Melanie Cole, MS (Host): Did you know that simple adjustments and making sustainable dietary changes can have such a big impact and help you to better manage blood pressure and blood sugar? Welcome to conversations with MIT Health. I'm Melanie Cole and we are offering nutrition tips for managing hypertension and diabetes today with Dr. David Podradchik. He's a Clinical Pharmacist with MIT Health. Dr. Podradchik, thank you so much for joining us. Can you start by giving us a quick overview of how nutrition plays a role in managing chronic conditions like hypertension and diabetes? 

David Podradchik, PharmD: Hi, and thank you for having me. So, I'm a pharmacist and for me, medications are my bread and butter. That said, I always try to address nutrition when I meet with patients because it is so important. Nutrition's one of the key components of therapeutic lifestyle changes that we can make, along with physical activity, getting good sleep, managing your stress and weight management. So for hypertension and diabetes, not only can improving nutrition lead to improvement in managing those conditions, but the opposite's also true in that poor nutrition and dietary choices can make control of those conditions worse.

Host: It's so interesting how much we've learned over the years about the role that nutrition plays in our overall health and wellness. And from your experience, Doctor, working with patients, what are some of the biggest challenges that people face when trying to make those dietary changes for their health? Because it's not easy for everybody. 

David Podradchik, PharmD: That's true. There are a few things that tend to be obstacles to making positive dietary changes. For one thing, processed and restaurant prepared foods are usually higher in sodium and sugar than we would want. So if you truly want to gain control of what you're consuming, you may need to cook more for yourself than what you're used to doing.

For people that work a lot or have a lot of school or family obligations to fulfill; that could be a big ask to have somebody reduce the convenience of having someone else prepare their food. You might also have to overcome some poor habits that may already be in play, such as snacking on food straight out of the bag or a package, which is very bad if you're trying to work on portion control.

Other things that tend to trip people up are their food preferences. And in the case of those who drink coffee daily, caffeine dependence. 

Host: Let's get really specific, Dr. Podradchik. Some of the key dietary changes that you would recommend that can help individuals lower their blood pressure, better manage their blood sugar. You just mentioned a few with not eating things right out of the bag, restaurants, cooking at home, but when we think of the foods themselves; are there certain foods that can help us and or hurt us? What are some of those really good changes that we can make? Things we can cut out of our lives and things we should add in? 

David Podradchik, PharmD: So for hypertension, for treating blood pressure and trying to manage that, the main thing that I would recommend to somebody is to really focus on reducing your sodium intake and reducing your caffeine intake. We want to make sure both of those things are moderated. For diabetes, we're looking to reduce carbohydrates, but you specifically want to target simple sugars. So obviously things like candy or other sweets, but also sweetened beverages like regular soda or juice. Those can cause spikes in blood glucose. We also want to reduce foods in general that have a high glycemic index. So glycemic index is a scale that ranks a carbohydrate containing food or drink by how much it raises your blood sugar level after you have it. 

Foods that have a high glycemic index, increase blood sugar higher and faster than foods with a low glycemic index. So lower glycemic index foods, are really what you would want to focus on consuming, and those often have fiber and protein that will slow down the rate the sugar is absorbed and that will prevent big sugar spikes. 

Host: People often hear about reducing salt and cutting carbs. Are there any lesser known tips that you can offer or simple adjustments that can make a really big difference? 

David Podradchik, PharmD: So something that I recommend to people with high blood pressure is that if you're cooking with salt; swap out your iodized salt for coarser grain salt, like kosher salt or sea salt. For example, one teaspoon of iodized salt has 2.3 grams of sodium, which is the full daily allowance. Those coarser grain salts have less sodium for the same volume. 

I also suggest that you could substitute out other spices or flavorings in place of salt. Things like onion powder or garlic, cumin, paprika. Those are great options that can replace some of your salt. For diabetes, something that I suggest is for things that you do identify that are high glycemic index foods, try to substitute some of that portion for a lower glycemic index food. So instead of having a cup of rice, you could have a cup half cup of rice with a half cup of beans. 

Host: When we talk about this Doctor, people think to themselves, that's going to be so difficult. How can someone balance eating healthier without feeling like they have to give up all of their favorite foods? 

David Podradchik, PharmD: The things that I suggest to people are moderation and substitution. So if it's possible, substitute a poor choice of food or drink for a better choice. If it's not possible, not everything has a, an exact substitute; try to moderate what you're taking in of a less desirable food, so control that portion.

I also, think that it's better to allow for an occasional cheat day rather than focusing on completely abstaining from your favorite foods. In that way, it's something more to look forward to rather than something to be ashamed of.

Host: One of the questions I imagine you get asked all the time, and as a clinical pharmacist, you work closely with patients on both medication and lifestyle. How do diet and medications interact when people are trying to manage conditions like hypertension and diabetes, because those require oftentimes medication intervention, along with, as you're discussing the nutrition changes. How do those interact? 

David Podradchik, PharmD: There are some medications that need to be taken with food or on an empty stomach. Some medications have to be separated from certain types of foods for various reasons. The best thing that you can do is to ask questions when you're prescribed a new medication. Either the pharmacist that's filling the medication or the prescriber should be able to counsel you appropriately and when you get your prescription, take a little time to read all the little auxiliary labels that are on the package. 

Host: What about supplements? Dr. Podradchik, there's, so many supplements on the market. There are walls and walls of them. Are there supplements that people should be cautious about if they're taking medications for blood pressure or blood sugar? And do they interact? Because I know there's some, we have to be careful of. 

David Podradchik, PharmD: Yep. So there are definitely foods and supplements that we should be cautious around. Many medications are metabolized in the liver by an enzyme called CYP3A4, including some medications for blood pressure or diabetes. If you've ever heard a warning that you should avoid grapefruit or grapefruit juice while taking a medication, it's because there's something in grapefruit that stops that enzyme from working, and increases the risk that you would have an adverse reaction or toxicity from that medication that the enzyme's supposed to be clearing out of your body. Many herbs also have the opposite effect on CYP3A4 and make it work faster, and that would potentially reduce the effectiveness of your medication. 

Some examples include St. John's wort, ginkgo biloba, and valerian. There are also some blood pressure medications that can cause a rise in your blood level potassium. So you would want to be cautious about taking supplements with potassium with those medications. For any patients that I prescribe, GLP1 agonists like Ozempic or Mounjaro, we have a long discussion about diet and foods that might make you more prone to having side effects. Again, the bottom line is to ask your prescriber or your pharmacist. 

Host: You've said that empowering patients to make their own health decisions is really a priority for you. What advice would you give someone who feels really overwhelmed by all the nutrition advice out there?

David Podradchik, PharmD: You have to find what works for you, what you feel is a sustainable, long-term positive change that you can make, and really lean into it. Managing these conditions is a lifelong process, so it doesn't make sense to adopt changes that you don't think you'll be able to keep up with.

Host: Doctor, when patients want to start this process, they want to start these goals and this journey. How can they work with their care team at MIT Health, whether it's pharmacist, doctor, dietician, to create that realistic, sustainable nutrition plans, smart goals as it was. 

David Podradchik, PharmD: I think that this is mostly about honest communication. If a prescriber suggests that you do something that you don't think is realistic, you have to speak up. So, for example, I think lentils are a fantastic option for people with diabetes because they're really high in fiber and protein.

But if I suggest that to you and you absolutely hate lentils, it isn't a useful suggestion. We all have the same goal of trying to improve your health, and we want to work with you to come up with real solutions that work for you. 

Host: As we wrap up and you've given us so much great information today, what's one simple step listeners can take today to improve their nutrition and better manage their blood pressure or blood sugar, something they can do right now today?  

David Podradchik, PharmD: You have to read nutrition labels. Sugar and salt are hiding in plain sight so know what you are eating and drinking. 

Host: Thank you so much Doctor, for joining us today and sharing your expertise today. And that concludes this episode of Conversations with MIT Health. Please visit our website@health.mit.edu for more information. I'm Melanie Cole. Thanks so much for joining us today.