PODCAST: What's a Normal Blood Sugar, What's High & How to Control It

ZACH MOORE: Welcome to On Health with Houston Methodist. I’m Zach Moore. I’m a photographer and editor here, and I’m also a long-time podcaster.

KATIE MCCALLUM: I’m Katie McCallum. Former researcher, turned health writer, mostly writing for our blogs.

ZACH: And Katie, blood sugar, right? It’s a big topic of conversation these days.

KATIE: Yeah.

ZACH: Maybe all days, I don’t know, but especially recently I feel.

KATIE: I saw this concerning stat recently that one in three adults has prediabetes. So, not type 2 diabetes yet, but, like, the version right before.

ZACH: And so, that’s, like, 33% of the population.

KATIE: 33% of the population, so it’s, like, you know, a fairly large number. The scarier part of that is about 80% of those people do not know they have prediabetes.

ZACH: Wow.

KATIE: So, that’s, you know, there’s some math involved there. The idea being that it’s something we would be thinking about, but a lot of us probably don’t think about it very much. How much do we understand it either? Like, I don’t -- Like, you know, I write a lot for our blog, and, like, blood sugar is one of those things that has remained very mysterious for me for sure.

ZACH: Well, you think about sugar intake, right? Like, what you eat or drink. But even that is not the whole story as far as your blood sugar goes.

KATIE: Yeah, yeah. I mean, it’s a big part of it. Well, I mean, we say sugar, but, you know, any kind of carbohydrate is where the story starts.

ZACH: Right. No, that’s what I mean. It’s already confusing, yeah.

KATIE: Exactly, yeah. And it’s very confusing because we call -- The way we talk about nutrition, there’s some terms we use that, kind of, mean different things to the inside of your body, right? So, like, if you eat a carb, you’re gonna break it down into glucose. So, I mean, you know, the story’s complicated, I think, and I’m not gonna try to explain it to you right now, I think we should let our expert explain it to us.

ZACH: Indeed. Who did we talk to about this, Katie?

KATIE: We talked to Dr. Archana Sadhu today. She is an endocrinologist here at Houston Methodist, and I’ve talked to her before about type 2 diabetes and some other related topics, and it’s always really nice to talk to her, she explains it really well. So, I’m excited for us to talk to her today.

[Sound effect signaling start of interview]

 

KATIE: Today, I’m sitting down with Dr. Archana Sadhu, endocrinologist at Houston Methodist. Welcome Dr. Sadhu.

DR. ARCHANA SADHU: What a pleasure to be here, thank you for having me.

KATIE: Yeah, absolutely. The topic of today’s conversation is blood sugar. It’s actually an interesting way, I think, to frame this because I know you probably often are talking to patients about type 2 diabetes specifically. We, kind of, wanted to take the angle of blood sugar because I think people don’t understand a lot about it, particularly people who don’t yet have type 2 diabetes, but might be trending that direction. So, we, kind of, wanted to unpack why blood sugar levels are important, what happens when they’re high for too long, talk about prediabetes, which is the predecessor to type 2 diabetes. So, that’s, kind of, everything we wanted to get into with you today.

DR. SADHU: That’s wonderful. It is a very important topic and knowledge is the first step to prevention. So, I’m really glad you’re addressing it.

KATIE: Perfect. You know, as you said it, when I was researching this episode, I read something, a stat, that essentially said that one in three adults has prediabetes and something around 80% probably don’t know that they have prediabetes. So, I mean, I think my first question is people thinking, “I’m young, I’m healthy,” or, “I don’t have symptoms of diabetes yet,” or, you know, “I think my diet’s fine,” even though they probably haven’t touched a vegetable in a week. I mean, in your mind, do you think people are even thinking about blood sugar and prediabetes and preventing diabetes early enough?

DR. SADHU: Absolutely not.

KATIE: Okay.

DR. SADHU: Which is why our work is so difficult.

KATIE: Okay.

DR. SADHU: And which is why I love doing these kind of podcasts to educate the public on what is blood sugar, what is prediabetes, when do you need to worry about it, and get them to care quicker so we can prevent the long-term complications of this disease. So, blood sugars are important, right? We need sugar in our blood, to put it simply or medically, we need glucose for all the cells in our body to function. So -- but, it needs to be regulated in a balanced way so that you don’t actually damage these cells from having high blood sugars, but enough so that they can function efficiently. Put it simply, diabetes is a disease where the blood sugar has gone beyond that normal range. And we have specific numbers that we test for to give the diagnosis. Prediabetes is a little bit trickier. It hasn’t gone into the diabetes range, but it’s still above the normal range, and actually, the damage there is not from the glucose itself, but from the insulin that has to circulate at higher levels to keep the glucose down. So, that is the physiology of prediabetes, and we call it “Insulin resistance,” which then goes on to the ultimate type 2 diabetes.

KATIE: Gotcha. And, you know, insulin resistance is something we’ve heard about on previous podcast episodes, and one way that I’m curious to talk to you about that we’ve heard about insulin resistance was we did an episode on chronic inflammation. So, I think when people think of diabetes, they think, "Oh, it’s in the future and, you know, it’s related to heart disease. All these things that people just don’t think they need to be worried about now. But as far as insulin resistance and then maybe how it’s linked to chronic inflammation, like, what’s happening in the here and now when someone has prediabetes. You know, they’re thinking they don’t need to worry. Like, what’s going on in their body that they actually do need to be worried about?

DR. SADHU: Right, so let me go back to the basic physiology of the pancreas because that, kind of, outlines what we’re talking about when we talk about prediabetes.

KATIE: Mhm.

DR. SADHU: So, the pancreas has cells called the beta cells that secrete insulin whose job it is to regulate our blood glucose. What happens with insulin resistance is that in the early parts of this process, the amount of insulin the beta cell has to put out to keep the glucose regulated increases because the body is resistant to that insulin action. And insulin resistance comes along with many other conditions: obesity or diet with a high carb load, physical inactivity, genetics, certain medications, and this interesting phenomenon you’re talking about is an inflammatory state which is a general term, but it really encompasses a lot more complicated processes going on. But to simplify, an inflammatory state is any condition where you’re revving up these cytokines, we call it that are products of inflammation and inflammation can be from many other things but they’re the products of inflammation and these cytokines cause more insulin resistance.

KATIE: Okay, so it’s like a vicious cycle at that point.

DR. SADHU: It is a vicious cycle.

KATIE: Okay.

DR. SADHU: So, in the prediabetes state, that pancreas is chugging, it’s trying to keep up, making sure that the glucose stayed down by putting more and more insulin. But insulin has other effects more than just lowering blood sugars. And one of the things it also does is it stores fat.

KATIE: Hmm. Well, there we go.

DR. SADHU: So, you’re in that vicious cycle, right? It lowers glucoses from the blood into the cells, it also takes free fatty acids from the blood and stores them into the fat cells and even cells that shouldn’t be storing fat, and that’s where the problem occurs. So, then you have the liver as well. So, as this process is going on, the liver becomes less and less responsive to insulin, maybe because it’s gone -- accumulating more fat too, and we call that fatty liver disease or metabolic liver disease now. And the liver is -- Regulates our blood glucose so now we got another organ failing to be able to regulate glucose. And so, as the process goes on and on and on, this high insulin levels will also cause other damage. They actually promote inflammation and they also damage the inner lining of blood vessels that causes the early heart disease, kidney disease, eye disease, all of these processes going on over years. And eventually, these poor beta cells just get exhausted from working so hard and they stop being able to produce enough insulin to overcome the resistance of the body to insulin, and then the blood sugars start to rise, and when they rise above that threshold, we give the diagnosis of type 2 diabetes.

KATIE: Gotcha. And everything you, kind of, just explained to this prediabetes phase, it’s all, kind of, silent I’m guessing. There’s no, probably symptoms that people are noticing the whole time.

DR. SADHU: Yes, it is a silent but deadly process.

KATIE: Right.

DR. SADHU: And it goes on for years if nothing is done to change it. We say that by the time you are in the prediabetes stage, you’ve already lost more than half your beta cell’s…

KATIE: Oh wow.

DR. SADHU: ...ability to function normally. And by the time you get to type 2, you’re well into that damage of the beta cells. Not that it can’t be slowed down, but when people say, “Am I cured of my diabetes because I’ve made these changes?” Technically not, because you’ve already lost those beta cells and beta cells are not generally regenerative like some other cells.

KATIE: Gotcha. In the prediabetes phase, can you quote unquote “cure” or “reverse” and get back on track? You know, you’ve lost maybe half of your beta cells, but is half left enough --

DR. SADHU: Enough to keep you healthy the rest of your life? Yeah, it could certainly be and that’s why we stress early diagnosis and prevention. So, we had a great trial decades ago called the Diabetes Prevention Trial, and what they did was they studied patients who are in these prediabetes stage and they studied weight loss or one drug called metformin, verses a third group, they just let them do their normal thing. The winner really was weight loss…

KATIE: Okay.

DR. SADHU: With the most prevention to type 2 diabetes of about 50%.

KATIE: Interesting. Okay.

DR. SADHU: Metformin is a great drug and it also did really well, about around 30-35% range. And of course, the others progress to diabetes. Nothing was done.

KATIE: But it tells a powerful story. I mean, it tells a powerful story that something as simple as weight loss at the point of prediabetes can, kind of, get you back on track. Not that that’s easy to do, so I’m not trying to say that part is simple.

DR. SADHU: No, and we’re not talking, you know, dramatic weight loss. Not that weight loss is easy, but in that study, 7% of your current body weight reduced your risk for going to type 2 diabetes by 50%.

KATIE: Wow, okay. You mentioned early diagnosis is important, so, you know, someone in their 20’s and their 30’s, do they need to be getting their blood sugar levels checked and what does that look like? I mean, I’ve heard of -- I mean, I actually was at my primary care doctor’s office yesterday and he checked my A1C levels. So, that’s, kind of, like, my frame of reference. So, is that what we need to be doing and how often and at what age? You know, what’s your answer there?

DR. SADHU: It all depends on your risk factors. So, we know classic risk factors for increasing diagnoses of prediabetes and type 2 diabetes and they are age, BMI or your weight to height ratio, and ethnicity, family history, other conditions, other medical conditions you may have that go along with diabetes like high cholesterol, high blood pressure, and all of these things contribute to your risk, and I encourage everybody to go on to the diabetes.org page, it’s the American Diabetes Association website, and there is a simple risk calculator on there that you, just, in one minute you’ll know if you’re low, medium, or high risk just by answering some of these questions for risk factors. So, if you are overweight, if you’re not active, if you have first degree relatives with type 2, you wanna get the screening done early.

KATIE: Okay. And by early, are we thinking, like 20’s or?

DR. SADHU: Yes.

KATIE: Okay.

DR. SADHU: Yes. So, one in three adults over the age of 20 have prediabetes, so.

KATIE: That’s crazy to think about.

DR. SADHU: What’s even crazier is the growing number of children with type 2 diabetes. We’ve not even broached that subject yet and it’s alarming to see just from ten years ago how many more children are being diagnosed with type 2 diabetes, and of course this comes along with the statistics for growing obesity rates as well.

KATIE: Yeah, absolutely. And I think it makes the case too for just this continuing care of having -- Like, regularly checking in with your doctor because it sounds like if there’s no symptoms of prediabetes, you’re not gonna know unless you go, you know, get your blood checked.

DR. SADHU: Exactly. And you go through years of insulin resistance and that damage from what we call high insulin levels or hyperinsulinemia, and by the time you actually get symptoms of type 2 diabetes, you’re well into the disease process, and those symptoms, of course, are frequent thirst, frequent urination. Actually, unintended weight loss is a common one.

KATIE: Okay.

DR. SADHU: And vision changes and just generalized weakness, fatigue, all of these things. And those -- At that stage, your sugars are well into 400’s or above and we don’t wanna get there before we get a diagnosis.

KATIE: Right, yeah. I was gonna, kinda, segway into what someone should be thinking about in terms of maintaining a healthy blood sugar or lowering their blood sugar. But before we move onto there, is there anything else you’d want to say about people who, maybe, don’t think they need to be worried about prediabetes? Anything else you’d, sort of, say that I haven’t asked about?

DR. SADHU: Well, I mean, the statistics you started off this conversation with is that one in three. So, pretty much everyone should be worried about it.

KATIE: It’s like, one of three of us sitting in this room right now technically.

DR. SADHU: Exactly, and one in three of your friends. So, I think it should be on everyone’s mind, especially in current times of lifestyle changes, especially after Covid. We know that Covid and the restrictions and isolation really impacted people’s physical activities and their diets, and everyone gained weight, you hear that a lot.

KATIE: Yeah, we were just sitting at home.

DR. SADHU: Just sitting at home, inactive and what was it? Baking bread was the worst…

KATIE: Oh yeah, baking bread.

DR. SADHU: Worst thing you could do.

KATIE: Yeah, I had a sourdough starter.

DR. SADHU: Yes.

KATIE: I’d never, like, successfully made bread with it, but I did try the sourdough starter.

DR. SADHU: Everybody did, right? My own children were sitting around baking all day long ‘cause that was the trend and unfortunately, it was probably the worst thing to do. Why everyone didn’t go do a cardio workout every day at home became the trend would have been nicer, but it was baking bread.

KATIE: I think they light up the brain differently maybe, I don’t know.

DR. SADHU: That’s interesting. Dopamine, yeah, the dopamine impact of different activities.

KATIE: Yeah, I’d say that actually and I have no idea if they light up -- Maybe exercise --

DR. SADHU: They actually do. They actually -- There is science behind what lights up the brain or, to be more medical, you know, where the pleasure center -- how the pleasure center is affected by different things, whether it be emotional things or physical things or dietary things. The pleasure center of the brain certainly has a lot to do with how we choose to behave.

KATIE: Yeah. Which doesn’t make any of this easy I’m sure when it comes to doing all the right things to preventing diabetes.

DR. SADHU: Right, right. Yeah, I have this conversation daily, 20 times a day with my patients, and I have to quote one of my patients just last week said, “Well doc, is there a pill to make you like exercise?”

[Laughter]

And I said, “I’m working on it.”

KATIE: Yeah, that would be nice. I would take that pill, I --

DR. SADHU: We all want that pill. But there is some science to that, actually. There are some brains that get a lot more dopamine and pleasure and endorphins from exercise than maybe other brains do, and that’s why those people just can’t get into that regimen.

KATIE: Yeah, that’s really interesting. That sounds like a whole, kind of, podcast episode topic right there.

DR. SADHU: Well, it probably is but I can’t claim to be the expert on that science but reading a little bit more about what makes us behave why we behave is important for us to follow through with these recommendations.

KATIE: Absolutely. You mentioned Covid and I wanted to, kinda, segway really quickly before we move on. Type 2 diabetes is a big risk factor for severe Covid cases. Do we know, I’m just curious, like, maybe to get down to the point of why we should be thinking about prediabetes and preventing diabetes. I mean, do we understand yet why type 2 diabetes was such a risk factor for getting a really bad case of Covid?

DR. SADHU: We don’t understand it to 100%, but we could make some logical conclusions, right? These patients, we always say patients with type 2 are immunocompromised in a certain way, their immune system is not as functional as a patient without diabetes. Their obesity had a lot to do with it. A lot of patients with type 2 are also obese and there are some theories about how the virus interacts with fat cells.

KATIE: Okay.

DR. SADHU: Another interesting and actually well studied and proven even before this SARS-CoV-2 -- CoV-1 was that the virus itself actually does attack the beta cells that make insulin.

KATIE: Oh. That’s, kinda, scary.

DR. SADHU: And compromises their function.

KATIE: Yeah.

DR. SADHU: And with that mechanism, we’ve also noted a sudden increase in new diagnoses of type 2 after covid infections. So, there’s a lot at play here, this virus is doing things, one, on patients who are already at risk with the disease but also another in promoting the disease of diabetes, so. And then to just throw in what happened during Covid with all of the quarantines and isolations and the behavioral changes with it too so.

KATIE: Bread, not exercising, sitting…

DR. SADHU: Exactly.

KATIE: Binging TV way too much.

DR. SADHU: Way too much, yes.

KATIE: I did all of it, so that was me. Okay, so moving on to what to do about blood sugar levels and keeping them in a healthy range or normal range, I wanted to, kind of, take a side step to -- I have some friends who actually are pretty concerned about their blood sugar levels, and some of it, sort of, came out of these ads on Instagram and you and I have actually talked about this for the blog of continuous glucose monitoring for people who don’t have diabetes. I have gotten ads too since I’ve wrote the blog article of, you know, a regular, healthy person has not been diagnosed with type 2 diabetes can wear a continuous glucose monitor so they can know what their, you know, blood sugar levels are like at all times. So, it seems like we have, like the extremes here. We have people don’t even know anything about blood sugar and then we have, like, these products being marketed to us that, like, wait you could know something about it every second of the day. I wanted to, kind of, get into what is actually your recommendation for maintaining a healthy blood sugar levels and then maybe we can talk about some of these products and things and whether those are actually helpful.

DR. SADHU: Number one, minimize all processed foods.

KATIE: Okay. They happen to be delicious, so back to lighting up the brain here.

DR. SADHU: But, you know, I think the key of that behavior modification is moderation. We all know when we’re indulging too much in these.

KATIE: I ate an enormous bag of Hot Fries the other week and I immediately felt sick after and I was like this is why. My body is telling me it doesn’t want this.

DR. SADHU: So next time just two Hot Fries, not the whole pack of Hot Fries. But moderation is, I think, the only way to really achieve these and balance your pleasure with, you know, health. So, we’re not saying, “Don’t eat carbs, don’t be, you know, a strict ketonic diet for the rest of your life. That’s not healthy either, and it’s not doable for the majority of people. But we all know when we should stop or when we shouldn’t eat something because. And so, kind of, self regulating that is really the intervention we’re looking for, right? So, these continuous glucose monitors, they are FDA approved for patients with glucose problems. They’re tested in patients with high glucose and diabetes. They’re not such significant data in normal patients, so we don’t know how those numbers relate exactly to normal patients. So, those with diabetes, those who are struggling to maintain normal blood sugar in that disease process, even in prediabetes. This technology has been revolutionary for behavior modification. There’s nothing a doctor can do with a visit every few months, even every few weeks for a short period of time in an office that this would not tell you every minute…

KATIE: Okay.

DR. SADHU: Right? You take a bite of a donut, you watch the sugar levels just go escalating up and immediately, hopefully, you would be like, “Okay, I’m putting this down.”

KATIE: There it is, it’s the proof. I mean, it’s something that you probably tell your patients every day and then they can actually see it right in front of them as they’re doing it.

DR. SADHU: And it has been remarkable in helping patients modify behaviors with that real time feedback. And nothing’s more powerful than that for a patient.

KATIE: I agree, yeah.

DR. SADHU: So, I have a little personal story. My daughter came to me just last week and said, “Mom, I have been drinking a lot more water I noticed. I’m really thirsty. Do I have diabetes?” Now this --

KATIE: The symptom list can be pretty subtle, or can be pretty, you know, like, “Oh wow, I have all those symptoms.”

DR. SADHU: Yeah, and, you know, this is the other end of the spectrum, she’s 17. So, the message is getting through to them that this is the issue and everyone should be aware of it. And I asked her a few more questions I’m like, “No, you probably don’t have one, but I don’t have a glucose testing machine here at home on a Sunday night to test you, but I’ll bring you one tomorrow. So, I put one CGM on her knowing that it’s gonna be normal, but it’s probably gonna freak her out, you know, and she did. Like, she sees the rise and she goes, “Oh gosh.” You know, “I just ate this and I see that.” And then the next day, she ate a salad for lunch and saw flat. So, immediately she got feedback, and this is my daughter that I have been trying to educate on her excessive carb intake since she was a toddler, you know what I mean? I’ve been trying to restrict her being an endocrinologist mother.

KATIE: Right yeah. So, you’re doing your due diligence, yeah, I mean.

DR. SADHU: But she didn’t buy it. And this just happened a week ago and I put this monitor on her and she realized. Now, her numbers were normal and she knew it too, she immediately Googled it and said, “What is a normal blood sugar after eating.”

KATIE: Yeah.

DR. SADHU: But just watching how different foods can change that slope was enough general information to know, yeah, you know, this very sugary, sweet, processed food item had a much more impact on my body’s ability to manage the glucose than this more natural, healthy, plant-based --

KATIE: Something of the earth.

DR. SADHU: Yeah.

KATIE: Yeah.

DR. SADHU: Yeah. Our bodies were, you know, made to process things coming out of the earth. We were hunters and gatherers as cave men, and now we’re processed food eaters so. But our bodies have not evolved that significantly to make that switch.

KATIE: Right, yeah.

DR. SADHU: So, we’re dealing with a manufacturing revolution with the old natural body process and that’s why we get the obesity and all of these obesity related conditions, heart disease, high blood pressure, high cholesterol.

KATIE: Yeah, and I mean, I think, you know, in my example, when I have, like, a bag of Hot Fries in front of me or, like, an apple, it’s just, like, really hard to pick the apple or the salad over the Hot Fries. Like, the side of my meal. And I think that’s the first struggle, right? Because those foods are so good. Like you said, we’re making them to be something that’s delicious, but then our body doesn’t know what to do with them. It’s an interesting contrast that’s got a place in front of us now.

DR. SADHU: Well, you know, there’s a whole psychology behind that and that starts in the womb.

KATIE: Oh, like what your mom eats? Oh wow.

DR. SADHU: And what your mother’s insulin levels were…

KATIE: Okay.

DR. SADHU: And how that translates to development of the fetus. And then of course what foods we choose the feed the babies and children at young ages ‘cause all of these pleasure foods get, you know, programmed in their brain over time.

KATIE: It certainly feels that way. Like I said, I felt sick after all the Hot Fries, but, like, those first couple Hot Fries, I mean, you just, like, can’t stop ‘cause it’s just like, “Oh my gosh, this tastes so good.” But when you really sit back, like, they don’t actually taste that good sometimes, and like, what is this flavor even that I’m tasting? But it’s too late, I’m already, like, on the train --

DR. SADHU: In another culture they’ll be like, “That does not taste good, I don’t know what you’re talking about.”

KATIE: That’s fair. I would totally understand.

DR. SADHU: But we all associate certain food items with that emotional feel-good feeling.

KATIE: So, I don’t need to feel awful about that it sounds like.

DR. SADHU: No, that’s very normal.

KATIE: Okay, gotcha.

DR. SADHU: If you wanna eat that Hot Fries, you eat it and then you go jump on a treadmill for half an hour and you may balance the two effects.

KATIE: So, speaking of jumping on the treadmill, other ways to maintain a healthy blood sugar. I mean, I know we talked about the risk factors and obesity was one, so other ways to maintain normal levels or bring down some, you know, entering higher levels if you have prediabetes. Is there, kind of, like, a list? I know we could probably talk about each a ton, but is there a list of things?

DR. SADHU: Yeah, there’s three main things…

KATIE: Okay.

DR. SADHU: Those that are struggling with prevention should make sure they do first. One is, we talk so much about the diet, you know, make it natural, make it from the earth as much as possible. Two is physical activity.

KATIE: Okay.

DR. SADHU: So, I mentioned how insulin is so key in lowering your blood sugar, but guess what else does it just as good? Physical activity.

KATIE: Okay.

DR. SADHU: It’s an entirely different mechanism than insulin, but it does it and they come to the same place in terms of lowering of blood sugar. So -- And that one of course is gonna be much more beneficial in other things, heart health, and musculoskeletal health. So, physical activity is a must. And the third is sleep actually. Sleep is really important and I think something we don’t -- Yeah, we don’t emphasize enough that kids should get enough sleep, adults should get enough sleep, and good sleep. So, I think those three things are basic, fundamental life activities that really play into prevention of disease progression.

[Music plays to signal a pause in the episode]

ZACH: Dr. Sadhu talked about the power of continuous glucose monitors for people with type 2 diabetes or prediabetes. But do healthy people benefit from using these devices? If your doctor hasn’t warned you about your blood sugar levels, but you’re still thinking of trying one, here’s a word of warning. Continuous glucose monitors are designed to alert a person with diabetes that low blood sugar is occurring or about to occur, and prompt them to take action. But that same reading may not be actually concerning for a healthy person. This alert might not only prompt anxiety and panic, it may lead you to taking an unhealthy action like eating a quick source of simple carbs in order to bring your blood sugar back up. A bag of chips for instance. This isn’t just  unnecessary, it’s unhealthy. Rather than believing the claims that continuous glucose monitors can help healthy people maintain their weight or control their metabolism, Dr. Sadhu emphasizes three simple steps for better blood sugar control: Eat whole, natural foods, avoid processed ones as often as possible, and be physically active every single day.

[Music plays to signal resumption of episode]

KATIE: One thing I wanted to ask you about that I, sorta have read was maybe something that contributes to blood sugar -- Like, abnormal blood sugar levels is stress. And, I mean, I think -- I wanted to ask you about it because it seems so, like, amorphous and I think we all have it, and, like, what does it mean and when is it too much? My first question is can str -- Does stress play a role in anything we’ve talked about today? Is that too --

DR. SADHU: No, it’s a great question and, of course, affects everybody.

KATIE: Mhm.

DR. SADHU: But it depends on what you mean by stress. So, there’s physical stress. Stress on the body, stress on you adrenal -- From your adrenal glands need to respond because you have an infection and you’re about to go low on your blood pressure and adrenals have to put out more hormones to keep your blood pressure up, those are the stress hormones. So there’s  -- Or you’re in a car accident, right? And you’re try -- And you’re bleeding and you gotta make sure your blood pressure’s up. So, there’s that physical stress. So, if you’re constantly ill, you are under constant stress, pain is another stress, physical pain is another stress that raises these hormones. Eventually these hormones, not only do life-sustaining things like keep your blood pressure up, but they also keep your blood sugar up…

KATIE: Okay.

DR. SADHU: ‘Cause your body needs it to function. And so, if you’re constantly under this stress and you’re constantly having high blood sugars, it’s gonna be a risk factor for your future chronic medical conditions.  And then there’s emotional and psychological stress, which is really much harder to study, but depression and diabetes go very closely together, and it makes sense, right? When your depressed or anxious, you’re more isolated, you’re less lless likely to go out and be active and do the things that you like to do. More sedentary and alone, and that’ll  play into it physically eventually. Weight gain is really common with depression as well and, of course, weight gain will lead to all diabetes and other conditions. So, those are the different types of stress and it certainly, certainly does play into your risk factors.

KATIE: Gotcha. And I guess I would imagine too, you mentioned sleep as one of the big, kinda, pillars of preventing diabetes and, you know, maybe when stress is leading to poor sleep or something. Is -- maybe that’s, kind of, the indirect -- That’s more direct measurement --

DR. SADHU: Right.

KATIE: Okay, gotcha. I wanted to ask you about a couple other things that I have either seen or read about as far as preventing diabetes. And the first one is I actually saw a commercial for this the other week which I had never heard of this, and it was literally just calling itself, like, a blood sugar supplement, or, like, a diabetes supplement.

DR. SADHU: GOLO.

KATIE: Yeah, like, what is it? And, like, does that work?

DR. SADHU: It’s just -- From my understanding, it’s a lot of different plant products.

KATIE: Okay.

DR. SADHU: Things you can get from a healthy diet.

KATIE: Okay, there we go. So, back to just eating a healthy diet.

DR. SADHU: With much more benefits than in a bottle, but these plant products, some -- You know, there are some plant products, alpha-lipoic acid supplements actually have shown to lower blood sugar in patients with diabetes. Normal patients, we don’t know. And there are probably nutritional deficiencies that patients with diabetes have that led them to that point. These kind of, you know, advertisements on TV and these commercialized products, there’s no science behind them to substantiate their claims. So, when GOLO came out, you know, so many patients, “Should I take this? Should I take this? It reduces insulin resistance?” Well, I’m not sure that it would do that first of all, and let me tell you what does…

KATIE: Right, exactly.

DR. SADHU: ...reduce insulin resistance.

KATIE: Yeah, yeah. It’s interesting when you think of it that way because it’s -- It certainly doesn’t seem like it can work against a bad diet I would guess. Like, if you’re taking the supplement but you’re still eating -- I’m still eating the bag of Hot Fries every day, like, I’m guessing it can’t counteract that. So, you still need to make changes.

DR. SADHU: Yeah, and I think these programs, they say, “We’ve got this supplement,” and they focus on the supplement, but they also --there’s a rest of the program and they don’t give, you know. Of course, someone who’s really try -- Like, motivated to improve their health and goes to these supplements will do other things too, and I bet it’s the other things like, “Okay, I’m not gonna sit around and watch TV today, I’m gonna go for a walk,” whatever other things that they’re doing is probably more influential than that supplement.

KATIE: Yeah, well and it -- it, kind of, reminds me of -- I’m glad you mentioned that trial of even when you compare metformin to weight loss. Weight loss is such a powerful prevention measure, so, I mean, I think it, kinda, gets back to, like, focusing on what actually works and what matters the most and --

DR. SADHU: Where are the sciences.

KATIE: Interesting.

DR. SADHU: And where actually just common knowledge, right?

KATIE: Well, I think that’s the thing. We all wanna, like, try to find some other thing we can grasp on to to be like, “No, it must be this,” or, “It must be something I’m missing,” or yeah.

DR. SADHU: Well, in some cases there are disease processes that need to be addressed if you’re hypothyroid low thyroid function for instance, it’s very hard to lose weight. But these are, you know, something that your doctor can easily screen for and help you with, but in general, it’s still gonna come down to changing some of these very bad behaviors.

KATIE: Yeah, gotcha. The last thing I wanna ask you about ‘cause I saw this on TikTok, I think it was. Apple cider vinegar for, you know, blood sugar management. Now, I’ve talked to a gastroenterologist about how, like, it’s actually, kind of, could be bad for your throat if you’re taking apple cider vinegar shots every  day. But is it even doing anything to your blood sugar levels?

DR. SADHU: Well, if it substitutes a soda, it certainly is.

KATIE: Okay, alright. So, maybe just not having the soda would be the first step and, kinda, back to this thing of addressing the actual problem.

DR. SADHU: Yeah, I don’t prescribe apple cider vinegar as a treatment for blood sugar management. So, again, there’s so many other things happening to this patient at the same time that is seeking these products as their answer, right? They’re very conscientious of their glucose, so maybe they are changing their diet in subtle other ways. We don’t have a study. Everyone has this same diet, but this one group has apple cider on top of it, we don’t have that direct comparison. But all of these people are making subtle changes ‘cause they’re very conscientious of trying to manage their glucose, and I bet those changes are doing a lot more than the apple cider vinegar.

KATIE: Yeah.

DR. SADHU: But, you know, in general, like, smoothies and these fruit smoothies, meal replacements. I mean, it couldn’t be worse, these fruit smoothies.

KATIE: ‘Cause they’re probably full of sugar despite --

DR. SADHU: They’re concentrated sugar, and depending on where you are in this disease process, that can be very detrimental to promoting the pr -- Like, if you’re in prediabetes stage, right? You load yourself with these simple carbs that are in fruits and your pancreas has to kick it, like, put out that insulin to get that carb down because they’re very rapidly absorbed and they spike glucose very quickly and very high. So, the pancreas has to respond with a fierce level of insulin and now you’re just promoting more of the insulin circulating and doing the other things that we don’t want it to do as well.

KATIE: Okay, so watch out for the -- The concentrated fruit smoothies.

DR. SADHU: You know, I would recommend against any fruit juices period.

KATIE: Okay.

DR. SADHU: Eat the fruit, don’t drink the juice.

KATIE: Gotcha. I like that, that’s a good tag phrase. I like that.

DR. SADHU: Well, ‘cause there’s a lot more fiber in fruit, in the whole fruit and that actually -- That helps naturally regulate your absorption of glucose.

KATIE: So, this is the perfect segway into -- I know the whole diet part of diabetes -- In preventing diabetes is probably a whole series of podcast episodes. The one question I did wanna ask you, because we’ve talked a lot about Hot Fries, we’ve now talked about fruit and simple sugars, and you, kinda, mentioned fiber. I just -- The one diet thing I wanted to get into is simple carbs versus complex carbs. What are they each and how do they affect blood sugar differently? Because I think that’s where I, myself, and even some of my friends, I think we all get the most confused with, like, which of these carbs are okay to have? Like, which are good for us and which are, like, let’s eat ‘em but let’s not prioritize them?

DR. SADHU: So, I go back to the fundamental, get it from the earth and it’s good. If it’s gone through a processing manufacturing plant, it’s probably not good. But to be more detailed, so we have under simple carbs, you have monosaccharide and disaccharides,  and complex carbs are polysaccharides. Which just means that the chain of sugars is longer. Eventually, all of them are broken down by our body into the simple molecule of glucose. So, fruit, for instance, we were talking about that. Fruit is simple monosaccharides. They get absorbed quickly, the blood sugar spikes quickly, and it gives you that fuel your body needs immediately, whereas the polysaccharides, the longer chains, they are absorbed more slowly, and they give you that glucose in a sustained way, the complex carbohydrates. Now, simple carbohydrates come in different ways. They come naturally in fruits and vegetables, which also come with vitamins and minerals and other good things our body needs. They also come in sugars. You know, white sugars, white flour, which have no nutritional value whatsoever. So, while both types of sources are giving you that glucose burst, the natural way is giving you a lot more health benefits, and they come with other components of good benefits like fiber for instance.

KATIE: Yeah.

DR. SADHU: You know, our body needs that as well. Whereas the processed ones, the ones in cakes and cookies and pasta and white rice, they’re just basic. The sugar itself, nothing worth it to come with the sugar.

KATIE: Gotcha.

DR. SADHU: Complex carbohydrates are the same as well. Those are also present in natural foods and also manufactured foods, and we do need complex carbs, but it’s much better to get them in a natural way than in the manufactured way.

KATIE: What’s an example of a processed complexed carb?

DR. SADHU: Pastas.

KATIE: Okay. So, like, what about whole wheat pasta?

DR. SADHU: So, that’s better. So, when we use the grain, it’s much better.

KATIE: Okay.

DR. SADHU: So again, the grainy carbs, which are also complex offers a much more sustained absorption of glucose so the body can react in a timely fashion and not have these huge peaks and valleys. Yeah, they’re like peaks and valleys. And a lot of our vegetables have complex carbs as well, but of course, they’re coming with so much other nutrients than the processed ones.

KATIE: Yeah. I think one of the dietitians I talked to at some point mentioned, like, doesn’t care how many vegetables you eat on your plate, like, whatsoever, which that was interesting ‘cause they’re carbs, so, when we think of, like, “Cut out carbs,” it’s like, well, you can eat as many vegetables as you have.

DR. SADHU: Cut out processed carbs is what we should say. If it went through a factory, it’s probably not good for you.

KATIE: Gotcha.

DR. SADHU: I mean, there’s some exceptions. Like, I love frozen vegetables. And they obviously went through a factory to get into a bag and into my freezer, but nothing’s really been done to it, and it offers us a convenience. Convenience is the big reason we seek a lot of these foods that are not healthy for us, right? We’re all busy. Convenience and cost.

KATIE: Yeah.

DR. SADHU: Unfortunately, the unhealthy foods are the most affordable.

KATIE: Yeah. Which I don’t -- I feel like it’s changing lately. I feel a lot of the, like, chips and stuff are getting -- it’s more expensive than getting a piece of fruit now. But to your point about the frozen vegetables, I think that’s a good one, ‘cause vegetables can get a little pricey because then you forget to -- You know, or just, like, you don’t forget to make ‘em. The week catches up to you and the salad bag you bought on Monday is, like, just not gonna make it into the meal plan by Friday. So, the frozen stuff is nice. So, it’s good to know that that’s still -- While minimally processed, it’s not something added in that way.

DR. SADHU: Yeah.

KATIE: Okay, alright. Well, that’s really helpful I think, ‘cause that’s the piece I think I definitely get stuck on the most is the carbs and how to make sense of all of it. So, I guess as we close out here today, anything else you would add that I haven’t really asked you about that you think is an important message to send people who probably aren’t thinking about blood sugar and need to be?

DR. SADHU: I would say know your risk.

KATIE: Okay.

DR. SADHU: You know, know your risk. Where do you land on that risk profile? And if you’re moderate or high risk, and there’s great risk calculators like I mentioned from the American Diabetes Association. Quick, one minute. You know, answer questions and you’ll get to know. And if you are at risk, you should get tested.

KATIE: Okay. Yeah and we can put a link to the risk calculator you mentioned in the show notes. Yeah, we’ll put it in there.

DR. SADHU: And then the other big message is our children.

KATIE: Yeah.

DR. SADHU: It’s very hard I know, I have three, I try to raise them with, you know, these helpful eating tips but all of society has to do it. They go to a birthday party and I’m the, you know, evil mom who says, “No, not a second slice of cake. Just that little bit is good.” Yeah. It’s very hard to do it alone, so do it with your family and do it with your social network together and I think we can get over this -- This horrible trajectory we’re on in terms of childhood obesity, childhood diabetes, and chronic medical conditions we never, never thought about and were never taught for pediatrics. So -- And that’ll just, you know, promote future generations of good health.

KATIE: Yeah, it’s a really good point and I, kinda, like ending on that note because it is -- It really is all of our duties, right? Patterning behaviors and things like that. I mean, if kids are seeing an adult over here doing something and then their parent asking to do something else, it’s hard. So, if we all just, kind of, collectively, for the better of our children decided, like, hey, maybe it’s time to clean up the diet a little, just as a group. I like that message. I think that also brings another layer of, maybe, kinda, like, importance to it.

DR. SADHU: Well, they say it takes a village for a reason, it certainly takes a village for this.

KATIE: There we go, there we go. Well, thank you so much for being here with us today, I really appreciate it. I learned a ton from this conversation, I’m sure that all of our listeners did too.

DR. SADHU: That’s wonderful, it’s a pleasure to be here and spread the knowledge.

KATIE: Awesome, thanks so much.

[ Sound effect signaling end of interview]

KATIE: So, Zach, we kicked off this episode saying that we didn’t really think we understood a single thing about blood sugar other than it’s something that happens. Do you feel like you’re more informed now?

ZACH: I definitely feel like I’m more informed on the nuance of it all. I mean, there are all these subcategories that I didn’t even realize, and now I’m not gonna just put it all in one category.

KATIE: Okay.

ZACH: Like, we’re talking about, like, food and this and that. Like it’s blood sugar, and then there are many layers of blood sugar, and I think she did a great job of explaining what those are.

KATIE: Yeah. When she talked about the study, looking at with people with prediabetes, the best ways to prevent that from progressing into type 2 diabetes and, kinda, surprisingly, or maybe not surprisingly, but I was surprised to hear that weight loss is actually, you know, no drug needed. Like, just 7% of weight loss was enough to help prevent type 2 diabetes. I think it just speaks to the power of some of these, you know, these healthy lifestyle changes that, like, they’re hard but it’s -- Like, that stuff is worth it, and if you’re a person who, kinda, doesn’t wanna be on medication, if you can find a way to make all that stuff work, you know, it’s impressive that that alone could be enough for someone who’s aiming for that.

ZACH: Yeah, like she talked about. Everything in moderation, right? It’s what we talk about on almost every one of our podcasts here when you’re talking about actionable items for you to do. I mean, that’s the number one thing, right?

KATIE: Yeah. So far, no one has told me that I can eat as many Hot Fries as I would like.

[Laughter]

ZACH: Now, she mentioned processed foods as well, which is another one of our favorite topics ‘cause, you know, they taste good, right?

KATIE: Yeah, they taste really good. Yeah, and it was fun to talk about how they, like, light up the brain and other things do too. You know, I think that’s the really tough part about this, and maybe something to dig into at some point. Like, actionable ways to, kinda, grab on -- You know, we’ve done a couple episodes this season where we’re taking these healthy lifestyle behaviors and we’re framing them in, like, a not negative doom and gloom light where we’re like, “Hey, here’s how to eat a heart healthy diet and make it taste good still.” Like we should do one of those probably with, like, exercise and weight loss and stuff like that.

ZACH: Yeah. “How to not hate exercise.”

KATIE: Yeah. I think she mentioned her patients ask her for a pill to make them like exercise and it’s like yeah, I would like that too.

ZACH: You know, something else she mentioned was fruit juice, and we’re all trained like, “Oh yeah, we have a nice, tall glad of OJ and it’s healthy, right?” And not necessarily.

KATIE: Yeah, she literally says, “Don’t drink juice.” Like, honestly, yeah.

ZACH: Eat the fruit, don’t drink the fruit.

KATIE: Yeah, that’s it.

ZACH: Yeah.

KATIE: Great slogan.

ZACH: What’s your favorite fruit juice?

KATIE: I’m actually not a big fruit juice person. My favorite is probably orange juice in the form of a mimosa. So, double whammy there, not good for me.

ZACH: I’m more of an apple juice guy myself.

KATIE: Okay.

ZACH: Yeah. Pineapple juice in moderation ‘cause it’s got some bite to it, you know.

KATIE: Pineapple juice? Okay, yeah.

ZACH: With maybe another beverage along with it.

KATIE: Yeah, I hear you.

ZACH: But…

[Laughing]

KATIE: Yeah. That’s true. I have had pineapple juice in a mimosa before.

ZACH: But I feel like people who don’t even have any kind of other juices in their refrigerator at least have orange juice, ‘cause it’s, like, the default juice you have. I drink much more orange juice than eat oranges for example.

KATIE: Well, and then that makes me think of people who do juice cleanses where, you know, for at least a week, all you’re doing is, I guess spiking your blood sugar.

ZACH: Yeah.

KATIE: Constantly over and over. Which, maybe isn’t a problem if you’re, you know, a person who doesn’t have any issues, but if you’re a person who has prediabetes and you don’t know it and you go do a juice cleanse, like, nothing good’s gonna happen.

ZACH: And one out of three people, right? It could be you.

KATIE: Yeah, that’s -- Thank you.

ZACH: Well, not you, but -- one, two, three, it could be you.

KATIE: Yeah, yeah, the amorphous “you,” the royal you.

[Laughter]

Another thing that I found interesting in getting back to, like, the healthy behaviors and why they’re so healthy and why they’re so good. I liked hearing the science behind it of physical activity works as a separate mechanism to help regulate your blood sugar. So, you know, a separate way from insulin. So, again, that’s, like -- That’s two ways that, you know, if you’re exercising a lot and then you’re also, you know, making a normal amount of insulin, like, your blood sugar level should stay pretty regulated. And again, it’s just like another one of these reminders where, look, exercising really is hard, I don’t like doing it, but if I have a reason and I know that there’s a reason I should be doing it, I’m more inclined. So, I always enjoy that.

ZACH: Yeah, these kind of conversations, maybe this is a weird analogy, but it makes me think of --

KATIE: Can’t wait.

ZACH: [Chuckles] Like, your body is like a car, right? It needs maintenance, right? It’s almost like I wish we had to go get that sticker every year of like, “Okay, you’re up to speed --

KATIE: That’s your annual checkup. Yeah, you’re supposed to.

ZACH: Like, give me a patch or something to wear. I don’t know, something tangible, you know? You know what I mean though? Because it’s like, it’s such an easy thing to -- Like, we all ignore change oil light on our car every now and then. But, there’s like, much more serious change XYZ lights on our body that we ignore way longer, it can have way more serious circumstances for us, ‘cause we’re not gonna get a new body, right? You can get a new car, but you’re stuck with what you have. So, do the proper maintenance.

KATIE: Yeah, I think it’s a good analogy.

ZACH: Thank you.

KATIE: Yeah, I like it. Well done.

ZACH: I just came up with that today. I can’t believe we done this podcast…

KATIE: Just got inspired.

ZACH: For how many seasons now? Like, I just thought that we’re like cars. But anyway, that’s gonna do it for this episode of On Health with Houston Methodist. Be sure to share, like, and subscribe wherever you get your podcasts. We drop episodes Tuesday mornings. So, until then, stay tuned and stay healthy.

[Music ends signaling end of episode]