the timing of the insulin or exploring other medication options can make a significant difference in managing blood sugar levels.

Dr Jedha, Host 10:18

I agree. You just really have to keep troubleshooting Riaz, and probably get more proactive too. So the first thing I would do as well as Emily said is review your diet and nutrition, because what you eat has a direct impact on your blood sugar levels, and also improving your nutrition can help reduce or minimize medications as well, and sometimes I find something as simple as keeping a food diary really helps. You know nothing fancy, just a piece of paper to write things down, because often we might be eating more of one thing than we realize, and it’s not until we see it on paper that we can really identify patterns or habits.

Emily, DMP Dietitian, Guest 11:01

I agree, and I even like, when you’re writing your food in a food journal, to also note when you’re checking your blood sugar, because then that can make it really clear to look back. You might not realize it in a day, but when you look back after the course of three or four days in a row and you see high readings after certain times, that can really help you troubleshoot. Or if you bring that information to the doctor, that can help them troubleshoot as well. So food diaries are great and including your blood sugar can be helpful as well.

Dr Jedha, Host 11:31

Yeah, really great point. It’s just getting that stuff on paper. It is just so hard to identify the patterns or the habits or anything that might be occurring. So when you get it on paper it just makes everything much clearer.

Emily, DMP Dietitian, Guest 11:46

So true. Let’s move on to our next question, which is from Wilhelmina. And Wilhelmina says my struggle is peripheral neuropathy. Is there anything that can help?

Dr Jedha, Host 11:57

Really good question, Wilhelmina, and there are certainly things that can help. Obviously, there are medications you can take, so please speak to your doctor about that, but let’s go over some natural treatment options. So, with any diabetic complication, it’s very important to focus on managing blood sugar levels effectively, so getting your blood sugar in a healthy range is key to preventing further nerve damage and potentially easing symptoms. Your diet and nutrition are a primary treatment strategy for getting and keeping your blood sugar levels on track and for decreasing inflammation, so being more proactive with your nutrition is a great thing to prioritize at all times. We also talk about regular exercise and in the case of peripheral neuropathy, that can also help along with physical therapy, and some people find relief through things like acupuncture, massage or mindfulness meditation. And then there are therapeutic supplements that have been found to support nerve health as well, and they may help to ease neuropathy symptoms. So things like B vitamins, particularly B12, B6, and folate, are crucial for nerve health and may be beneficial.

Emily, DMP Dietitian, Guest 13:18

And I just want to add one thing here, Jedha, talking about those B vitamins If you’re taking metformin, please be aware that B12 deficiencies can occur, so neuropathy can be a result of that deficiency. Or, if you have a deficiency, it can make symptoms worse. And for anyone with peripheral neuropathy, your doctor should be testing for B12 deficiency, because deficiency in B12 can cause or worsen peripheral neuropathy.

Dr Jedha, Host 13:48

Exactly. That’s a very important point, Emily, so thanks for noting that. So one of the best therapeutics I’ve come across for peripheral neuropathy, with quite a bit of research for effectiveness, is alpha lipoic acid, otherwise known as ALA. An ALA is a powerful antioxidant compound and multiple studies have reported significant reductions in pain and improvements in burning, numbness, tingling and itching, and over the years I’ve found it’s really helped people a lot tingling and itching and over the years I’ve found it’s really helped people a lot. For treatment of diabetic neuropathy, research tells us a dosage of 600 milligrams, taken as one dose, or up to 800 milligrams in divided doses, is the best dose for effectiveness. Higher dosages can sometimes be used, but these are usually prescribed by your doctor, so you could speak to your doctor about that, and you can also have intravenous ALA, which is reported in studies to be very effective. But just remember, before introducing any supplement it’s always a good idea to consult your doctor just to make sure you have no contraindications with other medications. 

Announcement 15:01

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Dr Jedha, Host 15:36

So we’ve got a question from Madhu, who asked I have muscle pain, especially in my legs. Could it be because of the diabetes?

Emily, DMP Dietitian, Guest 15:44

Great question, Madhu, and I’m sorry to hear that you’re experiencing muscle cramps. I know those can be extremely painful in some cases. But, to answer your question, yes, muscle pain in the legs can be due to your diabetes. Yes, muscle pain in the legs can be due to your diabetes. The good news is there are ways to deal with a muscle cramp when it strikes and, even better news, you can take steps to prevent muscle pain and cramps from happening in the first place.

Dr Jedha, Host 16:11

Yes, that is good news. So before you share some of the treatment and prevention methods, Emily, can you explain why people might get muscle pain or cramps?

Emily, DMP Dietitian, Guest 16:22

Muscle pain and cramps can be caused by a combination of factors. Sometimes they can be side effects of medication, so definitely consider reviewing meds with your doctor. You might also experience muscle pain and cramps due to nerve damage, a complication of diabetes called diabetic neuropathy. The other main culprit is an electrolyte imbalance. When you have high blood sugar levels, it upsets the natural flow of water and electrolytes, which can then lead to an imbalance in electrolyte levels. Another thing is, when your blood sugar is high, your body may excrete some of that excess sugar via the urinary tract, carrying precious electrolytes with it.

Dr Jedha, Host 17:09

Exactly. All great points, Emily. So have you got some practical things that people can do if they do experience these muscle cramps or have muscle pain.

Emily, DMP Dietitian, Guest 17:19

So two priority things are to make sure you’re drinking plenty of water every day and also supplementing with magnesium is very effective, as it plays a role in nerve function, muscle contraction and electrolyte balance. Magnesium also works as a natural muscle relaxant. Another supplement worth exploring is alpha lipoic acid, which Jedha mentioned earlier. Other things you can try is taking an Epsom salt bath. The magnesium from the Epsom salts will relax and soothe muscle pain and soreness. Or one more suggestion try doing self-massage and you can use a topical magnesium lotion for extra relief. Another thing you might want to get checked, if you haven’t already, is your vitamin D levels, because deficiency can cause muscle pain and weakness. Is there anything else that you can think of? I know that was a lot right there, Jedha.

Dr Jedha, Host 18:14

No, I think you covered everything. I think definitely all of those things you can apply, but the one thing I’ve found does help most is just supplementing with that magnesium as a first step. Then explore all of those other options that Emily talked about, because they’re all going to help in reducing those muscle cramps and pain.

Emily, DMP Dietitian, Guest 18:34

Jedha, this next question is for you. Pat said my troublesome area is sugar cravings. I eat candy in the evenings. I just need to get control of my sugar cravings. What can I do?

Dr Jedha, Host 18:48

All right, I’m not going to give a long answer here because we have done a whole episode on how to get control of sugar cravings. Episode 8 and one of the most effective strategies here for you, pat is going to be using the therapeutic herb Gymnema, sylvestre. You’ll be able to use it when you get these cravings so you can really get on top of things. It really helps provide a sugar reset. So go back and listen to episode eight, tip number seven I believe it was, because we talked about what it is and when and how to take it. All right, moving on, our next question is from Lisa, who said I heard that carbs minus fiber is the true carb number to be used when counting daily carbs. Is this true?

Emily, DMP Dietitian, Guest 19:38

Great question, Lisa, and this is a question that actually comes up a lot, so thanks for bringing it to us. The concept you’re referring to is called net carbs, which is calculated by taking the total carbohydrates in a food and subtracting the dietary fiber. Let me give a quick example here. If a food item has 20 grams of total carbohydrates and 5 grams of fiber, the net carbs would be calculated as 15 grams. The net carbs would be calculated as 15 grams. 20 grams of total carbs minus 5 grams of fiber would equal 15 grams of net carbs.

20:24

So the idea behind this is that total carbohydrates in our food are made up of sugar, starches and dietary fiber. But the thing is not all these components affect your blood sugar in the same way. Sugar and starches can raise blood glucose levels, while dietary fiber has minimal to no impact on blood glucose. So when you’re counting carbs, the idea of net carbs can be particularly relevant. Relevant. By subtracting the grams of fiber from the total carbohydrates, you get a number that more accurately reflects the carbohydrates that will impact your blood sugar, because net carbs provides you with the available amount of carbohydrate in a food.

Dr Jedha, Host 21:02

Yeah, exactly so. It gives you that available carbohydrate amount in the food, the net carbs. And I just want to point out, though, that net carbs aren’t applicable all around the globe Another confusing thing. But net carbs is applicable to our US and Canada-based listeners because on food labels it’s listed as a component of total carbs. But for our listeners who may be in Australia or Europe, food labels in those countries list the net carbs as the total carbs, because they list dietary fiber separately on labels.

Emily, DMP Dietitian, Guest 21:40

Yes, good point. That can be confusing, but good to know.

Dr Jedha, Host 21:43

Yep, just like blood sugar numbers being different around the globe, very confusing, but it is what it is, so we have to deal with that.

Emily, DMP Dietitian, Guest 21:51

Our next question here is from Maureen. She asks is it really possible to get off metformin? And actually a similar question from Lois, so I’m going to ask it now. Lois asks how to get off metformin gradually for good metformin gradually for good?

Dr Jedha, Host 22:12

All right, thanks, Maureen and Lois, for those questions. Is it possible to get off metformin? That’s the question Maureen asked and the short answer is absolutely yes, under the right circumstances, because clearly it’s not going to happen if you do nothing. As we’ve talked about in many previous episodes, you have to be proactive about your health and the key factors that can support you to reduce and stop medications include, number one your diet and nutrition. We often see medications reduced and stopped with the right diet and nutrition because blood sugar and A1c levels are improved so much. And other lifestyle changes can support you too losing weight if you need to, increasing physical activity everything that leads to better overall blood sugar control and better overall health. So when looking to reduce or stop any meds, you do need to talk to your doctor and work with them to do it, and chances are your doctor will reduce your metformin dose gradually as your numbers improve and stay stable with your A1c tests. That’s usually the most common form of deprescribing because it’s less likely that your doctor will just stop all your medications. But the good thing about metformin is, unlike some other meds, it’s not a medication that leads to hypoglycemia, so there’s a very low risk of taking it even if your blood sugar levels are going down.

23:42

But, as we spoke about in our medication series episodes 15 to especially episode 18 on deprescribing medications when you get to a stable A1c of 7% or below, you should begin the deprescribing conversation with your doctor and when you get to that point, ask for a medication dosage reduction. If you’re taking 1,500 milligrams of metformin a day, ask if you can reduce it to a thousand, then 500, before coming off it. And obviously during this time you’re going to be proactive with your natural diet and lifestyle treatment strategies. You never stop being proactive.

24:25

And another thing to consider is switching out metformin for berberine, a natural therapeutic supplement that can be more effective than metformin. So, for example, if you’re taking 1500 milligrams of metformin a day, you might speak to your doctor about reducing metformin to 1000 milligrams and replace that with 500 milligrams of berberine. Then, if your levels are stable during your next A1c assessments, you can further reduce metformin again until you’re off it. And we covered berberine in episode 21. So please do go and listen to that. So it was a pretty long winded answer, but I hopefully got to the point of yes, it is possible to get off your metformin and just keep being proactive.

Emily, DMP Dietitian, Guest 25:10

Yep, exactly, I think you did a great job and the biggest key point I hope all of our listeners can understand is that being proactive is so important. It’s important for your diabetes management as well as your overall health. If you don’t change anything, you’re always going to have the same health outcomes. But it’s a little bit of diet and nutrition and exercise when appropriate. You can have some very big positive impact in your health and diabetes management. Exactly.

Dr Jedha, Host 25:38

Okay, and to our last question of the day. Villa asked is Ezekiel bread good for diabetics? If so, what is a serving?

Emily, DMP Dietitian, Guest 25:50

Villa when it comes to Ezekiel bread and diabetes management, especially on a carb diet that we recommend. Here’s the thing Ezekiel bread is made from sprouted grains and legumes, so in terms of ingredients, this bread is definitely a better option and is more nutrient dense. It does have a lower glycemic index of 36 compared to whole grain bread with the glycemic index of 69. This means it can have a lower impact on some people’s blood sugar levels, but not all, because just keep in mind that it contains just as many overall carbs as other regular breads. Ezekiel bread still contains about 15 grams of carbs per slice, so some people still find this bread impacts their blood sugar levels too much. If you do choose to eat it, definitely stick with one slice per serving.

Dr Jedha, Host 26:47

Yes, for most regular beds you want to stick to one slice only, which will be generally around that 15 grams of carbs, but there are also some good lower carb breads on the market now too, or you can make your own. For example, we have over 30 bread recipes available for our members so they can make their own breads. But thanks, Emily, for sharing that information on Ezekiel to answer Villa’s question, and that’s all the questions we’re going to be covering today. Thanks again to all of you for sending your questions in, and if you have a question you want answered, send us your question for our next Q&A. Thank you again for joining us today. Until next week, Dr. Jedha, over and out.