13: All things DIABETES with Dr. Soham Patel

Diabetes.

Rates in the U.S. (and around the world) are skyrocketing. Chances are either you, or someone you know, has diabetes or is at risk for diabetes. If so, you do NOT want to miss today's episode with guest, Dr. Soham Patel.

He is an Endocrinologist who infuses Lifestyle Medicine into his daily practice. Dr. Patel is triple board certified in Internal Medicine and Endocrinology, Diabetes & Metabolism, and Lifestyle Medicine; and is a Fellow of the American College of Endocrinology. He’s active in a variety of professional organizations and stays up to date with best practice.

In 2018 he brought his passion to life with the founding of the Center for Preventative Endocrinology & Nutrition in Tampa,  Florida, using the power of FOOD AS MEDICINE.

My hope was to pack in a conversation about diabetes and thyroid disease, but we just didn't have time for the latter (stay tuned for his next chat with me in the next couple months). As you'll hear, there are a number of sub-types of Diabetes. But even so, lifestyle factors should be the foundation of treatment.

You can find Dr. Patel HERE (clickable)
Or on YouTube (clickable)

Want to learn more about diabetes?  Great!
Click HERE to check out my curated list of favorite books on Bookshop (includes the one mentioned in this episode, Life Without Diabetes, by Roy Taylor, MD). 

Anything else you want to hear about? Let me know! Send me DM on social. I genuinely want to provide (and translate) all kinds of great info for you. 

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As always, thanks to Lemon Music Studio for intro and outro music.

Transcript

[00:00:00] Susie: Welcome back everybody. I am here today with Dr. Soham Patel. He is a triple board certified physician in internal medicine and endocrinology, diabetes and metabolism and lifestyle medicine, and he is also a fellow of the American College of Endocrinology.

He's active in a variety of professional organizations like the American Association of Clinical Endocrinologists. The Endocrine Society, the American College of Lifestyle Medicine, the Physician's Committee for Responsible Medicine, and of course the Florida Medical Association. So he established the Center for Preventative Endocrinology and Nutrition in Tampa, Florida in 2018, where he harnesses the power of food as medicine.

And his passion to provide individualized care using nutrition as a cornerstone of his practice is really what he's passionate about. He walks the talk when it comes to healthy lifestyle, and he really inspires those around him to do the same whether they're friends, family, patients, and he's been very generous and gracious with me when I've reached out to him.

And I'm really excited about this conversation. There are so much I would love to ask you and so many things I'm sure listeners would love to know about. What I'd like to start with is you just to fill in any gaps if I missed anything, and tell us a little bit about yourself. And then what I'd like you to do after that is just answer the question, what is endocrinology? You know, so people that don't really know what that field is about. If you can tell us that. 

[00:01:27] Dr. Patel: Susan, good morning and thank you for having me on your podcast and getting the opportunity to, you know, share, my experience with your audience. I think you had a pretty complete intro there. I don't have much to add. Um, I've been in practice for more than a decade now. I was employed at a different clinic before I started my own practice in 2018, so it's been a journey. That started like anybody else. Uh, but, uh, my grandfather, my, my mom's father was a self taught, uh, naturopath and he spent many decades researching and also applying those same principles.

And in spite of, uh, very bad cardiac history in his family, he outlived his siblings He lived longer than his, uh, parents as well in terms of the age. 

[00:02:22] Susie: Mm-hmm. 

[00:02:22] Dr. Patel: Otherwise they had a very strong cardiac history and, and that was quite powerful for me to see how much significant impact, lifestyle and nutrition and overall the lifestyle changes can have on your health. So, you know, genes play a role no doubt, but what you choose to do with your day to day routine has a bigger impact. And that was the guiding force for me. Get into, you know, start researching about lifestyle medicine. And the more I learned, the more, uh, it became apparent to me that I, I had to, you know, it just felt, uh, there was no option left.

I had to go through the, you know, changes. And it's a, it's a journey. I don't think I reached, uh, the destination, but it's been a fun journey so far. Um, going to your question about endocrinology. The word endocrine means a gland that is releasing certain hormones that are affecting something more remote in the body.

So exocrine and endocrine. Exocrine means a gland that is releasing its fluids and it's impacting area right next to it, or very close by. Whereas endocrine means that secretion from that gland is essentially can impact. Some organ way away from it. So example, thyroid. You know, thyroid really this thyroid hormone, but that thyroid hormone can impact your brain, it can impact your heart, it can impact your skin, it can impact your kidney, it can impact your gut, essentially the whole body.

So that's essentially what endocrine means. And so the study of, uh, hormones and glands and. That is endocrinology. The whole certification is endocrinology, diabetes, and metabolism. And I think there's a lot of focus on diabetes, endocrinology. But I think the metabolism part, uh, doesn't get that emphasized in endocrine fellowship trainings.

I mean, yes. I trained at UAB, University of Alabama at Birmingham, and we had a phenomenal nutrition research center that we had access to and, you know, got to interact with researchers there. But that was something that we did on our own as fellows and not as a mandatory requirement.

 I think in, not just endocrine, but in general, I think the way physicians are trained and so, There is a significant lack of lifestyle education and lifestyle medicine training changes are happening. There are many, uh, residency programs not many, but few that have started across the country that have lifestyle medicine curriculum.

There are lifestyle medicine residencies now in a few spots across the US so it is changing. The American College of Lifestyle Medicine, I believe has 6,000 plus members now, which again is physicians and different other health professions along with it. Um, but it is changing, but it's a slow process. Sorry for my long winded answer. 

[00:05:25] Susie: No, that's good. That's great. I love that. That way people can have a better understanding. And I do, have some things that were top of my mind. I know when you look on your website and you look at the different services, there's so many, right. So diabetes is of course a big one cuz it's a growing concern with insulin resistance and, and, um, type two diabetes and things like that.

And then of course, thyroid, Lots of people with thyroid and it's always one of those things that I'm always trying to explore and learn more about, cuz I think it's even more pervasive than I think it is, you know? And then the other thing is a phrase. So if you wanna touch on any or all these, be fine.

There's a phrase called adrenal fatigue that I hear a lot. So I wanted to get your 2 cents on what, what that was about. So do you wanna dive into any of those? 

[00:06:11] Dr. Patel: So, so there are three topics I'll, I'll briefly touch, uh, you know, some of the clinical types of diabetes and then I'll touch about thyroid and then adrenal fatigue.

So first thing first, so diabetes, you know, although this whole concept that has been taught or,, propagated so far, Type one or type two, but it's actually, there are so many different clinical subtypes and um, to exemplify that. So, you know, people think, okay, if someone is young and they get diagnosed with diabetes, they automatically label them as type one, but that's not necessarily true anymore.

And same thing on the opposite extreme. If someone is older in their thirties, forties, fifties, they're automatically labeled or thought of as a type 2 but that cannot be the case all the time. There's entity called diabetes type 1.5, or latent autoimmune diabetes of adulthood. We call it lada, LADA or type 1.5 diabetes. And that's where in your third, fourth, fifth decade of life, you get, you know, diagnosed with diabetes. But what's different is you are, you're not having, uh, a lot of extra weight that is typical for type two insulin resistance scenario. But instead your, muscular bill or lean phenotype and your sugars are not getting controlled with just oral medications.

That's another telltale sign that you've been on, you know, metformin or any of those oral medications, uh, for a year, two years. And your a1c, which is your three month sugar average lab is still running 9, 10 or higher percentage. And that's because there is an immune attack against your pancreas. And that, uh, destroys the beta cells that produce insulin, but it does not completely destroy them like a type one, you know where type one diabetes is complete destruction of the beta cells, and so there is no insulin being produced, so you have to be on insulin 24 / 7 but with type 1.5, you produce some insulin, so you don't go into keto acidosis, but you don't produce enough insulin to be able to control your sugars, especially when you eat.

That's where you know, differentiating those, because if those patients are just kept on metformin, on and on, And yes, you can change their lifestyle habits and that can make a significant impact, but it will not still fully control their sugars if you do not give them some insulin. That's one common scenario I see all the time where they're misdiagnosed, Type two, and then I end up, you know, correcting that.

 On the other extreme I have, uh, I don't personally, but I have, you know, 20 year olds with type two diabetes and they were actually diabetic before I started seeing them. And I have pediatrician friends who are seeing 10 and, you know, 8 year olds with type two diabetes. So childhood obesity is another big driver of that.

And just because a person is below 10 or in their teens, you cannot just assume that's type one diabetes.

[00:09:22] Susie: Right. 

[00:09:22] Dr. Patel: It could as well be, you know, type 2 diabetes. The point being is it's a spectrum and there's some more clinical subtypes, but I think that will be little too much, uh, geeky. So if I can think of three scenarios. Pure type 1 where they don't produce any insulin.

Type 1.5, which can happen in the third, fourth, fifth, sixth decade of life. They are essentially behaving like type one but no keto acidosis, and they produce some insulin, mm-hmm, not enough. And then type 2 is where they're insulin resistant and if they don't change ways and they let it run like that, after 20, 30 years, you could burn out your pancreas completely and now you are insulin dependent.

Type 2 meaning you are not producing any more insulin. You have to take insulin. You could be needing insulin. Even that, but, so those are kind of the stages of what we call burned out pancreas or burned out diabetes. Mm-hmm. So that's kind of the broadly, uh, three categories that you would see all the time. And that's the majority. 

[00:10:27] Susie: So I do have a question about the type 1.5, so, you know, as a medical provider and say primary care, or you're a patient in primary care and you're being treated as a type 2, how are we going to differentiate type 2 and type 1.5. Is that easy enough to do in a primary care?

[00:10:44] Dr. Patel: Well, yes. I'm gonna, you know, explain the things you wanna look for. So number one, you don't wanna assume just by age that that's gonna be a type 2. So that's number one, right? You don't wanna assume the type based on age. Number two, you look at their body, you know, phenotype, you know, have the look if they are not having extra fat or very little fat in the middle and or rest of the body's quite muscular. Not much fat in the arms and legs, and they have been on a oral diabetes medication like Metformin or glymeperide or one of these newer ones like DPP 4 or SGL 2 inhibitors. Again, sorry for the uh, technical terms, but that will still not fully control it. So if they've been on something and they're taking it and their A1C is still running 9 and 10 and higher, then that's your second point.

It should start sparking in your head. Okay, Something doesn't match up here. And then when you check your C peptide, it's a lab that is a surrogate marker for the body's insulin production. So if you check a fasting C peptide with a concurrent glucose level, and if there's glucose level is below 200 and their C peptide is still below 0.5, then that's another indication that they're probably the type one and half and as soon as you put them on some insulin.

So that's another thing to keep in mind. If you assume they're type two and you put them on a starting dose, like a type 2, you will actually tank their sugars and have them get hypoglycemia left and right. And they'll get so jaded from that that they're like, I'm not touching insulin again, which they actually need.

So you wanna make sure you start at a lower dose and kind of work your way up and not make them hypoglycemic. It's not fun to experience hypoglycemia. I experienced that myself, you know, sometimes. It's not just, Oh, it's okay. Just drink some juice. That it is not that casual.

You want to do everything possible in your hands to make sure you can reduce and minimize incidences of hypoglycemia. But because hypoglycemic can kill you, your sugar's running high may not kill you right away. It will definitely have an impact, but it will not kill you right away. But a hypoglycemic, even if it's strong enough, Depending on what other factors you have, heart disease or kidney problems or liver problems, it can kill you. So hypoglycemia should be minimized. 

[00:13:19] Susie: Mm-hmm. Very good point. Thank you. Um, I do have a question about insulin resistance? Because I work in a lifestyle and functional medicine clinic, I've dipped my toe in functional medicine. There's this approach of, you know, there's so many more people that are insulin resistant than even prediabetic yet. So do you think there's utility in trying to figure that out, even beforehand? So we can do something, whether it's nutritionally and maybe you could touch on the nutrition part for diabetes. 

[00:13:47] Dr. Patel: So insulin resistance is the fundamental process that leads to prediabetes and then if not addressed, eventually leads to diabetes and then, you know, all the things further down from there. That same process is also one of the key factors or, pathological reason why you end up with high blood pressure and high cholesterol and PCOS. Women with PCOS, I don't quote me on the statistics, but I believe it's like one every two or one in every three women across the world have PCOS.

[00:14:25] Susie: Wow. 

[00:14:25] Dr. Patel: Which is a mindboggling statistic, right. And so again, the root cause of PCOS is insulin resistance. Yes, you can put someone on birth control pills and regularize their menstrual cycles, but you're not addressing the root cause. The root cause is insulin resistance. So, and then insulin resistance also leads to, uh, you know, more cancer risk because insulin is an anabolic hormone.

When you have high levels of insulin being released in your body 24/7, which your body is not designed to withstand, your body is gonna feel that impact of chronic high insulin levels. It's gonna promote growth of more tissues in the body. Uh, one of the tell signs of insulin resistance is to look at someone's neck and you will see skin tags.

So skin tags is a very telltale sign of insulin. Now, it can happen from some other issues too, like, you know, there's a few genetic lipid disorders, which can also cause those kind of problems, but the most common scenario is insulin resistance. The second telltale sign is people get this blackening of their skin, especially in the Indian subcontinent, people, uh, India and the surrounding, you know, countries.

You'll find that this area is the first place they'll start seeing blackening. Right. Um, I seen that same pattern in Hispanic community as well. You know, African-Americans tend to have more of that on the elbows and back of the neck. So those are again, signs of insulin resistance because high insulin level is chronically stimulating your melanocytes the cells. Produce the pigment that gives us different, you know, colors. It is pushing them to produce more. So that's where you see those increased pigmentations. Those signs are there if you are watching out. 

[00:16:21] Susie: Right. 

[00:16:22] Dr. Patel: And if you can pick on them early and start making changes, you can actually reverse. You can prevent prediabetes from happening and diabetes from happening before it even starts. So Right. And this period is a pretty long time. It could be 5, 10, 15 years depending on the person. So there is a lot of time that you can take action. It's not like it happens in a month, and that's a done deal after that.

[00:16:46] Susie: Right. And I worked in North Carolina before I came to Florida, and we had a very large population of African American and Hispanic. And I would see that all the time. And I would point out to them, and so many people are saying, Oh, have you all kinds of creams and hydrocortisone, like they're trying to use creams to make it go away. 

[00:17:03] Dr. Patel: So again, you, you're putting band-aids without really addressing the root cause.

[00:17:07] Susie: Right. Yep. What about using diet along that spectrum? Cause that's part of the cornerstone of what you do and through lifestyle medicine, which also I think underscores what's actually going on. So there's this misconception, I think about the cause of diabetes. So could you touch on that a little? 

[00:17:27] Dr. Patel: Yeah. So I'll first explain insulin resistance a little bit. Yes. Okay. And then I'll expand on what we can do. And obviously, you know, there is so much of nutrition debate going on, and there's so much information and I truly understand that, uh, it is challenging, It's challenging for even physicians to make sense of all the information out there.

So I can imagine that someone who doesn't have that background can find it even more challenging. And there are, you know, slightly different people who prefer to sell you different supplements and this and that and there's, there's place for different things. But, so let me backtrack again to insulin resistance.

Um, so normal scenario insulin is taken up by your liver cells and your muscle cells throughout the body and between those two liver and muscle, uh, pretty much accounts for 80% of insulin uptake. Remaining 20% is utilized by the rest of the body. So there are important sites, and if the insulin doesn't work on those sites, then that leads to insulin resistance.

If I can put it in one line in any of your viewers, I think they should note this down as well. Insulin resistance is deposition of fat in cells that are not designed to store fat. We have a tissue called adipose tissue, which is designed to store fat in our body, which we have throughout the body. And then again, there's differences in different ethnicities and where they tend to have those fats.

But liver and muscle cells are not designed to store fat. They have some fat storage in them, but that's just like a rainy day kind of scenario. It is not the primary function of liver and muscle cells to store fat. Now, when you are in a high energy consumption state, you're eating, uh, more, or even if you're eating, let's say 2000 calories, but those 2000 calories are coming more from high fat and high protein sources, especially animal protein, which leads to inflammation in the body.

Then that high fat and inflammation together interferes with the signaling of the insulin. So insulin binds to receptor on the cells of the liver, but it doesn't do what it's supposed to do. So then your body has to produce more insulin to do the same job, which initially that works, but then you reach a point because you keep doing the same process.

You keep depositing more fat. Because of the effect of insulin in your cells and that keeps interfering with the insulin signaling and perpetuates the problem, you eventually reach a point where your pancreas is producing the maximum amount of insulin that it can, and you're still not seeing the effect that you need.

Now, um, liver doesn't keep the party to itself. Liver is getting all built up with fat. It's like, okay, I need to share this measure with other organs. So the liver then starts sending fat to through the blood into different organs. So now you get deposition of triglycerides, which is type of fat in your pancreas, and you also get deposition of fat in your muscle cells.

Now your muscles are also not responding to insulin like the normal tissue. So you go from liver insulin resistance to muscle insulin resistance, and that takes two of the main sides out, right? Mm-hmm. . And on the back end, this is called a double hypothesis. Um, Dr. Roy Taylor in the UK, he published his many studies and his last one, I think the most impactful was the direct RCT.

Where they did reduce calorie dosing food pattern for a while, and then they were able to see reversal in insulin resistance, but mm-hmm. And again, that goes into kind of the fasting aspects of things, but going back to this, so when there is buildup of, in his studies, he has shown that when there is buildup of triglycerides in the beta cells, your pancreas' ability to produce insulin goes down.

[00:21:47] Susie: Mm-hmm. 

[00:21:48] Dr. Patel: So the number that they saw was if you have two grams of fat buildup in your beta cells, your insulin production goes down. And if you lose those two grams of fat buildup in your beta cells, your insulin production can come up. 

[00:22:01] Susie: Mm-hmm. 

[00:22:01] Dr. Patel: So for losing two grams of fat in the pancreas you need to have about 10 kilograms or about 20 pounds, uh, 22 to be accurate, but that much overall weight loss. 

[00:22:15] Susie: Mm-hmm.

[00:22:15] Dr. Patel: for that change to happen in the pancreas. And so that's the double hypothesis. On one end, you are not utilizing insulin that you're producing. Your liver and muscles are getting resistance effect. And on the other end, the factory, which is tasked with producing insulin, is also not producing it as much. It's going down. 

[00:22:38] Susie: Right, Right. 

[00:22:39] Dr. Patel: That's a double whammy. 

[00:22:41] Susie: Yeah. And so I don't think it's explained that well, maybe in primary practice. There's much more science that comes out, you know, with our understanding of diabetes, I think it can be very confusing. Dr. Taylor also wrote a book, if people are interested, that outlines all those studies you were talking about to come up with that double hypothesis.

[00:23:01] Dr. Patel: He actually presented, uh, his data at the 2019 American Association of Clinical Endocrinology annual meeting. That's, uh, when I came to know of that. They did it in a way where they were, you know, doing 800 calories a day for a few weeks and then kind of gradually increase that further up, right, to create that, uh, calorie deficit to create that weight loss effect.

[00:23:23] Susie: Right. 

[00:23:24] Dr. Patel: So that gets me into the nutrition part, right? Right. And again, people are like, Oh, do I do vegan? Do I do keto? Do I do this, do that. There's so much tug of war and confusion. But if I can simplify things that we definitely know, and I think both sides would agree on, is: 

Number one, you wanna say bye bye to junk food. And also process foods, right? There is no debate there. 

Number two, intermittent fasting has tremendous benefits. And I actually think that the reason why people with keto lifestyle tend to, you know, see results is not because of just the carbohydrate restriction, but because of the fasting and, and actually the effects that you can get from high fat protein consumption, which you have inflammation and all this heart disease and all this cancer promoting effects. You are compensating that with the fasting. So my approach is why do something where you're going opposite end? Take the benefit of fasting. You get the nutritional ketosis when you do the intermittent fasting or even longer durations of fasting, and then get the benefit of the whole plant foods when you do eat.

[00:24:35] Susie: Mm-hmm. 

[00:24:35] Dr. Patel: You get the nutrients and the fiber, which feeds your microbiome. Microbiome is the key, right. That gets even more synergistic. You're getting the benefit of the fasting and you're getting benefit of the food you eat.

[00:24:48] Susie: Right 

[00:24:49] Dr. Patel: Now, the thing that people need to understand is this is not zero fat. You're not talking about zero fat, but the number that studies have shown is if we can limit our fat intake below 15% of total calories per day, that is where the liver and the pancreas and the muscle cells starts offloading that fat buildup from from there. So they can actually get decongested and you're feeding the microbiome with all those fiber rich foods, with nutrients, and that allows your microbiome to grow and expand which also improves your insulin sensitivity.

It's helping the whole body. Now why do people, you know, again, feel like keto works better, but trust me, I see people all the time who done keto and then they're having more issues and then I'm having to work through that and transition them to more whole plant foods. Your eating standard American diet. So if you go to keto, it is a step up. Way step up.

[00:25:49] Susie: right? 

[00:25:49] Dr. Patel: Yes, you're gonna see improvements. No doubt. But the goal is to not just lose 20, 30 pounds in a month and then gain back 40 pounds in two months later. Because when you lose too much weight fast, your body actually fights against that. Mm. Versus if you can lose weight gradually, a pound or two each week or half, say maybe half a pound a week at some point. You are more likely to keep that weight off. And stay there rather than going the yoyo pattern. 

[00:26:16] Susie: Right. 

[00:26:17] Dr. Patel: Like I said, it's not zero fats, it's fats, but healthy fats. So things like nuts and seed or coconut or avocado. You know, we are not talking about refined oils. Now there's some value to, you know, extra virgin olive oil and things like that, but you can't just keep drenching everything in olive oil and say it's gonna make it better. The idea is to eat foods which are high in fiber and nutrients. If you ask yourself that question every time you eat, does this food have fiber and does this food have high nutrients? Nutrients meaning vitamins, minerals, anti antioxidant, you know, fighting, chemicals.

The only four food groups that you can get both are fruits, vegetables, beans, and whole grains. Now again, all the people out there who like to eat meat or consume some form of animal foods, it is not absolute. You know, you don't have to be a hundred percent plan based to get the benefit.

[00:27:12] Susie: Mm-hmm. 

[00:27:13] Dr. Patel: If you look at any culture or any long living population across the world, the Blue Zones was a study by National Geographic, but there are many more areas than just those five blue zones that they identified. The core concept in all those areas is they're eating predominantly whole plant foods. They have a small piece of meat, maybe once a week or few times a month as a special celebration or a special meal. It is not eating three times a day.

[00:27:44] Susie: Right.

[00:27:45] Dr. Patel: So if you like to eat meat, it should be a small portion, maybe once, twice a week. But 90, 95% of the time you're feeding yourself fruits, vegetables, beans, and whole grains.

[00:27:57] Susie: Mm-hmm. 

[00:27:58] Dr. Patel: And if I may make one more point before I wrap up this answer is fruit are protective against diabetes, and fruits can actually help reverse insulin resistance. That's another big misconception. But the reason why people see issues with sugars going up with fruit is if you're already insulin resistant.

[00:28:18] Susie: Mm-hmm 

[00:28:19] Dr. Patel: Then yes, your sugars are gonna go up, but you can actually make it worse, which people do all the time is when they combine fruit with the high fat food. So they'll combine, which again, they're told all the time, by unfortunately many dieticians as well. Eat peanut butter and apple, or eat a fruit with cottage cheese, or eat fruits and nuts. That's the worst combination that you can do because you are adding so much high fat that it's gonna prevent your body to utilize the fructose and the glucose that you're gonna get from the fruit. So you'll get a bigger sugar spike versus if you just eat the fruit by itself, either as the breakfast meal, not just one piece, but enough fruit.

[00:29:02] Susie: Mm-hmm. 

[00:29:03] Dr. Patel: Or as a snack before dinner. Not combining it with anything else, you will see that you're able to handle more fruit, you're able to get better sugars, feel better, feed the microbiome, and get all the nutrients with that. 

[00:29:18] Susie: Mm-hmm. 

[00:29:19] Dr. Patel: The second point is to not modify the form of the fruit. Now you'll have to chop it and clean it in whatever you need to do to eat that. But what I mean is do not blend it into a smoothie or do not juice it. Because when you do that, you are discarding the fiber in the juicing or you are breaking down the fiber too much when you turn it into a smoothie. So now that goes through your system a lot faster and your body has to mount a lot more insulin response to handle that high response.

[00:29:51] Susie: Right. 

[00:29:51] Dr. Patel: And so more insulin needs to more weight gain. Right. Versus if you eat the fruit and you actually eat a lot more fruit. But you have to chew it, you'll break it down, goes through your gut, goes through intestine. It's a slow process and so your body and your liver gets a steady release of that fructose and glucose, which it can easily handle with minimal amounts of insulin.

[00:30:17] Susie: Mm-hmm. Mm-hmm. 

[00:30:20] Dr. Patel: So there's a difference between, uh, eating the fruit wholesome versus having it in a juice or a smoothie form. So juices and smoothies. . . Don't, but if you eat the actual fruit, you'll be full. As a matter of fact, for the past nine months or so, my breakfast is just a big bowl of fruit.

[00:30:39] Susie: Ah, yep. 

[00:30:41] Dr. Patel: And um, whatever fruit is in season, I make a big bowl. It may be one fruit or it may be two, three fruits. Again, whatever is in the house. And I actually get a burp after I finish eating and I'm full for four hours. 

[00:30:55] Susie: Yeah. And in my mind too, like, people are used to eating one apple, so maybe you don't think of eating an entire bowl.

[00:31:02] Dr. Patel: Eat one apple, you'll be hungry in an hour, but if you eat enough, if you eat two apples, it doesn't mean you have to eat like five apples. I can tell from my own experience if I just eat two apples, Chopped takes me about 15 minutes to eat that I'm full for four hours.

[00:31:17] Susie: Mm-hmm. I love all of that. Do you help your clients do that? How do you get them to move from the standard American diet or keto diet? Is there a support system or do you just give them resources? How does that happen for them? 

[00:31:29] Dr. Patel: So it's uh, it's still evolving. I just, uh, build a new office where, which is a lot bigger space, and we are gonna start doing group visits and we'll start having support groups and all that. So again, you need the support system. I do have a plant-based, certified diabetes educator and health coach that works with me. So it's, it's a work in progress. What I do, because everybody's a different stage, you know, if I'm seeing someone for the first time and they have a liter of soda every day and a pack of cigarettes every day, I'm not gonna going even talk about nutrition there. If I can just get them to quit smoking and get them off the soda, and not get them on diet soda because that is really worse than regular. Not that regular is good, but diet is exceptionally worse. So if I can get them off those two things, it is a great start. You assess where the person is in terms of, you know, and what's the low hanging fruit. Right?

[00:32:26] Susie: Right. 

[00:32:26] Dr. Patel: So the soda and the tobacco is the low hanging fruit there. I don't need to stress them up with all this nutrition information. And then, then I'll see patients where they have already have had some reading or research and they've already done some changes, and then they're ready for more information. So then I'll give them more resources. Documentaries to watch and then mm-hmm. Start with one meal change at a time. You know, it's, it's not a cookie cutter approach you to assess where the person is and how ready they are for the change and how much open they are for the information. And I keep reinforcing that every visit. I do not just do it one time, uh, thing and then forget. Uh, it's, uh, so they realize that every time they come see me, I'm gonna ask them what they're eating. I'm gonna ask them about their sleep. I'm gonna ask them about their stress levels and how they're managing it. I'm gonna ask them about their activity levels, about tobacco, alcohol, if that's going on, so they know that this is gonna be discussed, and I'm gonna offer my suggestions and advice based on what's going on. So it's a, you know, reminder. And I'm doing it because it is a passion, you know. 

Does the insurance pay me enough to do all this? No, they don't. Sadly not. I'm trying to be a part of an ACO, which is lifestyle medicine based. So, uh, I'm working in that direction. Right. Then that's a huge aspect. You know, why most physicians are not, and, I have my own practice so I can decide how many, how heavy or light the schedule has to, I mean, I have to have some patients to keep the doors open, but I don't have to see 30 patients a day. Because I'm working for a big clinic or a big corporation or hospital. So I do have more time. Um, but yeah, the system is not designed to allow the physicians and provide them the right training to allow them to equip them to do that. System is designed against you, so it takes more efforts for you as a patient and for the physician as well, or any, you know, healthcare providers to be able to do this.

[00:34:32] Susie: Mm-hmm. maybe in the next generation or two, it might change a little . Hopefully. 

[00:34:37] Dr. Patel: It's starting to change and the change will pick up in the coming years, but, Um, it is a process.

[00:34:43] Susie: Right. I really wanted to do this podcast to share the message with a broader base because I think, what I see all the time, every day is that people don't know this information and um, a lot of times they're surprised or they're open to it cuz they wanna change. Some people are not ready yet. So I just plant little seeds, or ask, Well what's your one thing? Are you drinking eight cans soda a day? So we're gonna start with that only for right now, and then we'll move on to the next. Just depending on where they are, I give them resources. And of course, as a nurse practitioner and health coach, so I try to put some accountability and support in there too. 

[00:35:24] Dr. Patel: Sure. 

[00:35:24] Susie: But anything else that we didn't talk about that you think would be pertinent for people to know?

[00:35:28] Dr. Patel: I think, uh, we talked about the subtypes that get misdiagnosed, so keep an eye out for those, signs of insulin resistance as well as signs where you may not be type two and maybe type one and half. 

And then in terms of nutrition changes, If I can just impact one line, uh, I would quote Michael Pollan. He's a food journalist and a blogger, and he has written many books and I believe a few documentaries, but this quote I repeat all the time. If we can have more people apply this is, "Eat real food, mostly plans, not too much". 

[00:36:08] Susie: Right.

[00:36:08] Dr. Patel: Real food means all processed food package stuff goes out of the window. In his own words, I'm paraphrasing, is mostly plants is maybe once a week, four to six ounces of meat. And then remaining is all whole plant foods. And not too much. Uh, you can use intermittent fasting as that modality to apply "not too much". You're having at least 12, 13 hours of break every day. 

[00:36:33] Susie: Okay. I was gonna ask you about the time. You said 12 or 13 hours. 

[00:36:37] Dr. Patel: Again, it's, it can be whole, uh, topic by itself. 

[00:36:41] Susie: Mm-hmm.

[00:36:41] Dr. Patel: But at a minimum you want to get 12 hours. And 12 hours you know, 7:00 PM till 7:00 next morning.

[00:36:49] Susie: Right.

[00:36:49] Dr. Patel: If you're schedule doesn't allow 7:00, then maybe 8:00 PM till 8:00 AM.

[00:36:53] Susie: Right.

[00:36:53] Dr. Patel: But definitely after 8:00 PM should be hard stop because if you eat after that, your body's gonna metabolically not process it appropriately. It's gonna cause more insulin resistance, more weight gain, and all the issues from there. 

[00:37:07] Susie: Right. Alright, so we will have to save the thyroid discussion for another time. Maybe I can have you back on and we can talk about that. Okay. Very good. So thank you so much for your time. I really do appreciate it. And we'll circle back to the thyroid another time. 

[00:37:24] Dr. Patel: Sounds good. Thank you for your audience and, um, wish them great health.