Joey Wahler (Host): It can be very beneficial, especially for diabetic patients. So, we're discussing navigating the grocery store for a healthier lifestyle. Our guest, Michelle Cole. She's a Registered Dietitian and Program Manager for First Health Diabetes and Nutrition Education Center. This is the First Health and Wellness Podcast. Thanks for joining us. I'm Joey Wahler. Hi there Michelle, thanks for being with us.

Michelle Cole, RDN, CDCES: Hi, Joey. Thank you for having me.

Host: Great to have you aboard. So first, for some, a reset of our food shopping habits may seem a bit daunting if we're particularly set in our ways. So where should people start? What's a good place to get it all going?

Michelle Cole, RDN, CDCES: Absolutely. Tackling the grocery store or any major chain of store for groceries is overwhelming. So we always encourage to have a plan, plan ahead with a grocery list, maybe plan with your family in advance on meals that you'd like to have for the week. And also never shop hungry. When we shop hungry, we make rash decisions. Sometimes we choose unhealthy food options. So definitely go in after you've had a meal, and even order online if that helps you to reduce the temptation of purchasing foods that aren't exactly what are on your list.

Host: And what does it mean to shop outside in?

Michelle Cole, RDN, CDCES: So we've all heard the idea of shopping from the perimeter of the store. And the mindset behind this is that when we shop on the outside, we're choosing foods, first that are mostly whole foods, like fruits and vegetables, meats and dairy, and those are the foods that we obtain most of our nutrition from, or we'd like to obtain our nutrition from.

There's certainly room for more processed foods, which are usually located in the center of the store, but these foods should not account for the bulk of your purchase, so we do want you to start from the outside, work your way in.

Host: So, for diabetics or pre diabetics, what food shopping considerations are most important?

Michelle Cole, RDN, CDCES: So prediabetes and diabetes both are considered cardiovascular conditions, so anytime we have a patient who is struggling with their blood sugar or with their heart, we do recommend to go into the grocery store with a mindset of choosing whole foods, whole grain foods, low sodium, low saturated fats, and zero trans fats.

Those are usually found in our cookies, sodas, candies. So those are the food items that we'd prefer you to stay away from; especially if you are someone who's tempted by those foods in the home. Out of sight, out of mind. If they're not there, you're not going to choose them. And also just portion control.

So, once you shop for your groceries, if you have diabetes or prediabetes, as soon as you get home, we encourage you, if you can, to go ahead and chop your vegetables, prepare your fruits. We're more likely to grab foods that have been already prepared and cut up, than we are to reach in and grab a whole bag of carrots and eat those.

That's the plan for going in with a chronic disease is to kind of know what your goals are and base those choices on your goals.

Host: And going back to something you mentioned a couple of moments ago, you talked about preparing ahead with meals as well, that not only achieves what you just mentioned, which is it makes you more likely to eat healthier things if they're already made. But it also relieves a lot of stress, doesn't it?

Because so many people, families, they spend way too much time, don't they worrying about what they're going to eat. You get up in the morning and it's like, what's for dinner tonight?

Michelle Cole, RDN, CDCES: Absolutely. And not only that, the stress from financial burden. A lot of times we go to the store and when we don't have a plan, we're more likely to purchase things that we don't need and it ends up costing us more money, actually. Everybody says, eating healthy is so expensive when I understand that concept.

But in reality, if we cut out some of these extra foods we don't need and our bodies don't need, we can end up saving a lot of money as well. So that helps with that financial stress, the emotional stress from knowing what you're going to eat for the week. So try to have a plan going in. Talk to your family members, your husband, your kids. What do you want this week? If they don't give you any ideas, just choose for them, but absolutely it can help reduce stress.

Host: And speaking of which, how much can cooking your own meals be helpful here, even if you're not a gourmet or very handy around the kitchen, if you can at least, maybe I should use the word prepare as opposed to cook, since, pre prepared foods that you buy in the store, of course, tend to have more preservatives.

Michelle Cole, RDN, CDCES: Absolutely. So usually pre prepared foods contain more fat, more sodium. Those are the two ingredients that make foods taste better. So when you're cooking at home, you can control what goes into your foods. You can control what your children are eating, your husband's eating, family members. So, making healthier decisions on what you're preparing at home and choosing to cook at home, even if it's very simple, which we usually recommend, it's just a very simple approach to preparing meals.

Have a meat and a side, you know, vegetable and a starch. You can absolutely control what your family is consuming. And remove some of those harmful ingredients.

Host: Do you recommend when someone's starting out trying to make significant changes to their diet, whether it's because they're diabetic or pre diabetic, maybe they're overweight, maybe they just want to eat healthier, be healthier; do you recommend doing this gradually as opposed to going cold turkey and trying all at once to get rid of the stuff that's no good?

Michelle Cole, RDN, CDCES: It actually just depends on the person. I mean, a lot of our patients we work with have a hard time with the cold turkey approach. They end up falling off after a week or two. So as long as there's some accountability there to help, more people are likely to make smaller adjustments in the beginning and then work up from those habits.

So it just depends. Some people do fine with that approach. I've found in my personal experience that most patients of ours have trouble with the cold turkey approach. It's just harder to get rid of everything all at once.

Host: Okay, so organic foods, as you well know, have become so much more popular in recent years. Some of the bigger supermarkets have aisles and aisles or sections devoted to them. How much do you recommend those for the patients we're discussing?

Michelle Cole, RDN, CDCES: Honestly, my personal opinion is that the organic label is sometimes used as a marketing approach. As you can imagine, fruits such as bananas, fruits with a peel that you don't consume, those usually aren't affected by the organic marketing. And also it's not regulated. So organics use pesticides too. So for our purposes with educating patients on becoming more healthy, if I'm going to ask somebody to eat more fruits and vegetables, I'm okay with them choosing non organic fruits and vegetables, if it means they're taking in more nutritious foods versus more processed foods. So it's not something that, you know, if you can't afford organic, that doesn't mean you should skip the aisle of food.

It's okay to have the non organic fruits and vegetables. Same goes with frozen fruits, frozen vegetables, anything that's in a box that says organic. I would be kind of cautious of what that actually means. It's sometimes confusing if you look into the science behind it.

Host: So speaking of information you provide to your patients, what services, give us a little overview, please, on what services are provided by First Health's Diabetes and Nutrition Education Center for people to be healthier overall.

Michelle Cole, RDN, CDCES: Sure, so our program is staffed by Registered Dietitians who are qualified to make recommendations based on your medical background. We provide medical nutrition therapy and what we normally do is we just assist our patients in learning how to eat according to their goals to prevent chronic conditions like heart disease and diabetes. And we provide accountability to ensure that those patients have long term success and it's not just a quick fix, or just giving someone a meal plan. So we definitely want to work with patients long term to make sure that they are happy with the success they've seen and the goals that they've achieved.

Host: And when you talk about long term, Michelle, how do you and yours serve as a support system, which is so crucial for people trying to make these kinds of lifestyle changes. And as we've touched on trying to stick with them.

Michelle Cole, RDN, CDCES: Every patient referred to us and we do require a physician referral; the referral is good for one year and so that's open to the amount of visits the patient needs and sometimes they need more and sometimes they may need less. For instance, we hold a diabetes education course. And that course is a one time class, but then those patients will come back to us sometimes on a monthly basis just to make sure that they're meeting their goals, blood sugars are in line, medications are taken appropriately.

And as far as weight loss, we do see that more patients need closer accountability. So maybe not every month, maybe they need to be seen every week or every two weeks. And we do offer virtual appointments as well for those who can't make it in person to see us. So, we just have found that the accountability is really what helps people to stick to these goals.

Host: Accountability, I presume, meaning that there's more than their own set of eyes on what they're doing, right?

Michelle Cole, RDN, CDCES: Absolutely. We tend to make changes more effectively when we know somebody else is looking.

Host: Absolutely. Kind of like having a trainer at the gym, if you can afford that, right?

Michelle Cole, RDN, CDCES: Exactly.

Host: A couple of other things, sticking kind of with that theme, if people stumble when making these dietary changes, and most of us will, most of us have, what's the key to sticking with it and not getting discouraged? Because I know personally, one thing I've found when I start to try to make a change in my diet is if you have a bad day, you have a bad couple of days, even a bad week, it's so important not to use that as an excuse to just say, oh the heck with it. I'm gonna just throw everything out the window. It's still only one day or one week and you've got to stick to the plan, right?

Michelle Cole, RDN, CDCES: So it takes three months to develop a habit and to stick to it. So we always encourage patients to not become discouraged and reach out for help. The number one thing is to acknowledge that you need help and then reach out and then we'll get you back on track. And also, if you mess up, if you think you've messed up with your eating habits or your exercise or whatever it might be, don't say, I'll start again Monday.

Say, I'll start again today, next meal, the next snack. So it's not all or nothing. That whole all or nothing mindset can get us in trouble when it comes to making lifelong changes. We just need to look at this as a marathon instead of a sprint.

Host: Right because it seems what you're saying there is if you stumble and you say to yourself Okay, you know what? I'll get back on track a week from tomorrow. You're already off to a bad start, right?

Michelle Cole, RDN, CDCES: Absolutely.

Host: I'm curious from your experience and expertise, if you had to pick one or two foods or types of foods that are people's biggest weakness, what are they?

Michelle Cole, RDN, CDCES: Vegetables. I have a very hard time sometimes trying to talk patients into trying new vegetables or just including them in their diet. For whatever reason, that just seems to be the least popular food group. And so vegetables are so important and so vital across the board as far as health, with any kind of health condition.

So they just help us to have more energy and they help us with reaching our micronutrient goals, our vitamins, our minerals. So coming up with creative ways to make vegetables appealing is probably the biggest challenge that we see as dieticians.

Host: Interesting, because I think we typically think of kids, especially younger kids, as often being tough to get to eat their vegetables, but it seems like you're saying it applies to adults as well.

Michelle Cole, RDN, CDCES: Absolutely. Every age group. Not always, but mostly.

Host: Right. So that would be a food type, food group that more people need to increase. How about one or two foods or types of foods that people have the most trouble cutting out?

Michelle Cole, RDN, CDCES: I would say those are sugary foods, namely sweetened beverages. We see a lot of struggle with sweet teas, sodas, sports drinks, and switching over to just plain water, or another alternative that doesn't contain sugar or calories. That and salty snacks, because we tend to overeat. The portions are larger with salty snacks, especially when you're distracted watching TV, playing video games and you just had your hand in the chips bag. So I would say sugar and then salty snacks are the hardest to cut out for sure.

Host: Okay. And then finally, in summary here, Michelle, what would you say is most rewarding about the work that you do?

Michelle Cole, RDN, CDCES: Absolutely. It's the feedback from patients who will return back to us and say, Hey, because of these changes, I'm now taking half of the medications that I was previously on, or now I'm able to play with my grandchildren and not feel out of breath. So, just the feedback that we receive from our patients who have been working with us for a while is the most rewarding part.

And for me, it's knowing that they will go on in life knowing how to make these changes without me, and then can spread that to people they love.

Host: Absolutely. Well, folks, we trust you're now more familiar with making those healthier food choices. Remember, don't go to the supermarket hungry, right, Michelle?

Michelle Cole, RDN, CDCES: That's right.

Host: Michelle Cole. Thanks so much again.

Michelle Cole, RDN, CDCES: Thank you.

Joey Wahler (Host): And for more information, please visit firsthealth.org/diabetes. Again, that's firsthealth.org/ diabetes. Now, if you found this podcast helpful, please share it on your social media. I'm Joey Wahler, and thanks again for being part of the First Health and Wellness Podcast.