Your Blood Sugar Impacts More Than You Think

Amanda Newman (00:00):

What are naked carbs doing to your blood sugar? Is it bad to drink coffee on an empty stomach? Can stress spike your blood sugar? All that and more on this episode of The Healthiest You. Your blood sugar is a big deal. It’s responsible for a lot of things, from your everyday energy to your mood and potential for developing diseases in the future. Keeping your blood sugar in check is important to your overall health and longevity.

(00:30):

We are focusing on women’s health and wellness on The Healthiest You podcast. Whether you’re on your way to work or enjoying a cup of coffee, take this time to focus on your health. Here to talk about how blood sugar affects the brain and body is Dr. Erin Scholten, endocrinologist with the Diabetes and Metabolism Center at Lehigh Valley Health Network. Dr. Scholten, welcome to the show.

Erin Scholten, MD (00:54):

Thank you so much for having me. I’m excited to be here.

Amanda Newman (00:58):

Starting off with the basics, why is blood sugar so important to your body and its functions, and how does insulin play a role in regulating blood sugar levels?

Erin Scholten, MD (01:07):

So blood sugar, or glucose as we call it, is important for every function in our body. It’s the primary source of energy for our cells. And insulin acts as the key that allows glucose to enter our cells, to be used for energy and to be stored for later use between meals when we’re not eating.

Amanda Newman (01:28):

Well, thank you for breaking that down. Now, what are some signs a woman may be insulin resistant as we’re talking about what insulin is? If you could explain that.

Erin Scholten, MD (01:39):

Definitely. So after your cells use whatever glucose they need for energy and then whatever they don’t need, they convert to storage form. Once that storage form is filled, any leftover glucose is then converted to fat. So when your blood sugar levels are high and you have this extra glucose, whenever your storage is filled, then insulin is going to convert the process of making that glucose into fat, and that tends to happen in the liver and around our organs. So when you have that buildup of extra fat, it leads to insulin resistance.

(02:12):

Then your cells become less responsive to insulin when you have this insulin resistance, so your overall insulin levels are higher, your blood sugars can be higher, and so it can lead to feelings of hunger. So higher insulin levels trigger more feelings of hunger and cravings, especially for more carbohydrate rich foods. It can lead to weight gain. So when that excess glucose is stored as fat can lead to central weight gain, can lead to decreases in energy. When you have higher blood sugar and higher insulin levels, there’s more fluctuations in your blood sugar, so fatigue, low energy.

(02:53):

Insulin resistance is also a major part of PCOS [polycystic ovary syndrome], which affects women of reproductive age. So in addition to insulin resistance, these women can experience irregular menstrual cycles, infertility, increase in acne, hirsutism, which is abnormal hair growth. We can all see that in the presence of insulin resistance.

Amanda Newman (03:16):

Is there any way to reverse insulin resistance?

Erin Scholten, MD (03:21):

Yeah, absolutely. Targeting insulin resistance and prediabetes early is really the key to improving your metabolic health and reducing your risk of diabetes. So certainly focusing on dietary changes is a major key. Foods that are higher in simple sugars or sugars and simple carbohydrates are going to spike your blood sugars more, which leads to more insulin, which leads to more storage forms, which is higher fat levels.

(03:56):

So trying to prevent the blood sugar spikes by looking at our diets is one of the key steps. So avoiding the simple sugars and carbs, trying to eat more healthy, like vegetables that are high in fiber, proteins, healthy fats, looking at lifestyle modifications is huge. How can you incorporate regular physical activity that can help your body respond better to your insulin levels, so any sorts of physical activity.

(04:28):

I always tell my patients, prioritizing sleep and stress management. One night of bad sleep can raise your hunger hormones, so that stimulates your appetite to eat more. So getting adequate sleep can really help lower insulin levels and help with insulin resistance. So you think about somebody who has chronic sleep deprivation, what that can do to their hormone imbalance, and then stress management, so how can we manage our stress better? Stress, whether it’s physical stress or psychological stress, it can increase your cortisol levels, which can increase your blood sugar and insulin resistance. So it is sort of a multifaceted approach.

Amanda Newman (05:14):

Definitely.

Erin Scholten, MD (05:15):

Looking at all the different parts of your diet and lifestyle, that can help lead just an overall healthier lifestyle.

Amanda Newman (05:24):

Well, those are all, I think, great tips. So limiting the carbs, limiting the sugar, getting that physical fitness in, so important. And of course sleep. I think we can all admit we’re different people when we have a lack of sleep.

Erin Scholten, MD (05:39):

Definitely.

Amanda Newman (05:40):

I know I am. So continuing on with our discussion about blood sugar, specifically coffee, let’s talk about that. Are you a coffee person?

Erin Scholten, MD (05:50):

Yes, I am.

Amanda Newman (05:50):

Yeah, me too. Do you usually start your day with a cup of coffee or do you usually have breakfast first?

Erin Scholten, MD (05:57):

I guess it depends on my morning, but I’d say typically coffee [as] I’m getting my kids ready and things like that. So I do typically start with coffee. I think it’s more of a ritual at this point.

Amanda Newman (06:09):

Sure, it’s part of the routine.

Erin Scholten, MD (06:11):

Yeah, exactly.

Amanda Newman (06:13):

The smell of the coffee brewing, nothing beats ... it’s just, it’s like that morning wake-up.

Erin Scholten, MD (06:17):

Yeah, absolutely. And it feels like doing something for yourself a little bit.

Amanda Newman (06:21):

It’s like an act of self-care before you’re taking care of the kids and everything.

Erin Scholten, MD (06:25):

Yeah, absolutely.

Amanda Newman (06:25):

Or work responsibilities, checking that email, just taking a moment to pause and make that cup of coffee.

Erin Scholten, MD (06:31):

Yes.

Amanda Newman (06:32):

So how do you make your coffee? I’m curious.

Erin Scholten, MD (06:34):

So there is a debate about whether coffee affects blood sugar, and I think … it’s very individualized. I think some people are a little bit more sensitive and they might see an increase in their blood sugar just with coffee, but alone. I think the biggest thing is what you put in your coffee.

Amanda Newman (06:51):

Interesting. OK.

Erin Scholten, MD (06:51):

I think black coffee alone for most people is not going to affect their blood sugar, but when you start adding sugar and creamers that have high sugar content, I think that’s where it can really affect your blood sugar. So just using half-and-half or cream that has no added sugar, one to two tablespoons really should not have much effect on the blood sugar. So that’s what I do. I have black coffee and then add a tablespoon of half-and-half and no sweeteners.

Amanda Newman (07:22):

OK.

All right. So the debate online, we can debunk that myth that it doesn’t, it’s not going to impact your blood sugar terribly if you have it on an empty stomach.

Erin Scholten, MD (07:34):

Correct. I think for most people it will not. There are individual people that might have a rise. But I think on average, majority of people, if it’s black coffee with no added sweeteners, it shouldn’t typically … affect the blood sugar.

Amanda Newman (07:49):

Right. That’s what we wanted to hear.

Erin Scholten, MD (07:52):

So have your coffee.

Amanda Newman (07:55):

Now, what about mushroom coffee? Is it worth the hype? It’s supposed to help you sleep better, reduce stress, ultimately helping with those blood sugar levels. Again, they make it sound really good, but is it actually true?

Erin Scholten, MD (08:10):

I don’t know that there’s too much data to support it. I mean, I don’t think it’s harmful. Mushrooms have lots of vitamins and antioxidants, so I think they’re good to have in your diet. Is mushroom coffee going to solve everything? I don’t think so. I think if you’re drinking it and you feel good on it, it’s probably not harmful, but I don’t think that there’s enough data to really say it does all the things that some studies might suggest.

Amanda Newman (08:42):

It’s a bit of a big promise, I think. Have you tried it before?

Erin Scholten, MD (08:46):

No, I have not.

Amanda Newman (08:47):

I have, but I must admit, I still have several packets sitting on a canister on my kitchen counter, because it just doesn’t taste the same as coffee. It has kind of a spicy flavor and I think that’s that cinnamon and that cardamom in it. But yeah, it’s OK.

Erin Scholten, MD (09:04):

Yeah, I think it’s personal preference. I mean, it does have high oxalate levels I think. So if you’re prone to those types of kidney stones, like oxalate stones, it might not be a great idea to try. But I think overall, I don’t think it’s harmful for most people, but it’s really, I think, personal preference.

Amanda Newman (09:21):

So mushroom coffee, regular coffee, take your pick.

Erin Scholten, MD (09:24):

Yes, exactly.

Amanda Newman (09:26):

Now, what are some other things aside from – let’s move on from coffee – that may raise your blood sugar levels?

Erin Scholten, MD (09:34):

So I tell my patients all the time, it’s not just the food that we’re putting into our body that can raise our blood sugar. While that is of course one of the major things, the types of food we’re eating, like we said before, the high carbs, the high sugar, but other things absolutely affect our blood sugar. So stress, if you’re under a lot of stress, your cortisol levels are higher, that increases your blood sugar and causes insulin resistance. Infection, so any illness or infection can raise blood sugar. Certain medications, especially like steroids, there’s some antidepressants, antipsychotics that can affect your blood sugar. Certainly a more sedentary lifestyle could raise your blood sugar. And like we talked about before, sleep deprivation of course is a big thing as well.

Amanda Newman (10:22):

And that sedentary lifestyle, that’s really hard to beat because most of us are working eight hours a day. A lot of us are at desk jobs and a lot of us aren’t, but for those that are, it’s hard, that’s why [you] got to get up and get moving.

Erin Scholten, MD (10:35):

Absolutely. Trying to find little ways to incorporate physical activity into your daily life can make a huge difference. So whether that’s always parking in the last parking spot.

Amanda Newman (10:46):

Yes, that’s what I do.

Erin Scholten, MD (10:47):

You do? Good.

Amanda Newman (10:50):

My colleagues know. They’re like, “Oh, there’s Amanda, she’s all the way out.” But it’s good because it gives me extra steps that I wouldn’t otherwise get in.

Erin Scholten, MD (10:56):

Yeah, absolutely. And just that little bit of physical activity that can just keep the momentum going. Like you said, parking spot or taking the stairs wherever you are. Can you incorporate a 10-minute walk after lunch? Just some small things that keep the momentum going can really make a difference.

Amanda Newman (11:13):

And then that can also probably help with stress management too because there’s nothing like a little extra dose of sunshine. Taking a walk on your lunch break ... because we all are obviously balancing a lot of different things on our schedules with work, with family and such, so it’s nice to just have that little mental break.

Erin Scholten, MD (11:33):

Yeah, get some vitamin D. It’s all good.

Amanda Newman (11:37):

Now, what is considered a blood sugar spike, and are there consequences for a typical person?

Erin Scholten, MD (11:44):

So a blood sugar spike is going to be when your blood sugar increases to a high level or increases above normal and can stay there. So what can typically trigger a blood sugar spike are high-carb or high-sugar meals. Somebody without diabetes could have a blood sugar spike, and happening occasionally is probably not going to cause that much. It’s not going to cause any really immediate symptoms or side effects, but it’s when you have these persistent and recurrent elevations in blood sugar over and over, day after day, that leads to insulin resistance, prediabetes and diabetes.

(12:28):

So like we said before, when your blood sugar spikes, your insulin levels go up to help your cells use that glucose for energy, store what’s not needed. But then anything, the sugar is still high, the insulin level is still going to be stimulated, so all that extra glucose is then stored as fat. So happening once in a while is not going to cause those consequences, but happening all the time over and over again is what is going to lead to the insulin resistance and prediabetes.

Amanda Newman (12:57):

And unfortunately weight gain too.

Erin Scholten, MD (12:59):

And weight gain. Yeah, absolutely, absolutely.

Amanda Newman (13:02):

Are there some ways to prevent these blood sugar spikes from happening?

Erin Scholten, MD (13:07):

Yeah. So I think focusing on a well-balanced diet, so meals that are higher in proteins, vegetables, healthy fats, and really limiting the carbs and added sugar. And I think another important thing is focusing on portion sizes. So sometimes we eat everything on our plate because it’s what’s put in front of us, but really …

Amanda Newman (13:28):

Guilty.

Erin Scholten, MD (13:28):

And a lot of our diet is so processed with added sugars that we’ve really lost sense of our hunger and satiety cues.

Amanda Newman (13:37):

We have, yeah.

Erin Scholten, MD (13:39):

So trying to eliminate that processed food and added sugar just helps our bodies recalibrate to what is hunger, what is satiety. So trying to eat slower, monitoring your portion sizes and really checking in throughout the meal, “Am I full? I don’t have to eat everything that’s in front of me,” Or, “I don’t have to eat just because it’s mealtime.” So really listening to our body of knowing when we’re hungry, when we’re full. I think listening to those cues can really help prevent some of those spikes.

(14:06):

Staying hydrated. So that’s a big thing, a lot of us don’t drink enough water, so dehydration can lead to high blood sugars. So staying hydrated. And then what we talked about before, the physical activity, even just a small walk after a meal helps prevent some of the increase in your blood sugar and helps keep it steadier throughout the day so it can limit some of those spikes after meals.

Amanda Newman (14:28):

So really being mindful as we’re eating because I know myself when I have this beautiful meal in front of me, I’m like, “Oh, let’s just enjoy all of it,” but it’s not the best thing to do. It’d be better just to save some leftovers for another day.

Erin Scholten, MD (14:42):

Yes, absolutely. And trying to eat the protein and the vegetables first can be really helpful because it makes you feel full quicker. So it sends those hormones that tell your brain you’re full to stop eating sooner, and the fiber in our vegetables really helps slow down the absorption of carbs. So eating those first and not rushing through the meal can really help us keep those portion sizes down and help with that post-meal blood sugar spike.

Amanda Newman (15:12):

That’s always another challenge too, actually just slowing down because we’re doing so many different things ...

Erin Scholten, MD (15:18):

Absolutely.

Amanda Newman (15:18):

... rushing through. As a mom, you’re attending to the kids and all the other emails and work that you have to cope with throughout the day. So it’s a lot to balance, but it’s important.

Erin Scholten, MD (15:31):

Absolutely.

Amanda Newman (15:32):

So it’s natural for blood sugar to rise when you eat, but are there symptoms to watch for that may be a sign of an underlying problem, and at what point should you start the conversation with your doctor?

Erin Scholten, MD (15:43):

When we eat, it is normal for blood sugars to rise, and when blood sugars rise, our pancreas releases insulin to help bring that blood sugar down by directing glucose into your cells like we talked about before. But if your blood sugar is staying high over long periods of time, it can lead to symptoms like increase in thirst, urinating more frequently, headaches, fatigue, sometimes weight loss, unexplained weight loss.

(16:13):

So any of those symptoms, I would definitely talk to your doctor. More severe symptoms would be like a fruity odor to your breath or nausea or vomiting that you would want to seek more urgent medical attention. But I think just if you’re noticing more fatigue, feeling more thirsty, urinating a lot is a good idea to check in with your doctor, get your blood sugars tested for sure.

Amanda Newman (16:35):

Start that conversation.

Erin Scholten, MD (16:37):

Exactly.

Amanda Newman (16:37):

That’s really important. That way it can be caught early on before things worsen.

Erin Scholten, MD (16:42):

Yes, absolutely.

Amanda Newman (16:45):

Now, why do some women feel warm or experience almost like a hot flash after eating a meal? And I can relate to this, especially after I have something that maybe had a little too much sugar in, maybe a very heavy carb meal.

Erin Scholten, MD (17:00):

Yeah, no, absolutely. It is common. It’s more common with, like you said, high-carb meals. More common also after caffeine or alcohol, that can happen.

Amanda Newman (17:10):

That rush.

Erin Scholten, MD (17:11):

Yeah, exactly. So it’s thought that the increase in blood sugar with a high-carb meal, you get that stimulation in insulin, which helps bring the blood sugar down. So it’s that fluctuation in blood sugar that can sometimes lead to that feeling of heat or sweating. Caffeine and alcohol also can cause vasodilation, so that can lead to that warm feeling. Even when you’re eating as your body’s breaking down food, it releases heat. So that can stimulate sort of that flushed hot feeling, but definitely more common with the higher-carb meals.

(17:46):

So if you notice that’s happening, it’s sort of just a trigger to just be cautious of the foods that you’re taking in. And if you are having something higher carb to pair it with a protein or a food that’s higher in fiber, that would help prevent that spike and might help with those symptoms.

Amanda Newman (18:05):

So like fruit, for example, you should really have with a protein or fat, so like apple and peanut butter or an orange with scrambled eggs maybe.

Erin Scholten, MD (18:15):

Yeah, definitely, pairing those. I mean, even an apple, for example, does have fiber. If you’re eating the whole apple, if you’re having a smoothie where it’s all ground-up fruit, you’re not really getting that fiber. But eating the whole fruit, you do get fiber with it, but pairing it with a healthy fat like cheese or a protein like peanut butter can help.

Amanda Newman (18:38):

I’m hungry now. Now, how important is it to go on a walk after eating? This is something that I strive to do. It’s great when it happens. Sometimes it doesn’t, especially if there’s a lot going on in a day. But what can it do for your blood sugar?

Erin Scholten, MD (18:56):

So exercise is an insulin sensitizer, so it helps your body use the insulin that you have better, it helps your cells use the insulin more effectively. So going on a walk can be great for helping your body lower your glucose and use that insulin better. So there’s studies that show even just a small 10-minute walk after your meal, there was a slower rise in blood sugar and a quicker return to normal of the blood sugar.

Amanda Newman (19:24):

That’s amazing. Definitely worth the 10 minutes. Go for the walk.

Erin Scholten, MD (19:28):

Absolutely.

Amanda Newman (19:30):

Now, as we’re continuing to talk about women’s health on this episode, let’s dive into female hormones, specifically estrogen and how that can affect blood sugar.

Erin Scholten, MD (19:43):

Yeah, absolutely. So estrogen is one of the primary female sex hormones and it plays a major role in our blood sugar. It has an effect on your insulin sensitivity and also on the glucose metabolism itself. So estrogen is an insulin sensitizer, so it helps your cells, like exercise, be more receptive to insulin.

(20:08):

This comes into a big role when we talk about menopause. In menopause you have a decrease in estrogen levels, so your body’s less sensitive to insulin and can predispose you to insulin resistance. Estrogen changes throughout our lifetime, through puberty, through the menstrual cycle, through menopause. So certainly where somebody is in their lifetime as far as their estrogen levels can affect how they’re responding to insulin and affect their blood sugars. It is not the only thing, so it’s one of many, many, many things that affect our blood sugars, but it’s something to consider when we’re investigating why someone is having the response that they’re having in their blood sugar.

Amanda Newman (20:54):

Well, that’s really interesting, and I love how you said that estrogen is an insulin sensitizer, and you brought up a good point that blood sugar can fluctuate throughout different phases of our life, which makes me wonder specifically during your menstrual cycle, how does that fluctuate?

Erin Scholten, MD (21:12):

Yeah, so during the first half of your menstrual cycle, it’s estrogen dominant, so people tend to be more insulin sensitive, and then the second half of your cycle is higher in progesterone levels, so can be more insulin resistant during the second half of the cycle.

(21:29):

So I don’t think that we really say to do something different during each phase of your cycle. It’s still focusing on the healthy lifestyle and healthy diet, but can help explain sometimes those fluctuations in hunger and cravings.

Amanda Newman (21:48):

That makes a lot of sense because there’s times throughout my cycle that I am so much hungrier and I’m reaching for those carbs or just more sugar, especially during this specific time of the month, and you want that chocolate.

Erin Scholten, MD (22:00):

Yeah, absolutely. So yeah, when you’re more insulin resistant, your insulin levels are higher, and insulin triggers, hunger triggers those cravings, so can certainly explain some of that.

Amanda Newman (22:11):

So a lot of women have a smart device of some sort to monitor their health. That could be a smartwatch, a ring, or even their cellphone to track things like sleep, steps, activity and heart rate. I know I love my watch. I wear it every day. It’s really helpful for me. So I’m wondering, is it helpful to start regularly monitoring your blood sugar even if you don’t have diabetes, because there’s a lot of discussion online that, “Hey, you should consider getting a glucose monitor,” but is it really necessary for us that don’t have diabetes?

Erin Scholten, MD (22:42):

So I think it’s individualized. So the body, the pancreas is so good at. ... Somebody without diabetes is so good at regulating your blood sugars that those people who wear the continuous glucose monitors, it’s going to be so tightly controlled because the pancreas is constantly adjusting your insulin level to keep your blood sugars normal.

(23:08):

So I think for most, it might not be helpful. If you have insulin resistance though, or prediabetes, or certainly somebody with diabetes, it can be extremely helpful. It shows you what’s happening with your blood sugar after your meals, you can see how different foods are affecting you. So something that is lower in glycemic index or overall considered maybe healthier, you could see that it actually does spike your blood sugar.

(23:39):

So it helps you to kind of individually tailor your diet to how your body is responding to those foods. So again, I think it’s individualized. For some people, I think it could be helpful to receive that kind of real-time feedback.

Amanda Newman (23:52):

Sure.

Erin Scholten, MD (23:54):

I think without a history of diabetes or insulin resistance or anything, your body does such a good job that it’s going to be pretty steady, but any signs of insulin resistance, especially women with PCOS, I do think it could be helpful to see how you’re responding to your meals.

(24:13):

So a continuous glucose monitor is like a little sensor that goes under the arm that’s monitoring your blood sugar every five minutes, and it shows it to you on your device, so you could see where was your blood sugar before your meal, where was it 30 minutes after, two hours after to see how that affects you.

(24:30):

Those other devices you mentioned, the watch or the Oura ring or things like that, it helps track activity, sleep. So I think as long as you’re using that to help move yourself forward and have it be a positive reinforcement and not looking back and punishing yourself for like [a] bad day.

Amanda Newman (24:49):

Oh, I didn’t get my 10,000 steps today.

Erin Scholten, MD (24:52):

But if you can use it as something to motivate you to reach a goal and kind of hold you accountable and track that, I think that could be hugely helpful for people.

Amanda Newman (25:01):

That’s great. And they even have little challenges that you can do with one another, someone else that has a smartwatch. I really love it, and I think it is just that, a tool that motivates me to get outside, get that exercise in, and also meet that move goal and burn those calories that I want to get.

Erin Scholten, MD (25:20):

Yeah, absolutely.

Amanda Newman (25:22):

So how often should you get your blood sugar tested?

Erin Scholten, MD (25:25):

Yeah, so when we’re screening for prediabetes and diabetes, we tend to use a blood test called an A1C. So a single finger stick blood sugar or a blood sugar on a lab is really just one point in time. It doesn’t tell the whole story. So an A1C is a marker of your average blood sugar over three months. So that is a better long-term marker of what’s going on with your blood sugars.

(25:52):

So an A1C, which is recommended … starting at the age of 45, it’s recommended to get it checked. If you’re under 45 and you have a risk factor for diabetes, then it’s recommended to get checked. So a risk factor would be overweight or obesity. If you have history of gestational diabetes, PCOS, family history of diabetes, then we’d start the screening earlier. But if you don’t have any of those risk factors, starting at age 45, it’s recommended to get an A1C.

(26:25):

If it’s normal, then about every three years you would do another screening. If it’s abnormal, then we check it more frequently. So if A1C less than 5.7 would be considered normal. 5.7 to 6.4 is considered prediabetes. So we’d probably monitor every six months, six to 12 months if you had prediabetes, and then 6.5 or above is consistent with type 2 diabetes, and then you’d be monitored much more frequently.

(26:54):

And so if we know you’re in the prediabetes range, that’s a crucial time where we can really intervene with our lifestyle modifications and education to really help reverse it, go back to the normal range and prevent the progression to diabetes. So screening is huge to really be able to catch this early and put forth those interventions that can help prevent the development of diabetes.

Amanda Newman (27:18):

It all goes back to how important screening is. Which brings me to my next point because 98 million American adults have prediabetes, but the most concerning part about that is eight out of 10 of them don’t even know that they have it. So let’s talk about who’s at risk and how can we start reversing prediabetes if we are on the verge of having it.

Erin Scholten, MD (27:43):

Yeah, absolutely. So prediabetes is when your blood sugar levels are higher than normal, but they’re not in the diabetes range yet. And this is a crucial stage because this is where you could have a huge impact in reversing it and getting it back to normal and preventing the development of diabetes.

(28:01):

So in prediabetes, we have a huge emphasis on really education and really helping patients incorporate those lifestyle modifications and those eating habits that we talked about, really just incorporating it into their life. At the Diabetes and Metabolism Center, we have classes specific for prediabetes as well as type 2 diabetes.

Amanda Newman (28:22):

What kind of classes?

Erin Scholten, MD (28:23):

So it’s really focusing on looking at your diet and how can we cut out those refined carbs, the sugars, how can we help support patients in creating a more balanced diet higher in proteins and vegetables and those healthy fats, helping them figure out how they can incorporate small lifestyle changes, small activity changes, I should say, into their lifestyle, so getting more active. It’s hard for patients to go from no exercise to 150 minutes a week.

Amanda Newman (28:57):

Yes.

Erin Scholten, MD (28:58):

How can we set small goals and really help patients reach those goals, whether it’s just a 10-minute walk or something that’s attainable for them. So with our education classes, we have patients meet with our diabetes educators to look at diet. We also have a lifestyle medicine doc who can really help patients focus on all those other aspects we talked about, like sleep, stress management, different types of diets that might work for them. And we have health coaches. The health coaches are really helping patients implement behavioral change. So we can say do X, Y, Z, but really helping them incorporate into their lifestyle and making it a part of their every day. People are their own worst enemy sometimes ...

Amanda Newman (29:46):

Oh, definitely.

Erin Scholten, MD (29:47):

... can sabotage themselves.

Amanda Newman (29:48):

Yeah, having an accountability partner like the health coaches, that’s wonderful.

Erin Scholten, MD (29:53):

Yes, absolutely. It’s somebody to hold you accountable and help you figure out what’s the barrier to doing this and how can we break down those barriers and make those changes. So we try to arm people with all this information so that they can lead a healthier lifestyle.

(30:09):

So our patients that are at higher risk for prediabetes are those that have a family history of prediabetes or type 2 diabetes. Somebody who’s had gestational ... A woman who’s had gestational diabetes during a pregnancy, they’re going to be at higher risk of developing diabetes in their lifetime. PCOS, because insulin resistance is a major component of PCOS, they’re going to have higher risk of developing prediabetes and diabetes. So those are definitely people we want to try to target and get the appropriate screening done for them.

Amanda Newman (30:44):

That was wonderful. Thank you for sharing all of that. Super helpful, because again, prediabetes, it’s out there, it’s prevalent, and we all have to be mindful of it so that it doesn’t escalate to diabetes.

Erin Scholten, MD (30:58):

Absolutely.

Amanda Newman (30:59):

When it comes to eating right for blood glucose, does time of day and order help?

Erin Scholten, MD (31:06):

Yeah, absolutely. So a couple of things. So I think when we are sitting down to eat our meal, trying to eat our proteins and our vegetables first before the carbs can be helpful. Vegetables are higher in fiber, so they’re going to help slow the absorption of glucose from the carbs. So we get less of a spike after our meal. They also are a bulking agent, so they make you feel fuller. They start the process of sending those signals to the brain to say, “Hey, I’m full. I don’t need to keep eating.”

(31:37):

So if you are filling your stomach with those more nutrient dense foods first you’ll probably be eating less carbs. So that can help feel full quicker, eat smaller meals and help prevent that spike in your meal.

(31:55):

The other thing I tell patients is try to eat your set meals per day, so whether that’s two or three meals. ... For most people, obviously you need to talk to your doctor based on your medications and conditions, but for most people, eating your three set meals per day and trying not to snack in between.

(32:14):

So we talked at the beginning of this too. When you eat, your blood sugar goes up, which triggers insulin release. So the insulin can direct the glucose into your cells to be used for energy. It stores what you don’t need now for later, and then any excess is stored as fat. If you have this continuous stream of glucose coming in all day, you never even need to access those reserves, so you’re not going to be able to lose weight.

(32:43):

So eating the set meals allows your blood sugar to drop between your meals, your insulin level decreases, and then when the insulin level is low, your body is able to access that stored fat for energy and converts that to energy. So allowing those insulin levels to decrease between meals is really going to help your body use your stored energy, your stored supplies better.

(33:05):

The other thing I tell patients is try. ... Whenever time you eat dinner, say it’s 6 o’clock, then set a time, after 7 o’clock, you’re not going to eat again until breakfast. So then that entire evening, you’re considered in a fasted state, your body is using your own energy stores or your own glucose stores for energy.

(33:24):

For some people, after discussing with their doctor, might do a more extended fast. So something called intermittent fasting where maybe you don’t eat after 7 p.m. and you have your first meal of the day at 11 a.m. So you have 16 hours without eating, and then you eat just during an eight-hour window.

(33:46):

During that time, it allows the insulin levels to be low, so your body is using your own fat stores for energy, and that’s how it allows us to release that stored fat to use for energy, but also can help with weight loss and lowering insulin resistance.

(34:02):

So intermittent fasting is not right for everyone. Certainly you need to talk with your doctor. Certain medications or medical conditions might preclude that, but it can be a really good tool to help with insulin resistance and to help with weight loss.

Amanda Newman (34:17):

And cutting off those snacking habits.

Erin Scholten, MD (34:19):

Yes, absolutely.

Amanda Newman (34:21):

It’s hard. But yeah, because you have that hunger memory that sticks around if you’re used to snacking all the time like myself, but that’s probably why I have ... would it be excess insulin? I’m not using that up because I just keep snacking throughout the day.

Erin Scholten, MD (34:35):

Yeah, and I think for some people it’s habit, it’s just what they’re used to doing. So it’s trying to come up with new habits or just new nightly routines that don’t have you in the pantry, but going for a walk, reading a book, tea, like a hot tea, just something else that can kind of help distract you.

(34:59):

Most of the time it’s not true hunger in the evening, it’s just cravings from having that elevated insulin levels. So trying to just redirect can help break the habit. And then I think, again, going back to those, we’ve lost those hunger cues. Once you go through a period of cutting out more processed food and sugar, most people notice that those cravings decrease significantly if not go away completely.

Amanda Newman (35:28):

Oh, OK. That’s good news. Progress is possible. We can break bad habits together. Why are naked carbs bad for blood sugar?

Erin Scholten, MD (35:42):

Yeah, so naked carbs are really just simple carbohydrates without anything else. So there’s no fiber, there’s no protein, there’s no fat with it, and it just leads to a quick spike in your blood sugar, which is quick spike in your insulin, and it tends to not fill you up, often leads to more cravings. So it’s usually not nutritious, so it doesn’t really serve a huge nutritious component.

(36:10):

So trying to pair it with a protein, pair it with something higher in fiber really helps slow that rise in the blood sugar so there’s less of an insulin spike. So just kind of trying to even things out.

Amanda Newman (36:25):

Like putting cottage cheese on toast.

Erin Scholten, MD (36:27):

Yeah.

Amanda Newman (36:27):

So which carbs are good for you?

Erin Scholten, MD (36:31):

Yeah, so good carbs are ones that provide a lot of nutrients, fiber, they’re going to provide a lot of more sustained energy. So you want to look at things that are more whole grains like your quinoa, your oats, your brown rice. Your white bread, your white carbs, they’re really stripped of fiber, they’re stripped of the nutrients., ... They taste good.

Amanda Newman (36:57):

Of course they do.

Erin Scholten, MD (36:58):

But they have very little nutritional value, so trying to really use the whole grain. The other thing is something. When oat is converted into a flour, when you’re breaking down these whole grains into a flour, your body doesn’t have to work as hard to break it down, so they can spike your blood sugars more.

(37:18):

So really trying to keep the grains in their whole form is healthier for you, more nutrient-dense and less of an effect on your blood sugar. So eating those whole grains in their whole form.

(37:31):

Legumes like beans, chickpeas, peas, they’re a good source of protein and fiber. Fruits like berries, apples, like I said, apples have that fiber in them. … Those have sugar in them, but they’re natural sugars. It’s the added sugars that really affect the blood sugar more.

(37:55):

And then your non-starchy vegetables like broccoli, cauliflower, peppers, carrots, cucumbers, all of those are good, healthy, healthy carbs. And then if you have to have processed grains, doing more whole wheat, whole grain, like whole wheat pasta, whole wheat bread if you have to have that.

Amanda Newman (38:15):

OK. Great tips. And going back to that saying of if it’s white, you should avoid it, correct?

Erin Scholten, MD (38:24):

I think everything in moderation. It’s true that they’re more processed, they’re going to have a bigger effect on your blood sugar and your insulin level. I think saying something is all bad and you should never have it probably is not sustainable, but everything in moderation. So keeping the sort of treat foods, the celebration foods, just at a minimum.

Amanda Newman (38:48):

For a special occasion.

Erin Scholten, MD (38:49):

Exactly. Never say never, just in moderation.

Amanda Newman (38:53):

Fried okra. Well, anything fried is delicious, let’s be honest. But this is something new. Okra water, apparently soaking okra pods in water is now a health trend on TikTok. There are claims that it may support weight loss, keep you hydrated and even manage blood sugar as we’re talking about. Is this true?

Erin Scholten, MD (39:17):

Well, I don’t think there’s any magic fixes to managing blood sugar. Okra has a lot of antioxidants, vitamins, anti-inflammatory benefits. So I don’t think it’s harmful. Is it the answer to regulating your blood sugar? Probably not. I think eating a well-balanced diet of fruits and vegetables can give you the same vitamins and minerals. Certainly it promotes increase in water intake, which is always good for our health. So I’m for that. Does it have to be okra water? No.

Amanda Newman (39:50):

It can just be regular water.

Erin Scholten, MD (39:51):

Regular water is fine. I mean, I don’t think it’s harmful. I just don’t think it’s the magic-bullet answer to preventing diabetes or high blood sugar.

Amanda Newman (40:02):

What about those electrolyte packets? Are those important?

Erin Scholten, MD (40:06):

I would be cautious that if there’s added sugar in them, so some of them can contain a lot of sugar, but sugar-free ones, particularly somebody who exercises a lot, who’s sweating a lot, can be helpful to add. But again, just being careful of added sugar in those packets.

Amanda Newman (40:25):

Yeah, avoiding the ones with added sugar.

Erin Scholten, MD (40:27):

Yes.

Amanda Newman (40:29):

OK. So okra water, not necessarily the answer to all things blood sugar. However, what about supplements, maybe alpha-lipoic acid?

Erin Scholten, MD (40:41):

Well, alpha-lipoic acid is a compound that is an antioxidant in the body. It’s been studied for its potential effects on blood sugar, but I think more research is really needed to confirm its effectiveness. But in studies, it shows that it can improve insulin sensitivity. Some studies show its use in reducing peripheral neuropathy. Again, I don’t think there’s enough data to definitively say it helps. I think it’s probably not harmful. But is it, again, the magic answer? I don’t think so.

Amanda Newman (41:17):

OK. And what about apple cider vinegar? Because I’ve seen things where if you drink two tablespoons right before a meal that it can help with blood sugar regulation. Is it real? Is it not?

Erin Scholten, MD (41:31):

I guess probably it’s individualized to people. I mean, I think just focusing on a balanced diet with that meal could also help regulate your blood sugar just as much with that meal than having to add all these supplements.

Amanda Newman (41:43):

Extra supplements. So it goes back to we don’t have to add all these excess things like okra water or another supplement, more so it goes back to that whole foods approach.

Erin Scholten, MD (41:56):

Yeah, absolutely. Absolutely.

Amanda Newman (41:57):

And getting that exercise, staying hydrated, all of those things.

Erin Scholten, MD (42:01):

Yes, absolutely. I think that it’s the cumulative effects of doing that every day that are going to provide the most success.

Amanda Newman (42:09):

What is the blood sugar diet, and is it a good plan for some people?

Erin Scholten, MD (42:14):

So there are so many different diets out there.

Amanda Newman (42:18):

Too many.

Erin Scholten, MD (42:19):

Yes. The blood sugar diet ... focuses heavily on a very low calorie diet and emphasis on fasting. So I find that those really restrictive diets, while in the short term they can be effective, they’re really not a long-term solution. So when we look at all different types of diets out there, there’s not necessarily one that’s better than another for weight loss. It’s really what can you sustain for your lifestyle and your culture and your goals in life, which can you sustain long term that’s really going to be the most success. So I think the more restrictive ones are harder to stick with.

So we try to encourage patients to make more small changes that they can more regularly incorporate in their everyday life and they could see themselves doing a year from now. The blood sugar diet is a very intense eight-week diet plan. So I think for those ... if you can follow it, it can be effective in those short eight weeks. But then what happens six months from then, a year from then? We encourage patients to find diets ... or not necessarily diet, but more lifestyle changes, that are more sustainable for them.

Amanda Newman (43:40):

Because when you stop the diet ...

Erin Scholten, MD (43:43):

It’s a lot of yo-yoing.

Amanda Newman (43:44):

Yep. You start it, then you stop, and then you deal with the weight gain again or all the other issues that you’re dealing with. So it’s an endless cycle. So that’s why it’s better to do things in small steps, things that are actually attainable.

Erin Scholten, MD (44:00):

Yeah, because very restrictive. So it’s extremely low-carb, focuses on what we’re talking about, focuses on high protein, high vegetables, healthy fats, but in such an extreme way that it’s hard to be sustainable.

Amanda Newman (44:18):

What about eating according to the glycemic index? This sounds like something that may be a little too much for some. How’s this done? Are there proven health benefits?

Erin Scholten, MD (44:29):

So the glycemic index is a scale that ranks carbohydrates into how much it affects your blood sugar. And it usually is comparing it. A reference is either glucose or white bread. According to the glycemic index, you’re going to be eating carbohydrates that have less of an effect on your blood sugar.

(44:51):

So I think it certainly can be helpful. Foods that are lower on the glycemic index are your non-starchy vegetables, your whole grains, your nuts, your seeds, chickpeas, beans, things like that, or have a lower glycemic index, so less of an increase in your blood sugar after your meals. And again, that’s important because less of a spike in your blood sugar is less of a spike in your insulin.

(45:17):

Your higher glycemic index foods are going to be your more simple carbs and sugar and things like that that aren’t as nutrient dense and then also have a higher spike in your blood sugar. So I do think it can be helpful looking at the glycemic index of foods and just trying to help guide you to the healthier carbs.

Amanda Newman (45:37):

For everyone really.

Erin Scholten, MD (45:38):

Absolutely.

Amanda Newman (45:39):

OK. Recently there’s been a warning from the TikTok health community to stay away from oat milk. And this kind of breaks my heart because we have oat milk in our fridge and we use it for a lot of things because my husband’s dairy free, and if you want to have hot chocolate, you got to add something. But I guess because it scores so high on the glycemic index. Again, the TikTok health community, very upset about oat milk. Do we really need to be worried about oat milk drastically raising our blood sugar?

Erin Scholten, MD (46:14):

So, no. I think that it is moderate to high on the glycemic index, but its impact on your blood sugar really depends on what else you’re eating it with. For somebody who’s lactose free, they need an alternative.

Amanda Newman (46:30):

Alternative.

Erin Scholten, MD (46:30):

And I think it’s a fine alternative. There are other nutrients also in the oat milk that are good for you. It’s rarely used in isolation. Usually it’s with fruit, used in a smoothie, or eaten with another protein or another fat that can really help taper that rise in the blood sugar.

(46:53):

So again, I don’t think it’s all or nothing. I don’t think it’s all bad. I think it absolutely can be used as part of a healthy diet as a milk alternative. I mean, milk itself does have sugar in it as well. So none of those things are completely sugar-free. So again, it does have a high glycemic index, but when it’s used as part of a healthy, well-balanced diet, I think it’s fine.

Amanda Newman (47:21):

Good. Now, on the other side of the spectrum, what about things that are unsweetened or least they say they’re unsweetened. So this is besides oat milk, other drinks, foods where they sneak certain things in, market it as unsweetened, but there’s actually super sugars in these things; they’re just hidden with a different name.

Erin Scholten, MD (47:46):

Yes. So sugar alternatives, like artificial sweeteners, while they might not have as much of an effect on blood sugar, they can raise insulin levels. So I think it’s all in moderation and how else you’re incorporating it into your diet. So eating it with more well-balanced meals shouldn’t have a huge effect on your blood sugar, but just being careful of the added sugars or the added sugar alternatives, that it is in moderation and not overdoing it.

Amanda Newman (48:20):

Simply being mindful of everything ...

Erin Scholten, MD (48:21):

Yes, absolutely.

Amanda Newman (48:22):

... that we are taking in, whether that’s food, beverage, whatever. To wrap up today’s episode, what are the best ways to be mindful of your blood sugar in order to prevent prediabetes?

Erin Scholten, MD (48:35):

I think focusing on a balanced and healthy lifestyle is key. I think for most of the time, avoiding foods that have added sugars or processed carbs. I think it’s not all or nothing, but most of the time to try to focus your diet on more healthy vegetables, proteins, healthy fats, and avoiding those added processed carbs and sugar is ideal. Trying to incorporate exercise into your life, like we said, doesn’t have to be all or nothing, but picking something small that you think is attainable and trying to incorporate that into your lifestyle.

(49:14):

I think important to prioritize sleep, so we make sure we’re getting enough sleep every night. And that being screened for sleep disorders, if there is something going on with our sleep, and stress management. I think that it doesn’t have to be all or nothing. It’s sort of picking little ways you can improve your lifestyle every day.

(49:37):

I think having a plan. So I tell patients kind of pick what’s something you can commit to, like one dietary change, one physical activity that you think you can commit to, write it down. That’s going to be your goal. And it doesn’t have to be major, but just a small change, and try to do that every day. Once that’s comfortable for you, once you’ve incorporated that into your lifestyle, then add something else.

(50:02):

So it’s making these small changes that, over time, I think, can add up. For some patients it’s meal planning. We’ll say, “OK, pick a day of the week that you will plan out three or four meals for that week.” I think it’s a daunting task to say, I’m going to plan every meal, breakfast, lunch and dinner for the next seven days.

Amanda Newman (50:22):

A little overwhelming, but small steps. Start with maybe Friday at the end of the week.

Erin Scholten, MD (50:28):

Can you plan three lunches this week where you’re going to bring something or three dinners that you’re going to make and not get takeout or whatever they normally do? So trying to figure out small goals. And once you’ve set that goal, do you think you can do it? A scale of 1 to 10, it should be an 8, 9, 10 that you think you can stick with it.

(50:46):

And then once they’re doing that more regularly, then what else can we add? What other small goals can we add? And it’s just kind of building on that, that really. Then you look back and you have made all these changes that weren’t so daunting once you broke it down and did it one at a time.

(51:04):

So I think trying to focus on what are those small changes that you can make and really incorporate into your lifestyle. And we have, at the Diabetes Center, educators that help patients figure out where can they make substitutions in their diet, where can they make these changes? The health coaches help them with these behavioral changes. So whether you have prediabetes or diabetes, we can help you make these lifestyle changes and kind of incorporate it into your life.

Amanda Newman (51:33):

It goes back to that habit stacking, as you were saying.

Erin Scholten, MD (51:35):

Absolutely.

Amanda Newman (51:36):

We start with one thing and then you keep building.

Erin Scholten, MD (51:38):

Absolutely.

Amanda Newman (51:39):

Thank you so much Dr. Scholten; this has been wonderful. We have learned so much. It has been great having you here today. Thank you.

Erin Scholten, MD (51:46):

Thank you so much for having me.

Amanda Newman (51:48):

To learn more health tips, visit LVHN.org/healthyyou. Remember to subscribe to or follow The Healthiest You wherever you get your podcast so you never miss an episode. And remember, be safe, be smart and be the healthiest you.