Amanda Wilde (Host): Diabetes is often called the silent disease, but over 37 million Americans have diabetes, and an additional 96 million of us have pre-diabetes. We're talking diabetes control and prevention with Erica Langford, Clinical Nutrition Manager at Bergen New Bridge Medical Center.

This is Wellness Waves, a Bergen New Bridge Medical Center podcast. I'm Amanda Wilde. Erica, welcome, and thank you for being here to talk about this crucial subject.

Erica Langford, MS: Thank you. I'm glad to be here.

Host: Well, looking at those numbers, 96 million of us have prediabetes. That's almost a billion people. It makes me wonder, would you qualify this as a public health crisis?

Erica Langford, MS: Absolutely, this is definitely a public health crisis. But the good news is there are steps we can take on an individual level to help combat this disease and help prevent this disease.

Host: So, there are steps we can take to be not just one of those statistics. Let's talk about some of those. What are some, first of all, dietary changes we can make now to try to even prevent diabetes entirely?

Erica Langford, MS: Right now, overall, anyone who's looking to make some changes for prevention of not only diabetes but other chronic disease, can really make some simple changes to their eating habits. A big one is introducing some more non-starchy vegetables and fruits into your diet. You would want to aim for about five servings a day. Examples are pineapple, berries, you know, peppers, mushrooms, asparagus, broccoli, and these vegetables can be fresh, frozen or canned. You'll get the benefits no matter which type you choose. You also want to be including some lean protein in your diet: turkey, fish, chicken. Also, vegetarian proteins like tofu, eggs, and yogurt can be beneficial.

Something else that we recommend is whole grains because of their fiber content. So, adding into your diet things like quinoa, brown rice, oatmeal and maybe even making some swaps. For example, maybe doing brown rice a few times a week instead of white rice.

One other small change would be choosing water as your beverage of choice as your main drink throughout the day and other unsweetened beverages. There are some foods that we recommend eating in moderation or limiting, and those would be your processed foods, foods with added sugar, drinks with added sugar and also alcohol.

Host: Which is especially hard as we come upon the holiday season. Should I be eating a certain amount of carbohydrates per day or per meal?

Erica Langford, MS: So, the amount of carbohydrates that you eat will be highly individualized. And carbohydrate counting is a great method for managing diabetes, it's extremely effective. But the goal is not to eliminate any carbohydrates from your diet, but figure out how many carbohydrates are right for you and eat that amount consistently. The amount that's right for you is highly individualized based on many different factors, your doctor, nurse or dietician can really help you come up with that number that's right for you.

Host: And this may fall into the same category of question, it may be highly individualized, but I wonder how often we should eat throughout the day, because you hear you should have many small meals, but you also hear other ideas. What's the best way to eat through a typical day?

Erica Langford, MS: Yeah. So when we're looking at aiming for blood sugar control, it's important to eat at regular intervals throughout the day. And not only for blood sugar control, but just even throughout the day, if you think about yourself, if you've gone a long time between lunch and dinner, for example, without a snack, you're not only hungry, but you might start to get a headache, you might feel lightheaded, you might start to feel irritable, and that's because of that blood sugar dip.

So, the recommendation, you know, to keep your blood sugar even and steady throughout the day, a very general guideline would be three meals a day and two to three snacks per day. And one of the keys with this is also making sure that these meals and snacks contain a protein source, and some healthy fats, fruits or vegetables and whole grains. These not only help slow your digestion, which helps to keep your blood sugar steady, but also provides fiber. So both of these things reduce blood sugar dips and spikes and they also provide essential nutrients. So, eating at regular intervals spaced throughout the day. It's going to be individualized based on when you wake up and when you go to bed. But if you find that pattern that works for you, you can keep your blood sugar more steady throughout the day.

Host: I find that eating well can take up a lot of time in the kitchen, but we do have the convenience in many places of being able to shop for some of these foods and not having to prepare them from scratch ourselves. So, what should we look for on those nutrition labels when we are shopping for more convenient food?

Erica Langford, MS: So on nutrition labels, you want to look for, if you're conscious of diabetes, if you have diabetes or trying to, you know, reduce your sugar intake, you want to look for total carbohydrates and added sugars. You want to aim for products with less than 5 grams of added sugar. Knowing how many total carbs are in a certain food can help you with carbohydrate counting.

Other things you might look for on the nutrition label are the sodium and also saturated fat. But with to-go and convenience items, like you said, they can be a great resource, especially with how busy we are today with not spending all of your time in the kitchen. The trick is just looking at your labels, looking at those ingredients, and finding what aligns with your health goals.

Host: You mentioned to limit processed foods, which are kind of one of the worst things I guess we can put into our body. Are there any foods that are completely off limits?

Erica Langford, MS: There aren't really any foods that are strictly off limits because we don't want to create an all or nothing mindset around food. Creating that mindset can lead to guilt when eating, and it can even lead to eating disorders or a disordered eating pattern. So, we don't want people to feel bad about what they're eating.

 What we really want is people to eat in a more informed way and understand how certain foods will impact things like blood sugar and health. So, that's really the key to building a way of eating that works for you without cutting out things like birthday cake or holiday meals. There are definitely strategies that we as dieticians use to work with clients to allow them to eat these foods without creating any major blood sugar issues and helping to find balance in your life and your day to day eating habits.

Host: Well, for those of us who are pre diabetic or already have diabetes, it sounds like seeing a dietician is going to be really helpful.

Erica Langford, MS: Absolutely, because everybody is unique. Everyone's case is unique, everyone's medical history. We also have to think about the social determinants of health. So, everyone's economic status, where they work. how active they are throughout the day, what their job is, their education, all of these things impact our health and also what we eat. So if you meet with a dietitian, you can really come up with an individualized plan that works for your own lifestyle.

Host: Yeah, and really look at that whole picture.

Erica Langford, MS: Absolutely.

Host: What about weight loss and exercise? Will that help control diabetes?

Erica Langford, MS: There is research that suggests that if you are overweight or in the obese category, losing 5 to 10% of your body weight can help improve blood sugars. And I do want to emphasize that's just 5-10%, so we're not looking at any sort of extreme weight loss. We're looking at, you know, if you weigh 200 pounds, that's maybe 10 to 20 pounds. Your dietitian can help with this, making small changes to create this little bit of weight loss that can help you.

If you're already at a healthy weight or weight loss isn't right for you, maybe you have a history of any sort of disordered eating and that's not the right path for you, you and your dietitian could instead focus on maintaining a weight that feels good for you and also those healthy eating habits and healthy eating patterns. And exercise, where that comes in is when you exercise, your body, uses the glucose circulating in your bloodstream for energy. This will help bring down the blood sugar levels in your bloodstream, which is beneficial. You want to aim for about 30 minutes of exercise, five days a week. But what that exercise is depends on what's realistic for you. That might be going to the gym. Maybe it's walking your dog. Maybe it's playing with your kids, riding your bike, swimming. And if you're new to exercise, you might start out walking a couple of times a week and really working your way up to that five days a week recommendation.

Host: Absolutely. As a dietitian, what do you see in your patients that shows you that diet changes are working?

Erica Langford, MS: We look for a number of different factors. Obviously, your lab work, so we look at your blood sugar, something called A1c, which shows us your blood sugar over time. We would look at your lipid labs, your cholesterol, and we would also look at how you feel, what are your energy levels throughout the day? Are you feeling full and satisfied throughout the day? Are you having moments through the day where you're super hungry and then, you wait to eat, and you're not feeling good? We look at sleep. So, are you sleeping well at night? Are you getting enough rest? There's really a number of different factors that we can use to determine if any of these changes are making a difference in your life.

Host: Erica, thank you so much for this holistic approach that you take and this crucial information that you shared today to raise our awareness of diabetes and how to cope with this disease.

Erica Langford, MS: Thank you so much. I enjoyed talking with you.

Host: That was Erica Langford, Clinical Nutrition Manager at Bergen New Bridge Medical Center. For more information, visit newbridgehealth.org/healthservices, then go to ambulatory specialty care, endocrinology, diabetes. If you found this podcast helpful, please share it on your social channels, and be sure to check out the entire podcast library for topics of interest to you.

Until we meet again, thanks for tuning into this episode of Wellness Waves, a Bergen New Bridge Medical Center podcast.