Transcription:
Let's DISH on Nutrition & Diabetes

Gina: Welcome to Iowa Specialty hospitals and clinics ISH Dish Podcast, practical health advice from Iowa Specialty Hospital experts. We want to connect the members of our communities with the latest healthcare information that's understandable, relatable, and useful to your daily life. With us in the studio today, we have Amber Kastler, and Amber is our, I'm gonna call her a nutrition coach and diabetes educator. Is that fair?

Good. Alrighty. So, we are going to talk today about nutrition counseling and diabetes education, right? And I think there's a lot of people that can benefit from this conversation.

Amber Kastler: Oh, without a doubt.

Gina: So, to start it off, first of all, tell us you are, what you do exactly. I've kind of teased it a little bit, but just so we make sure.

Amber Kastler: Yes, absolutely. So I'm Amber Kastler and I am a registered dietician, circa 2010 and a diabetes specialist. I've been working with people with diabetes for a while now, but I became specialized this year.

Gina: Nice. Yeah. Good for you. What did that entail exactly?

Amber Kastler: Well, in order to sit down for the board exam, you've gotta have oodles of hours behind you. I don't quote mean, and I think they just upgraded this, but I think it's a thousand hours. of time spent with people with diabetes, educating them, and then you have to pass a board exam. So It was grueling. I am much better. I wish it was a spoken test versus a written test. I have a tendency to get inside my head, but it was actually just fine. I surprised myself, so I was, it was more prepared than I thought I would be, so, yeah.

Gina: So that kind of leads me and segues me into the next thought here. I was looking at your profile on our website, which I will just give a shameless plug. It's Iowaspecialtyhospital.com, and you have several designations behind your name. What are they and what do they mean?

Amber Kastler: Yes. So, I believe the first one is M F C S, which is Master's and Family Consumer Science. So I got my master's degree from Iowa State emphasis in dietetics back in 2016. Was a wonderful experience. And then RD LD, which is registered dietician LD, is licensed dietician here in the state of Iowa. You have to be a licensed practitioner in order to provide medical nutrition therapy. and then CDC ES is certified Diabetes education and care specialist. A lot. But you can just call me Amber.

Gina: Aw, we'll do do that. Thank you. So Amber and I have a little story to tell and, I think that you do this frequently for different things, but a couple years ago I was at the north Iowa Fair in Mason City, and I invited Amber to come and sit with me for a while at the fair. And you brought an interesting display with you. Do you wanna tell everybody what that was?

Amber Kastler: Yes. So I love interacting with the community in that regards, and I always like to have visuals. I'm a visual learner, so I like to include that kind of stuff. And for this particular fair, because it was heat of the summer I chose to bring some urine samples. Now they weren't actual urine. I had fun in, our kitchen over here at Iowa Specialty messing around with food colorings and waters. But I had A visual display of what it looks like to have hydrated urine all the way up to, you probably should go see your doctor type of urine. Yes. So it was basically clear all the way up to Brown, through the yellow variations.

And it's so much more fun to do it that way because people can see it and without even coming, they don't worry about coming up and being nervous about taking a free pen or asking questions. They can just be like, what is that?

Gina: Yeah. And I think Correct me if I'm wrong, but it actually says, what color is your pee?

Amber Kastler: Yes. Yep. So I had a cute little display of what color is your urine and, all of that kind of stuff. So I try to make it. less intimidating for people to come up and talk because, you know, it does get kind of awkward coming up and talking to people. So I didn't mean to steal the show, but it really did, a lot of people came up and were mostly just, what is that?

Gina: It was, the absolute best icebreaker I have ever seen.

Amber Kastler: Well, you're welcome to steal it. I still have the models in my office if you'd like to come get them.

Gina: All right. Well, so tell us just a little bit about what it is you can do for the general public. What is it that you actually do in your day?

Amber Kastler: Yep, absolutely. So as a dietician and a diabetes specialist, I kind of, which is how I've always loved it, had my thumbs in a couple different pies. So as a dietician and a diabetes educator, I can patients for their diabetes, obviously being a specialist. But beyond that, as a dietician, I can see a whole host of different folks. So for diabetes in general, as nutrition is a big part of diabetes. But also if you have food allergies, if you have, if you are a mama and have gestational diabetes I see a lot of those patients as well too. If you're looking to lose weight for weight management, if you I've had Dr. Kerry Reese refer down several patients for gut health. So the list goes on and on. You. I don't think many people realize that of the top 10 killers here in America, nine of them, the last time I checked, nine of them were impacted by nutrition.

Gina: That's frightening.

Amber Kastler: Yes. So there's, lots and lots of things from cooking classes or just feeling more comfortable in the kitchen to, recipe management and meal planning, all of the things. Anything that you can think of I can help out with.

Gina: So you're not a one woman show at the hospital. Obviously you have some

teammates that work with you. So you guys provide inpatient and outpatient services? Both?

Amber Kastler: Yep, mostly outpatient. Kelly Bens she's our nurse educator and we've got a new gal coming in, another dietician coming in for the diabetes team that is, so we primarily see outpatients five days a week. But yes, absolutely if there's a need on the inpatient side, then we are there to help supplement that as well too.

Gina: Okay. what else do you have on your list of fun things to tell us about?

Amber Kastler: Well it is, November. Is diabetes month. So this came out pretty well timed, so I applaud you on that. More than 37 million people in the United States have diabetes.

Gina: That's an alarming number

Amber Kastler: Yes. And sadly, one in five of them don't actually know that they have it yet. So, a lot of people walking around with hyperglycemia or high blood sugar and really having no clue about it and the damage that can cause.

Gina: What are some symptoms of that? Like how would I, maybe?

Amber Kastler: Excessive thirst, excessive urination. There's a plethora of different, but that's usually what we see most often. if your vision is blurry those are gonna be some of the main symptoms that you'll see with high blood sugars. So yeah, great question. and then outside of diabetes, you have the pre-diabetes world. where you're showing some insulin resistance, you're not able to use that glucose properly, but you're not full fledged diagnosed yet. 96 million adults. So even more than the, Type two diagnosis. 96 million adults are walking around, with prediabetes. Eight in 10 of them don't know.

Gina: Oh, wow. That's a big number.

Amber Kastler: It is a huge number. So really making sure that when you go in to see your provider, that you're asking, Hey, can we draw my A1C? If you have a family history, if you are overweight those are some areas that immediately qualify you for being able to get that drawn. Don't be afraid to ask for it, you know, providers I feel like they have a lot going on, and so it's important to be an owner of your own health as well too. If they happen to have forgotten something that day, ask for it. So make sure that when you go in to see your provider, that you know what your areas of concern are and.

Gina: Advocate for yourself.

Amber Kastler: Absolutely. Because while we do our best to do that here, it is helpful to have the patient being an for themselves So, yep, absolutely. Let's see, what else do I got here? yep. Diabetes is a seventh leading cause of death in the United States, and sadly much of it isunderreported because it's generally, a segue to another health related problem. Type two diabetes accounts for approximately 90 to 95% of all diabetes. There are several different forms of diabetes, but type two diabetes is the predominant form.

Type one diabetes is generally diagnosed in youth. We're seeing a little bit more in older age, but that's a kind of a segue into a different type of diabetes versus being just type one. So mostly the kiddos with the type one diabetes. And what that means is basically your Pancreas is not pumping out any at all. So you're 100% insulin dependent. You have to give yourself those injections. we've segued here to really encouraging patients over to using a pump.

Okay. it's fascinating how technology has changed and they're basically using what would be like a, an exterior pancreas to help do that job. Now there's definitely a lot of input still needed by the wearer, but, I would not be surprised of all if in some time in our lifetime they've developed something that can just do it on its own.

Gina: Sure. So if type two diabetes, I understand type one, and that's, something that you're gonna just have to live with it. Type two, you can get over it. Or do you always have it?

Amber Kastler: You'll always have it. Once you've been diagnosed with it, you'll always have it. You can go into, just a remission essentially from diabetes, but it'll always be lingering there in the background. So you'll always want to be aware of how you're treating your body, what you're putting into it, how you're, behaving. The fun lifestyle things that we can do. You'll always have to be aware of that. But yes, you can put it into remission. However, at some point, you know, it's a progressive.

So at some point, no matter what you're doing, even if it's everything perfectly, you're gonna still progress and need medications, potentially even needing insulin way down the road. And my job as a specialist is try to, delay and prevent that, to teach my patients how to treat yourself so that way you, can delay that process.

Gina: Wow. that's very enlightening to me because I was always of the thought that, you know, if you're overweight, severely obese or something of that sort and then you end up getting type two diabetes, that if you reverse that, it's just gone, cured?

Amber Kastler: Yep. Nope. Unfortunately. Nope. So if you have pre-diabetes, your, pancreas is usually generating, or it's operating at about 50% already. Just with pre-diabetes. And then when, depending upon the severity of type two diabetes, it's gonna be less, obviously your pancreas isn't gonna be functioning as well. So it's progressive and it will always be there in the background once you've, got it. So, unfortunately, yeah.

Gina: Diet, lifestyle. changes forever.

Amber Kastler: Yep. Absolutely. Yep. That sand lot, you know, forever. You gotta do that stuff. I mean, and that's regardless of taking care of diabetes or weight management. A lot of people come in and they wanna choose something super quick that's gonna be down and dirty and efficient.

Gina: We all want thast.

Amber Kastler: Absolutely. And I don't blame people, but I think a lot of people forget that you have to make those change. Forever in order to maintain those And that's the hard part. So if you are, if you pick a diet that elicits a lot of weight loss initially, Then you go back to your old habits, or you didn't change any of your habits, so they just sneak right back in. Or you meet your goal weight and you decide, Hmm, I'm fine. I can do whatever I want. Again, it's, going to come back and then some generally, so it's hard. Yeah. So much of my, what much of what I do is being a cheerleader for my patients, which I love to do.

It's fun to see them make those changes and to figure out, oh my goodness, this leads to this, and why didn't I figure that out before? And most people often know what they need. They just lack the accountability.

Gina: So what kind of impact does exercise have on all of this?

Amber Kastler: Tons of, impact. Yep. Absolutely. and you should have an exercise, physiologist or something come in, one of our therapists come in and explain more of the down and dirtyof that, it 100% impacts all of that. So regardless of if you have a disease that you're trying to manage, we should all be super duper active. So I always try to encourage my patients to, you know, you don't have to get a membership to a gym, you don't have to buy some wicked expensive bike or treadmill, anything like that. Just use what you have, take a bottle of water, start throwing, doing some bicep curls.

We all generally have smartphones and many of those people also have smart watches. So track. If you average a thousand steps in a day, let's try to bump you up to 1500 steps a day for the next couple of and then slowly work you up towards, I always like, my younger crowd, I'm pushing them for 10 to 14,000 steps in a day. but it's all the goals that the patients set for themselves. They're in the driver's seat. I'm just sitting shotgun. Enjoying the ride.

Gina: Yeah. good for you. That's awesome. Yeah. So what else? Do you have anything any other words of wisdom?

Amber Kastler: Not a ton on the nutrition side. I always wanna plug for dieticians and getting your nutrition advice from a registered and licensed dietician who has credentialing to back them.

Gina: Not Google, not just google?

Amber Kastler: No, not Google. there are so many influencers out there nowadays. Many of them are dietician. And many of, them are plugging accurate stuff. But oftentimes if it's too good to be true, you're probably finding it from a source that isn't very credible.

Gina: Sure.

Amber Kastler: So, just as you're mindlessly scrolling, which we should all back on just make sure that you're investing that energy and learning, absorbing the tools from credible sources.

Gina: Good advice. Yes. I also would love to have you back. To talk to the public about macros. Our, Iowa weight loss leader is a registered dietician by trade, and I was picking her brain one day when I was working down there about macros and how that looks. Because You have to have a balance of your carbs. Protein and fats, Correct? Yeah, that's right. And how much protein do we actually really need in a day to either lose weight or maintain or build muscle? It is overwhelming the information.

Amber Kastler: It really is. Yep. it is numbing. It's paralyzing. You feel like it could be simple though. Oh, it is. It absolutely can be. But if you find it from the right place and you, and that person knows how to digest it in a manner that works for you, which is what most dieticians then yes, it can be, fairly easy. It's just hard implementing that work day in and day out. you know, yes. I'm a dietician because I love to eat. Right? That's how I happened upon this field is because I enjoy cooking. I love to eat. I was a student athlete and I realized, holy moly, I could be way better of an athlete if I took better care of myself essentially.

So, it's amazing how much nutrition impacts everything. I mean, outside of just fueling your body, but the mental load of it as well. What am I onna feed my family? And you're going to a dinner party. Everything is centered around putting something into our mouth.

Gina: It is absolutely.

Amber Kastler: And it can be very dangerous.

Gina: If somebody wants to get ahold of you for more information or schedule, you take appointments?

Amber Kastler: .Absolutely. Just reach out to the clinic. Yep. Just call the clinic and ask to schedule an appointment in Clarion. Yep. So I see patients and folks, we have dieticians all over. We've got a dietician up in Belmont, we've got dieticians down in Des moines. So it's not just me. We, our teamwork makes the dream work here. So if you are centered here in Clarion, our operators are actually pretty amazing. So if you just call a single number, they will likely get you where you're needing to go.

Shameless plug for the website as well. We're all listed there so you can take a peek at what our interests are, what we look like. I know for me personally, that's something that I take into account if it's somebody that I feel like I could be comfortable with. So yeah. Take a peek there. All of the information for scheduling an appointment is there. You will need a referral if you have diabetes Okay. To come and see us. But if it's just medical nutrition therapy related, you don't, so.

Gina: Thank you so much for your time and being a guest.

Amber Kastler: Thank you for having me

Gina: Thank you for listening to Iowa Specialty Hospitals and Clinics ISH Dish Podcast. For more information on the topics we discuss today, visit us on the web at iowaspecialtyhospital.com. There you can read a transcript of today's episode or previously aired episodes, as well as get the latest news from Iowa Specialty hospital. You'll also be able to explore all of the services that we offer. For the ISH Dish Podcast. I'm Gina. Thanks for tuning in.