22. A Plant-based Diet to Treat and Reverse Type 2 Diabetes with Dr. Janel Gordon

[00:00:03] Hi everyone, welcome to the Better Medicine podcast. I'm your host Dr. Omar Akhter. In this podcast I talk with various experts to find better ways of addressing chronic disease. I hope you find this content beneficial. Type 2 diabetes is one of the most common

[00:00:20] diseases in the western world. Much of the emphasis in medical communities based around medications for treating diabetes and often times the discussion of diet and lifestyle gets left behind. On this episode I speak with Dr. Janel Gordon on using a plant-based

[00:00:36] diet to improve and reverse your type 2 diabetes. Yes, reversing your type 2 diabetes is possible contrary to what we've been taught in medical school. I hope you find this discussion beneficial. Now let's head over to the episode. Dr. Janel Gordon

[00:00:52] Hi everyone, today I have the pleasure of speaking with Dr. Janel Gordon. Dr. Gordon is a board certified family obesity and lifestyle medicine physician. Dr. Gordon is certified in plant-based nutrition by the T. Colen Campbell Center for Nutrition Studies and the E. Cornell

[00:01:10] University. She is certified in culinary coaching by Harvard Medical School, the Institute of Lifestyle Medicine and Spalding Rehabilitation Hospital. Dr. Gordon was recently selected as a leading physician well-being fellow with the American Academy of Family Physicians through which she is receiving further training in leadership development, program development

[00:01:30] and quality improvement. Dr. Gordon has special interests in culinary medicine, food security, community development and sustainable efforts. She enjoys spending time with loved ones, traveling and discovering delicious and nutritious foods near and far. So Janel,

[00:01:46] thanks so much for joining me on this podcast episode. I look forward to this conversation on diabetes and nutrition. Dr. Janel Gordon Thank you Omar, thank you for having me. Dr. Gordon This is an important topic and we connected because we share a lot of really important

[00:02:05] ways of looking at diabetes, looking at food as medicine. You're obviously board certified in lifestyle medicine. I want to just first ask you a little bit about your background, how you were trained in your triple board certified and just a bit about your background

[00:02:21] and journey from then till now. Dr. Janel Gordon Yes, so I was trained traditionally like most physicians in our country today. So I finished medical school. First I'll start by saying all my education was in the South after high school.

[00:02:35] So after finishing high school in Indiana, I went to North Carolina for undergrad then Kentucky for meds going up to Maryland for residency and it really was the traditional training. Once entering into practice after completing my residency, I started realizing

[00:02:50] that I didn't have all the tools I felt like I needed to really help patients. I had medicines, the latest medicines but my patients still weren't really getting better and we needed to continually add medications either to deal with side effects or because of additional diseases popping up.

[00:03:07] So that really led me to focus more on obesity medicine and from there I've since added lifestyle medicine as well. Dr. Janel Gordon And type 2 diabetes, does it hold a special place for you? Can you talk a little bit about that? Dr. Janel Gordon

[00:03:25] Sure yes. So my father actually passed away from cardiac arrest when I was in high school due to complications from uncontrolled diabetes, high blood pressure as well as high cholesterol. Additionally, my mother has diabetes and high blood pressure recently had a stroke at the beginning

[00:03:44] of 2021. Her mother, my maternal grandmother has diabetes and my father's adoptive mother also had diabetes and ended up undergoing amputations of her lower extremities when I was in elementary school. So it definitely is near and dear to my heart and that really does shine through when I

[00:04:01] am meeting with patients and guiding them through lifestyle changes to either improve their chronic diseases such as diabetes or hopefully resolve them. Dr. Janel Gordon Yeah I think when it hits you personally with family members, I think that it just

[00:04:15] carries so much more impact. I mean we all see patients with diabetes and we know the extent of diabetes but when you're seeing a loved one go through it like you did then you know it just hits so much more. So I appreciate you sharing that.

[00:04:30] So right now when you see a patient with type 2 diabetes obviously there is the medications and then there is the management. We can talk about that maybe another time of the medication management but I think what people are particularly interested in and the message that they need

[00:04:49] is what role diet plays in type 2 diabetes and I think there is some misunderstandings around that. So I wanted to talk a bit about that. How do you approach a patient with type 2

[00:05:01] diabetes whether they're a new patient with it or they are a patient that has had it for a long time but you're counseling them on the how to eat given your culinary background. How do you go about that initially? Dr. Janel Gordon

[00:05:15] Yes so historically we've always felt that if someone is either pre-diabetic or has diabetes and new onset or as you said have had it for some time that they need to avoid carbs but more and more we're learning that it's not just any carb but truly those ultra-processed

[00:05:33] carbohydrates that can easily cause the blood sugar to spike up on eating or drinking and let's not forget those sugary beverages right? So we're now noticing that the carbohydrates that are found in whole plant foods such as fruits and vegetables, beans and whole grains actually

[00:05:50] don't cause such high level spikes in blood sugar as those ultra-processed counterparts do. So I first like to really talk to a patient especially from a culinary standpoint in here well what are their foods that they enjoy eating or foods that they may feel or categorize as bad

[00:06:05] foods that they should avoid and kind of work our way back and move forward and not taking away those foods that they enjoy but trying to find more healthy ways to prepare them and eat them.

[00:06:17] Okay and what do you find are the biggest barriers that patients are having when you're having these initial conversations that patients might have towards trying to manage their diabetes from a diet perspective? What I've noticed is that the biggest barrier that people in general

[00:06:36] be that in the doctor's office or out in the community when I'm speaking with people is time. People just feel like they're too busy and they don't have the time to prepare

[00:06:45] healthy foods it seems like it takes forever you buy the fresh produce it seems to go bad very quickly and so we try to find ways for them to manage their time and plan in advance maybe not trying to buy

[00:06:58] the groceries prep the groceries and then cook the meal and try to eat it all within the same day or couple days but doing that over time throughout their week and a big or easy way to

[00:07:09] do that is through batch cooking so if you cook a meal that will provide multiple portions maybe even two weeks worth you can freeze half of that right away and then divvy up the meals throughout the week

[00:07:23] and when you get home or when you're at work and it's time to sit down and eat you don't feel like gosh I don't have time let me run out and get food that may not be as healthy. Right so

[00:07:32] preparation and planning is certainly very important right um and I think you made a really important point when you talked about the types of carbs that we're talking about where when when we

[00:07:44] say whole foods these these whole plants and talking about how they tend to spike in the sugars much less and hence insulin much less and so they are they aren't contributing to

[00:07:58] insulin resistance in the same way that a lot of these ultra processed foods are so that's a very important point because I think that people get pigeon holed and tunneled into this low carb

[00:08:11] versus high carb versus low fat high fat you know these these are two simplistic terms when we're talking about it from an overall how to eat or overall dietary perspective when it comes to

[00:08:24] to any chronic disease really doesn't have to be diabetes so I think that that's a very important point and I just want to stress on it a little bit more for people that may not understand

[00:08:34] it what are some of the foods that you would put in this category of not highly processed and that that are carbs or perhaps slow carbs and perhaps that don't spike your insulin up as much. Sure

[00:08:48] so it seems like potatoes and rice have been demonized and my current practice I work with patients from all over the world and what we know is that a lot of individuals who didn't grow up

[00:08:59] eating that standard American diet which we really like to refer to as the sad diet they have potatoes and rice as staples in their nutrition and those are foods they still want to eat so then

[00:09:10] when we tell them that they now have this disease again be it pre diabetes or full diabetes oh well you can't eat rice and you can't have potatoes well how does that make someone feel so we're

[00:09:21] really trying to move from being so restrictive but again helping individuals choose individuals choose healthier options so maybe instead of that white rice having brown rice and I even try not to automatically tell them oh don't eat the white rice at all but maybe try mixing it in

[00:09:36] right adding some brown rice like half and half and then the white rice or other types of rice is where it hasn't been as processed and they're getting more fiber in the diet and that

[00:09:46] fiber which we know most Americans do not get enough of really helps them stay full longer helps prevent the blood sugar from spiking so quickly or as high helps prevent you from having high triglycerides or cholesterol and really also contributes to a healthier gut microbiota

[00:10:08] yeah reduces the risk of colon cancer as well and we you know we know that our this country has the one of the highest rates of colon cancer and it has one of the

[00:10:19] lowest intakes of fiber so that correlation is also there the point on rice is very important because I myself come from a South Asian background and so you know I know the importance of

[00:10:33] certain foods in a cultural setting and so we really have to individualize diet because you know to tell two people to the exact same diet can be very different because one person it could be such

[00:10:47] a deeply ingrained aspect of their existence and their culture whereas for another person it could be very easy to remove white rice let's say so I think that that individualization is important and that's why it's it's important to work with patients where they are depending on

[00:11:04] the background and everything you know someone with type 2 diabetes like you mentioned instead of removing rice altogether it could be going to brown rice or just making those small changes so

[00:11:17] a very important point there I want to ask you now what are some of the barriers when it comes to cost do you have that issue when patients say that oh you know fast food is so much easier

[00:11:32] to you know grab and so much cheaper right whereas preparing meals can be much more expensive you have to buy you know groceries that that are more the cost more so what are you telling people

[00:11:46] that are more on a budget sure yes so it is very important to partner with patients to help them make changes that they can actually uphold and I know historically a lot of us a diagnosis

[00:11:59] code that oftentimes will see listed is non-adherent to medical treatment what are we really taking in time to figure out why that is is it from a financial standpoint which is another barrier that I often hear from patients especially depending on what population you're

[00:12:13] commonly working with so going back to the batch cooking that's a good way to do it if you're using dry beans and whole grains and a little goes a long way when it comes to a dollar

[00:12:23] also a lot of people assume that in order to eat healthy they have to eat organic and that's not necessarily always the case for every food item so again I like to start with well what are the

[00:12:34] foods that you enjoy or what are the type of meals that you enjoy and then I myself love food as we know that's everything is about food is medicine culinary medicine culinary coaching so oftentimes I'll find myself in the grocery store and even though I myself already have

[00:12:49] a list I'm perusing the aisles for different items that I've heard patients tell me they enjoy and that's not just where I live locally in Indiana but even when I'm out and about and traveling

[00:12:59] throughout the US or even globally and that allows me to help patients oh you know why I saw this was on sale at Aldi or Target or Walmart had this item on sale and I even do that in

[00:13:11] the patient visit like when they tell me what food items are their go-tos we'll look it up together I have my computer screen facing them and I'll show them not just the nutrition facts and

[00:13:21] showing oh look how much sugar is in this item or how much salt or sodium is in this item but look at the price point for this product compared to this one and I've noticed that I do get more results

[00:13:31] with that so I think the message is that certainly if you're on a budget you can still make it work and you can still eat in this whole foods kind of plant-based way and with meal prep

[00:13:43] and all that so I think that that's important for people to understand because this is one of the biggest barriers in their mind I find so sure and that's very important I wanted to add is that when

[00:13:54] it comes to produce so we do know that it is more sustainable and usually more affordable when you are buying those items in season but we can't always do in season or you feel like again the

[00:14:06] foods go bad pretty quickly so what I do myself is buy some of these items frozen and especially when it comes to the fruits those are easier to do and avoid added excess salt fat and sugar but for

[00:14:17] the vegetables sometimes especially if it's a mixture there could be a marinade or sauce either on it or a package separately and so I usually will recommend that the patients avoid the use of

[00:14:27] those or use those sparingly and then you can season those items to your liking especially with like salt free seasoning exists okay yeah good point um so I wanted to ask you now kind of um zooming

[00:14:41] out and looking at things not from an individual patient perspective but more from a societal perspective what are the different ways that you've come across in terms of guidelines and in terms

[00:14:52] of studies that um that we can point people to and say here is really good evidence that this type of diet lifestyle change works equally if not better than medications and is really important for you to take in order to enhance your health specifically related to type 2 diabetes

[00:15:12] yes so through my preparation for the lifestyle medicine boards I came across the CDC's diabetes prevention program study and through that study they showed that individuals who assumed a low fat diet or nutrition actually had a lesser progression into type 2 diabetes or lessening

[00:15:34] of their blood sugars compared to those individuals who were taking metformin and that really did blow me away because metformin we know is the gold standard when it comes to diabetes care or even individuals who have free diabetes and though those patients were not eating necessarily

[00:15:50] a full plant-based diet it is difficult we know to have a lower intake of fats especially saturated fats if you are not consuming a more plant-forward diet or nutrition so meats dairies especially red meat and more processed meat such as bacon sausage luncheon or deli meat

[00:16:13] is usually going to be higher in saturated fat as well as salt additionally patients not only were eating a low-fat diet but they were partaking in 150 minutes of moderate physical activity weekly okay and so oftentimes patients will ask me well how do I get 150 minutes in or what

[00:16:32] does moderate intensity mean and I tell patients start where you can just like with the food when it comes to activity if you can only walk for 10 minutes today we now have data to back up that

[00:16:42] that is beneficial if you have a desk job or you're sitting for long hours during the day try to get up at least once every hour in stand for about 10 minutes because simply sitting is cutting

[00:16:53] years off of our life and increasing our risk of chronic disease and then when it comes to measuring moderate intensity you should be able to talk while you're partaking the activity but not necessarily saying yeah that's all very important information and I appreciate you

[00:17:09] relaying that cdc study hopefully we can send the put it or put the link in that in the show notes I wanted to ask you also about um you know it's important for people to hear about

[00:17:22] patient success stories when we're talking about patients coming in with type 2 diabetes and you know a lot of people that wonder if this could help them if a diet change can help them or how it's going to help them sometimes it's very impactful to hear about patients getting

[00:17:39] better and that can spur people on in order to make these changes themselves so do you have any specific cases or stories that you can share about patients going through these programs and going through these changes and actually making the requisite changes and improving their health

[00:17:58] sure yes so one of the things I did notice when I first entered practice after completing my residency training when I would see a patient and recommend follow-up within a few months

[00:18:09] oftentimes they did not want to do that no doc I'll come back in six months I'll come back in a year just give me my medicines and I know what to do but when they would come back you

[00:18:18] would see that there really hadn't been much improvement so in my current practice I found when partnering with patients and really doing lifestyle changes or practicing lifestyle medicine patients are actually eager to come back so my patients usually will follow up with me monthly

[00:18:34] if they are interested in intensive lifestyle intervention which the studies show through intensive lifestyle intervention meeting with the physician and a nutritionist patients are going to lose the weight and maintain that weight loss at a year's time and so I actually do

[00:18:49] have a patient who I've been seeing recently and over the last five months this patient and who has a history of high triglycerides pre-diabetes as well as obesity and is used to doing multiple

[00:19:05] fat diets in the past to help drop weight but not really focused on well-being so he's been seeing myself he's been meeting with our full-time chef as well as a health coach and he was

[00:19:17] able to get his a1c down from 5.9 to actually 5.5 and it's still a work in progress but it's no longer elevated to the point that it was he's also been able to normalize his cholesterol

[00:19:31] so his LDL went from above 100 to 89 now I would love to see that 70 or lower because we know when it gets to that point that is really going to have the lowest risk of

[00:19:43] cardiovascular disease but again he's moving in that process and I just love hearing him say oh my gosh Dr. Gordon you know I'm not even focused on the weight I'm just focused on

[00:19:55] living healthier and I feel so good I've never felt this great but as a byproduct the weight is coming off and we know that ultimately that will help continue to decrease his incidence or risk of insulin resistance. Yeah it's a very important message for people to hear

[00:20:11] because oftentimes they're told and we were told in residency medical school the diabetes is a chronic progressive illness is a chronic progressive disease that is not going to get better is only going to get worse and it's important for people to know that they can actually reverse their

[00:20:27] numbers they can decrease their numbers this patient you just talked about when from pre-diabetes back into the normal range you know you can also go from diabetes back into a

[00:20:37] normal range so there are ways to eat in a way that that can actually you know heal you from these illnesses drop your weight and give you so many other benefits so I appreciate you mentioning

[00:20:51] that because it's an important message for people to hear. And I will highlight that that patient specifically when it comes to his nutrition so this was an individual who was used to eating out due to the busy work schedule so a lot of those foods were or meals

[00:21:07] were fast food and although this patient has not assumed a whole food plant-based diet they definitely have decreased their intake of animal products again including meat and dairy but they do still partake in those foods at times and again of the mindset that oh I can't eat

[00:21:25] carbs but really realizing that wait I'm still eating rice I'm still eating potatoes and usually I'm able to control the blood sugar when those are made at home and I'm controlling the added salt or a sweetener but still even when eating out not feeling

[00:21:41] stuffed to where oh my gosh I need to lay down but still feel like they enjoyed the meal and the foods that they hold dear and dear to their heart. Yeah absolutely so do you have

[00:21:51] any overall take home messages for you know those people suffering from type 2 diabetes or just any chronic disease in general from your unique vantage point as a physician and an MD but also you know someone certified in lifestyle medicine obesity medicine and from a culinary

[00:22:13] background so it's a very unique blend and so I think that your voice is certainly very important for people to hear. Thank you I do appreciate that so what I do want people to know is that how we

[00:22:26] used to think that these chronic diseases are for a lifetime and they can't be improved or prevented or reversed and that they're going to be on medication for the rest of their life

[00:22:37] or if their family members had it then they're destined to have it that's not always going to be the case and it's important that you find a provider who you can partner with

[00:22:48] and really discuss care and concern and have your voice heard and do know that your nutrition plays a big part in it if affordability is an issue please speak up with that because there are resources available and especially becoming more and more available now that food of medicine

[00:23:04] food as medicine is really taking flight in this country with government backing I might say and don't be afraid to acquire new skills and understand that this should be an exciting journey like I tell patients you don't want to feel like you're being restricted but especially

[00:23:20] if you start considering eating a whole food plant-based diet or nutrition I try not to use the word diet that you're opening yourself up to foods that you may never even have heard of

[00:23:30] I know since I transition I people feel like they're restricted and they're not able to eat as much but really I feel like I'm eating more foods than I ever did before and finding

[00:23:39] ways to put them together I want people to know that fiber is what we lack the most not necessarily protein most individuals whether they're eating plant-based or the standard American diet are

[00:23:51] getting more than enough protein and that's usually an issue or can be an issue but fiber is what we don't get enough of and eating fiber will help decrease inflammatory processes in the body which underline a lot of the chronic diseases that we see diabetes high blood pressure

[00:24:08] high cholesterol cardiovascular disease and as you mentioned cancer such as colin cancer yeah such an important point so thank you for making that and I appreciate your time Janelle and your expertise on this subject such an important topic so thank you for sharing

[00:24:27] everything that you shared and look forward to talking more thank you if you like this episode please share with your friends and family and please remember to subscribe so we can share this message with as many people as possible