#1112 Grand Rounds: Food and Nutrition

January 22, 2024Scott Benner

The fourth Grand Rounds discussion focuses on food and nutrition.

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Scott Benner 0:00
Hello friends, and welcome to episode 1112 of the Juicebox Podcast

Welcome back everyone to the Grand Rounds series with myself and Jenny Smith. You know sometimes I just think everybody knows Jenny So I forget to introduce her properly, but Jennifer Smith has lived with type one diabetes since she was a child. She has first hand knowledge of the day to day events that affect diabetes management. Jenny holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She's a registered and licensed dietitian, a certified diabetes educator and a certified trainer and most make some models of insulin pumps, and continuous glucose monitoring systems. She is also all over this podcast from the Pro Tip series to defining diabetes, to ask Scott and Jenny. Also call her a friend. And I think she's one of the smartest people I know about managing type one diabetes, you can hire Jenny at integrated diabetes.com. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan are becoming bold with insulin. Don't forget to save 40% off of your entire order at cozy earth.com. All you have to do is use the offer code juice box at checkout that's juice box at checkout to save 40% at cosy earth.com This episode of The Juicebox Podcast is sponsored by ag one drink ag one.com/juice box. When you use my link and place your first order, you're gonna get a welcome kit, a year supply of vitamin D and five free travel packs. This episode of The Juicebox Podcast is sponsored by us med U S med.com/juice box or call 888721151. For us med is where my daughter gets her diabetes supplies from and you could to use the link or number to get your free benefit check and get started today with us met. Today we're going to talk about food to just briefly go over so far we've gone over hospitals diagnosis, insulin and safety today food should be a slightly shorter episode, although I expect you to go off on some sort of a tangent at some point. So maybe it'll take a little longer. The reason I thought that you'd have a lot to say about this is because obviously your background in nutrition. So we have a few pieces of feedback from the listeners about what they prefer, what they would have preferred to hear from doctors, we'll go through a little bit of that we'll talk about it from a couple different perspectives, and we'll we'll let people get back to their lives.

Jennifer Smith, CDE 2:50
I really liked the feedback from people, especially in this because I think I think it offers a lot of perspective of knowing now what people know, and what would have been really helpful. And I think food is a big place. I mean, it's one of the three things that helps manage diabetes.

Scott Benner 3:12
So I agree, I think for this episode for these episodes, specifically, having someone go through it not knowing what they should want or need. And then having them live long enough to think back and go, Oh, you know, what would have really helped back then. And sending in that information is great, right? This person says I wish I would have known in the initial phase with MDI that my toddler can have up to five grams of uncovered carbs for a snack. I came home from the hospital terrified to feed him anything, but meat and cheese. Wow. This is this is interesting, isn't it? Because a new diagnosis may assume some honeymooning and, but But telling somebody they don't need to Bolus for anything under over under five carbs is really giving it's really setting up the quiet expectation that we think you're going to get low. Or we're okay with you being higher one or the other. Right?

Jennifer Smith, CDE 4:07
Correct. That's it's a good assumption. Yes. But it also creates a lot more confusion. Right, right. Because I guarantee that nobody said that as long as it's under five grams of carb. You don't have to Bolus for it. They didn't go on to say, but if you add up multiple things that are under five grams, and you eat them all at once, then you need to Bolus because the complete total is well more than five grams. And I guarantee that wasn't clarified.

Scott Benner 4:35
Right? That's an assumption that doctor will make like, oh, that they'll understand that. I don't mean you know, if you have five grams at two o'clock and then five grams to 230 and etc. But there's no reason to think anybody would understand that. Correct? None. Yeah. And it sets up long term problems. Because now in their mind forever and ever anything under five carbs doesn't. It doesn't need insulin, and then they see a high blood sugar. I bet they don't even put two and two together at that point,

Jennifer Smith, CDE 5:00
and they wonder unless they're paying enough attention to and have a continuous monitor, that they've really tried to pay attention to some trends or things that are, you know, happening over and over again, in those early days or weeks. Absolutely.

Scott Benner 5:17
It's just a good example of if you can, outsmart yourself. So if you over I'm not saying every doctor does this, but we know what happens you over basil somebody because you don't believe that they're going to count their carbs correctly, or Bolus on time or whatever you whatever you're imagining isn't going to happen. And then you give them this piece on top of that, they now have to, I mean, two things that are gonna send them down the wrong path and create confusion for the rest of their lives. Right, and

Jennifer Smith, CDE 5:42
some clarification there too. I mean, a lot of this is, if you're just clear upfront with some simple pieces, about insulin, about food about the variables, and even just a couple of the variables, especially for little kids, the explanation of what we might tell you right now, because sensitivity for your three year old child is going to be high, that maybe they can get away with a couple of grams of carb to nibble in between, you know, toddlers, I mean, they grab something, or they want something. I mean, they don't just sit down to a big meal three times a day, right? So you know, it brings in the idea that, well, if they want one cracker, and it's two grams, they can have that and you don't have to worry about having to give insulin for it. But then again, the understanding that that's going to change. Right now, they might not need insulin, they might be going through honeymoon. But eventually that five grams is meat, it needs to be counted.

Scott Benner 6:44
The other thing here, I mean, no disrespect to the person who was kind enough to send in the question or the statement, but they now have a misgiving. They do like she now thinks like, listen to the words. I wish I would have been told that my toddler can have up to five grams of uncovered carbs. Yeah, not true. Like Like, yeah, it might be true in that situation. Maybe the kids honeymooning, but you need all the context of that. But now moving forward. This is how she speaks. He or she speaks about it when when she says it out loud. She's got a misgiving. I'm sorry. I'm just assuming moms are the ones listening to this podcast. Not that guy's dads are a lot of dads. I know. It's funny, like I'm a dad. And I just assumed no, there's no dads listening. But. But she's got this misgiving. And now when she goes out in the public, she's spreading it. Because she's telling us like, you need to let people know, your kid's gonna have five cards that are covering, like, okay, like, so here we are, we're spinning down a rabbit hole, and nobody's ever going to get back out of it.

Jennifer Smith, CDE 7:49
And someone that may have read it and knows better already, at this point from what they've seen and dealt with thus far. can absolutely say, well, that's not the case. And may chime back in and say, Well, you know, especially, you know, with your group, they're really great about

Scott Benner 8:06
going off each other. Oh, no, they're fantastic and helping each other. However, why did I set this up to tell you this one first, because here's the next one. It's a fantastic. Even three grams of a snack, like a small cheese puff package. We have to cover that. Even within days after diagnosis, we found out real quickly, there's no such thing as a free snack.

Jennifer Smith, CDE 8:30
There you go. Absolutely. So good. Yeah, absolutely. And it just, it justifies the, the idea that individualization of the information that you give, which is really hard at initial diagnosis, you can't get to know somebody in that tiny amount of time where you're trying to give them some, save yourself or save your child kind of information. Because that's really what it is at initial diagnosis, right? They're setting you up to get you going to get you out the door to get you home. And then to be able to connect with somebody that can give you the broader scope of let's call it the correct information. Yeah, hopefully, yeah.

Scott Benner 9:14
Hopefully, you'll find a next person who will go a little deeper with you. But again, a lot of this, a lot of these episodes to me are about what happens when you say these kinds of just offhanded things in the first days or weeks, and you leave people like, like the one person figured it out, and the other person didn't figure it out. And they're both listening to this podcast. So even that didn't help completely. No, this person says, I'd like my doctor to know that my son doesn't need to be on a low calorie diet to achieve a Grade A one say somebody was told to limit calories frequency.

Jennifer Smith, CDE 9:49
That's where you said, you know, you'll wait for me to go off on a tangent. This might be my tangent, honestly. Because, depending on what facility You get diagnosed at and I'm, I'm speaking more toward the kid and teenage kind of facility, right? Because nobody anymore really pays attention to nutrition needs of a growing child or a growing teen. And I said nobody, that's not 100% Correct. But less and less I see that parents have an understanding when I get to work with somebody finally. And my question comes up, well, what parameters? Were you given for portions? Right? Because just because you can eat food and cover it with insulin, doesn't mean you need three packages of something. Right? And so initially, that's something that should be set up sooner than later, is the concept of containment of portion. Yeah. And it's not, it's a lot of just centered around carbohydrate thinking, centered around how to count the carbohydrates, with no idea that somebody needs this much, or the 13 year old needs this much in the 18 year old who plays you know, field hockey five days a week needs this much. There is a major variance, but no, just cover your carbohydrates, whatever you're choosing to eat.

Scott Benner 11:19
I don't know that this would come to a shock to anybody. But Jenny and I talk privately. Fair, a fair amount. I think that what I saw in my life is the way I grew up. In the beginning, they tried, here's some chicken, here's some beans, like, have a salad boba. And the minute we push back as kids, they were like, Screw it. And then when money got tight, it all went to, like, processed prepackaged. And you can probably I don't know the dates, but I think in my childhood lifetime, you can look back to where processed foods became more and more prevalent, and ugly, and they were cheaper, and they were more convenient. And then my parents went to that before you knew it. Like you know, you weren't making something from scratch anymore. You were making it from a package or box. How amazing is this? Look, you just dumped this into water and add meat, Mike? Okay. Yeah. I want to say I've never liked Hamburger Helper, I will not eat it. But that is what um, but that is the thing that somebody was like, here, look dinner. It's got meat in it, like, you know. And so when that's all going on, and your body gets rewired to just like, I don't know, to crave those things. That that's tough then, because now these portion control problems are insane. And I only have perspective about it. 40 years later, because I'm taking a GLP one and my brain works differently now. Right? Right. Kelly and I were out last Saturday. It's Friday. Now last Saturday, we were out and we got this like we saw this chocolate cupcake. It was like chocolate cake with chocolate icing. And it was big. It was like four around and we were like we can split this. Sure. Three goddamn days later, we couldn't eat the damn thing. Like we were like taking a fork full out of it and being like, Oh, that was good. That's enough and putting it down. But if I'm not on this GLP we probably would have like, fought each other with the forks to get to the rest of the cupcake that we would have been gone in a couple of minutes. Correct. Then so you now you're giving this stuff to your kids. They're like, Let's go like and it's not them. It's their. It's their wiring. It's their, you know, it's the I hate to sound like a hippie, but it's the way it kind of restructures your gut to want these like carbs and all this stuff that goes with it. Absolutely Sugar,

Jennifer Smith, CDE 13:33
Sugar. There is there is something to be said about sugar addiction. It's a real thing. 100% It is. And so again, if I were to go off on a tangent, it's it's definitely about the fact of today's life is busy. It's even busier than when these processed packaged all convenience, you know, you brought up a hamburger helper. And the reason it was there was because well we've got these dehydrated, like peas mixed in with noodles that you just have to pop in and Oh, then your ground beef. All you have to do is mix it together and you've got a complete meal. Yeah, we've got everything that you need within 15 minutes.

Scott Benner 14:11
But that's not good for you. It's just not it's not good. And I think that more and more, we are eating food that is not it's not fueling us. It's not actually providing nutrition. And I'm not against saying that I think people are having other issues that are probably nutrition based that we're not even aware of at this point, correct? Yeah. Arden has been getting her diabetes supplies from us med for three years. You can as well, US med.com/juice box or call 888-721-1514 My thanks to us med for sponsoring this episode and for being longtime sponsors of the Juicebox Podcast. There are links in the show notes and links at juicebox podcast.com to us Med and all the sponsors.

Jennifer Smith, CDE 14:55
Absolutely. But I think it compounds it then when you know URL In diagnosis, you've not been given the information about what your body actually needs, even on a caloric level. And by no means do I ever really recommend anybody count calories. It's tedious. It's it's just not purposeful, but understanding portions are visible. Your child needs this many portions of this in a day. Your child needs this many portions of this, making sure to emphasize that these foods should be real food.

Scott Benner 15:29
Yeah, right. Yeah. So those are the words rattling in my head. While you're talking. I, you know, you do this long enough. And, you know, you know what you're gonna say next sometimes. And while you're speaking right there, I thought when she stops, I'm going to say real food. That's exactly what I was just thinking. So portions important, right? You can't just you don't want to be taking in 10s of 1000s of calories, when that's not what you need to get by, you are going to have an issue with your weight if you do that. But also, you're gonna end up using more insulin, that then very well may cause lows later that will cause you to need to eat again to like, bring it back up. But the problem we're trying to figure out here is what should doctors be saying to people? To a not? Because you don't want the people to hear? Oh, yeah, okay, I'll have four ounces of chicken and a salad and three beans. And I'll never drink soda again, like, because if the doctor leads with that, the people who don't want to hear that are gonna be like, Man, nevermind, not listen to that. The people who already eat that way are like, Yeah, cool. That's what we eat anyway, no big deal. Right? I really think that you should lead with real food, reasonable portions. I think that's enough to get people going. Right?

Jennifer Smith, CDE 16:41
Correct. Absolutely. And I think within that, to the understanding that I think a lot of I know that a lot of parents also feel like all of a sudden there are these restrictions that are going to be in their child's life. And so they try to make up for these restrictions very early on, by not restricting in one of the places that there should be restricted.

Scott Benner 17:08
I understand it, by the way, I'm not, I'm not, I would never come down. But I know you don't want there to be like these grand changes to your lifestyle, but I think it is worth mulling over privately, we were on a bad path, it just got shown to us earlier, because of the diagnosis, this path was going to lead you to a bad place eventually, but your body probably would have hammered through it for 10 or 15 years, then you might have got a couple of medications that got you a little farther. And then somebody would have been said, take our proton pump inhibitor, if you've got, you know, reflux and and maybe you would have got through it until finally one day in your 50s you would have been like I can't like it the medicines not helping. And I can't fight through this anymore. I've got pre maybe I'm working up on some type two diabetes, you know, or all the other things that come mobility and problems like that. You're just finding out earlier. So there's a way to think about that as a bonus. I know that's a weird thing. But you can say like, you know, I or my kid was diagnosed at least now I know, this food is like I think diabetes is just shining a light on the fact that you're eating things that aren't beneficial for you sometimes. And yes, you know what? I mean? Does that make sense? No,

Jennifer Smith, CDE 18:23
it does. Absolutely. I've said that and thought that many times myself. I mean, if I wasn't diagnosed when I was with type one, I'm sure my career path would have been different. And would I have wanted to focus as much on overall like human health? I don't know, I originally wanted to be a veterinarian. So I don't know where that leaves nutrition information, right. But I'm very, I'm very happy for many reasons that I had to learn as much as I did. And obviously, where that led and how I can help people and everything. But I think that many people who live with some type of health condition, that lifestyle impact, you can start to learn a lot more about yourself and what, what makes a difference. And I mean, fortunate or unfortunate diabetes, it sure shows you a lot about the impact of food. Yeah,

Scott Benner 19:23
and I mean, we've talked about this before, but it's worth bringing up you some luck for you, right? Your mom was a person who grew food she cooked she took it seriously when the doctor told her this was What's up, you didn't push back terribly. Like Like, there's a lot that went your way. But my point is, is that, okay, some people aren't going to have that that's not going to be their trajectory. It doesn't mean you shouldn't tell them. Correct. They still deserve to know, because maybe something will happen later in the future. And they'll just like, get smacked in the head and think, oh, that's what they meant. And, you know, maybe I could be doing that. Maybe not fair enough. Like we're not going to save it anybody and I understand all that. But as the doctor, I think it's incumbent upon you to tell them the truth, without scaring them or making it sound like you're stealing something from them. And that's not going to be easy to do. But again, from my perspective, listening to you listen to other people, if you just preach real food at a reasonable amount, I think that's most of it, really, you know, cook your food, you should be able to look at it and see what it is and actually go that's chicken. I know what that is. That's chicken, right? You know, you look at Hamburger Helper, and you go, that's noodles, and peas, and is it. Keep reading, there's more in there, like ever notice you don't flip the chicken over and it doesn't say chemicals. It's a chicken. And even now, like people are smart enough to know, like, look, organic might be better because or no antibiotics that have been used or grass fed for some reasons. Like these are all reasonable ways to avoid pesticides and chemicals and things that again, I feel like I'm just I feel like I sound like Joni Mitchell's like, like guru you hear or something, which is just a reference nobody's gonna get at this point. But like, these things are going to change the microbiome in your gut. And you're going to end up one day with a headache, or an achy joint, and you're going to think, Oh, my wrist is hurt. And somehow it's going to be that those billions of little things living in your stomach have gotten messed up by something, somebody sprayed on something. I partnered with ag one because I needed a daily foundational nutritional supplement that supported my whole body health. I continue to drink at one every day because it works for me. Ag one is my foundational nutritional supplement. It gives me comprehensive nutrition, and it supports my whole body health. Drink, ag one.com/juice box, when you use my link to place your first order, here's what you're gonna get a free welcome kit that includes a shaker scoop and canister, five free travel packs, a free year supply of vitamin D, and of course, your ag one. So if you want to take ownership of your health, it starts with ag one, try ag one and get a free one year supply of vitamin D and five free ag one travel packs with your first purchase. Go to drink ag one.com/juice box that's drink ag one.com/juice box, check it out.

Jennifer Smith, CDE 22:22
You know, as I'm thinking about this, and where's the Introduction to Food started, it started at diagnosis. And majority of people with type one or younger people diagnosed with type one in a hospital setting are admitted. Right? What's your introduction to food? And what is possible to eat now that you have this new diagnosis that you're learning? Well, food has an impact on this. And now I have to pay attention to something called blood sugar or blood glucose. And we have to do these finger sticks and what the number pops up. Like, what is that? I mean, all of these thoughts are circulating around and then what comes in three times a day? Is the food from the cafeteria. Yeah, I know hospital food I worked in hospital cafeteria was when I was in college. And it's it's not

Scott Benner 23:15
It's garbage. Yeah, no, it's terrible. And it's not good for you. And by the way, that diabetic menu is ridiculous. It just it just limits you from choosing from like one portion of men, it's, you could still get apple juice if you wanted to. You know, like we live in a world now where you could walk outside and ask anybody? Hey, do you think you should drink fruit juice? And most people would go no, I've heard that's not a good idea. Right? The hospital hasn't heard why they didn't get to them. And then you realize the hospital's a private company. It's not good. I mean, it's they're trying to make money too and etc.

Jennifer Smith, CDE 23:48
Correct? Absolutely. But you know, I've, I've, I've had parents who've come to me and said, Well, you know, as we talked about this, like the process components and how to make things a little bit, you know, better overall. And, you know, I've heard it a couple of times will my child likes pancakes, and this is always happening. Okay, there's some alternatives. These are some ideas to still keep that in the picture. But they ate pancakes in the hospital. That's what they serve them after they were diagnosed now.

Scott Benner 24:17
If you're a physician, maybe a good place to start is to go back to your the board of directors or however you report things. Okay, look, I don't know how you expect me to put these people on a good path. If this is the garbage we're sending into their room as we're diagnosing them. You know, how am I supposed to stand there and go real food reasonable portions while they're eating pretend food? So under a dome that makes everything moist? Has anyone been often in the hospital ever? Like, oh, I don't want I'm hungry, but you handled it. I don't want this now. I know when

Jennifer Smith, CDE 24:50
we they actually looked at us like we had foreheads when we arrived for our first child to be born.

Scott Benner 24:57
There's no way Jenny didn't bring food whether you He weighed

Jennifer Smith, CDE 25:01
like three bags of groceries. And they looked at it like they looked at us, like, so weird, like these people who are these people? Where did they come from? What are they? Are they going to work in the food service and make their own?

Scott Benner 25:15
Ladies got a hot plate? I I remember asking you one time, Jenny, what do you do on road trips? And you were like, I bring food and I was like, oh, okay, I'm like, you don't stop at a gas station ever and get a Milky Way bar? And she was like, No. I don't do that. So, listen, I am not the picture of health, right? Obviously, I've been on a lifelong, a bad path. Somebody put me on and my bodies crave things and move me in directions, etc. But I'm doing much better now with literally just because of a GLP one medication. There's no other reason I wanted to. And I, I searched it out and everything. But even now, I found myself Jenny and I spoke together recently at an event in Texas. And I was at the airport. And I was hungry. And I stood at that thing at that airport. And I thought there's no food here. That's what I kept thinking that I can't even get a drink. If it's not a bottle of water. Like there's nothing here for me to eat. I grabbed a banana and I left. I was like, That is the only real food I see sitting here. Yeah, that was it in a giant kiosk where people were just like, grabbing things and going in different directions and everything or, and so I eat reasonably clean now. Right? And not like it's not the way you think of it. Like I'm not like, I don't know, it's not like a bro science guy or something like that. I'm not like drinking amino acids and powders and stuff. Like I've just, I just I stick to things that I can recognize. The other night someone said, let's get Chinese food. I couldn't even eat that much of it. Because I'm on a medication that tells my stomach it's full. Right? Listen between me and you. It was maybe 45 minutes after I ate the Chinese food where I was like, Hey, I gotta Excuse me. I gotta go. Excuse me a second. Because my body was like, this ain't right. And that was it. I was and I don't even want to say second. I don't want to be dainty. Like, I just get rid of this right now. It fascinating, like, absolutely fascinating. So no nutrition. I was eating for sport when I had that Chinese food. Basically. Yeah, absolutely. Okay, yeah. But again, do not tell newly diagnosed, they can eat whatever they want and just Bolus for it. Nobody should eat whatever they want. Not in today's world of crappy food. And I made a note to this. I said it's the right message with the wrong wording. Because I do understand telling people, listen, you can eat whatever you want. You just have to cover it with insulin, not only do I understand that, I've made a podcast about it. Correct? Right. I want people to understand how to use insulin. But that's from a heavier perspective than you think. Doctors say it. I'm guessing because they want you to use your insulin, I'm guessing they know you're not going to eat well to begin with. That's probably their expectation. And they probably don't want you to feel limited. I'm guessing those are about the three reasons. The reason I say it is because I think if you know how to use insulin, for whatever you're eating, that means you'll know how to use it for other things as well. And hopefully one day, you'll figure out the rest of it. But in case you don't, I want you to be able to cover Hamburger Helper because I don't want you to have poor nutrition and poor diabetes management. Right. That's where I'm Yeah,

Jennifer Smith, CDE 28:30
no, that's that's a good, very good clarification. I think from the doctor perspective of a new diagnosis, it's one of the thing it's sort of a feel good statement to hate it. It's yeah, they don't, you know, they don't want so much to change, because they know so much is going to change the fact that you don't have to change what you eat. Just make sure you take this medicine along with what you choose to eat. That's the blanket statement is you can eat whatever you want. Well, that's 100% True, as you're saying, but your level is learn to use insulin. So in the case of choosing something like Chinese food, or whatever, that you can actually manage the blood sugar, which has the impact on overall health.

Scott Benner 29:14
Right to my expectation, just to be very clear, is that I don't think most people are going to eat well. That's I hope they do. I really do. I don't think they're going to and in that case, I don't want them to be again, like poorly fueled and poorly like managing their type one though, because they have now they have two different problems instead of one different problem. And now we're just spiraling out of life. By the way. I don't see any difference between this bit of conversation here about a physician saying oh, don't worry, you can eat whatever you want. I don't see any difference between that statement and oh, I've heard there's going to be a cure. I think those are both meant very passionately like and compassionately Excuse me. Yes. But again, you you run the risk of starting somebody on the wrong path, which is don't worry, eat whatever you want. Well, people do not understand nutrition to begin with. They're like, oh, let's go, you know. And the same thing when you tell somebody like, oh, you know, I heard there's a cure these algorithms work so great, now you barely have to do anything. What people hear is I don't really have to pay attention to my diabetes. And that's the unintended message. So find a way to talk to them about food, without scaring them about it, putting them on the right path, without giving them a hall pass to eat whatever they want. Like, you got to use better words. It's all communication, really. So yeah,

Jennifer Smith, CDE 30:34
I always think, you know, at diagnosis, this, again, is, especially for kids and teens. I think a dietitian should be part of that. Team education, and in many cases it is. But I think what's left out still is the idea of, not only should it possibly be better food than maybe you're already eating, but also just how much does your kid need? Because if they go home with that, even if they are eating, you know, Doritos, or whatever it is, at least they know that the bag isn't the portion.

Scott Benner 31:12
Right? That opened it, and we're gone. And that was it. Yeah, no, people don't listen, diabetes taught that to my daughter. She's like, there's 15 in here. I went No 15 to the serving, how many servings are in it? And she's like, Oh, yep, yeah, but she was young. But she got to figure it out that way. Again, another benefit of I can't believe I'm saying this is another benefit of her getting type one diabetes art is actually a fairly healthy like, fit person. So let's go over this last little bit of feedback. And then I'm going to say something banned. And and then I want to finish with you. This person says, please just find out how people eat before you start their meal plan. Our doctor had our son snacking five to six times a day, which was not just unsustainable, but we're not snackers to begin with. So this is not a thing we used to do. They were literally telling them like, eat more. And they're like, we don't do that. She also says he or she says that we're also not junk food people. And so like snacking, see what she's saying is you made a snack, we went and got bad food to snack with because he can't cook a meal six times a day, which is the way we usually eat. And she also said, please stop telling people protein is free food and doesn't need insulin. Yeah, because it's not. I'm gonna say this, even though there are probably some incredibly low carb people who think that I am pushing insulin on people because I say I think you should know how to use insulin. I am not. And I so I'm going to just ask Jenny here to dispel the the idea that you need carbohydrates to grow. Because fell it? Well, I think you need some carbohydrates, but from the right foods. And I think that some people hear that and think, oh, Doritos counts, you know what I mean? It's, it's another one of those mixed muddled messages. Correct?

Jennifer Smith, CDE 32:55
Absolutely. Carbohydrates contain, especially the type of carbohydrates that should be being eaten, the vegetables and the fruits that should be being eaten in terms of carbohydrate content, they contain an enormous amount of antioxidants. The colors of the rainbow, are a phenomenal piece of the fruits and vegetables. And if you're aiming for lower carb, then you're aiming for the lower glycemic ones, you're not being carb free, or just being aware again, of how much of it are you eating, and you're eating those foods, not from an energy necessity standpoint, because the body can convert in a low carb environment, it can convert to using fat. And that's what many low carbers are doing. But you have to also talk with somebody who can really guide you in the right way for that, because you can really do it wrong, right?

Scott Benner 33:48
And then not be getting a nutrition that way. Correct? Absolutely. So then when doctors say you need carbs to grow, their concern is that if you do keto wrong, you're not going to have the nutrition you need.

Jennifer Smith, CDE 34:01
That would be my expectation, or that they really are just thinking that because the because the human body works very quickly and easily off of carbohydrate, but it's a quick burn, it goes in it goes out it goes in it goes out. And so if you have a really, really high carb intake above and beyond what you really honestly need, you're going to be on a constant roller coaster of hunger. And your brain is going to work off of carb and it's going to want want want want, right? Whereas if you moderate that, again, understanding what are your nutrition needs, what are your caloric needs, then your body can actually do very well. But you have to have balance, you have to know how to do that balance the right way.

Scott Benner 34:45
I'm afraid that I don't know how to do it well, but I also wouldn't lie and I'd say there are days that I fairly low carb were all like I mean, I've said on here a million times like I'll I'll smoke a couple steaks and slice them up and pick at them for days, you know, or something or something like that. But I'll still Fruit during the day are you know, I've come to starting to eat like coconut milk, yogurts and things like that. And I also supplement pretty reasonably like I'm covering my supplemental needs if I don't think I'm getting them through food. Again, that's an expense. It's not a thing people know about. I think some people think vitamins are no bullsh. I think some people think they're everything. I don't think there either. You know what I mean, you still got to eat. You can't just take a vitamin. That would be the Jetsons, that'd be the opening to the Jetsons, which is another reference, no one will know. Yes. Jenny might be,

Speaker 1 35:32
oh my gosh, I love the Jetsons. They were they were great. I used to be

Scott Benner 35:36
jealous because they'd get that pill that would come out of the machine. And then they'd cut it in half with their knife and eat it and then go about their day. And I thought, Oh, I wish eating was like that. Right.

Jennifer Smith, CDE 35:46
You know, what I always find funny about the Jetsons is that they had down what we do. All over, especially in the past five years, we've really come into zoom, and all of these online, like webcasts, and all of these, that was the Jetsons were like, they were well ahead in terms of our cartoon.

Scott Benner 36:06
It is funny. I did a thing for World diabetes Day where I spoke to 100 people for two hours, like from sitting right here. Yeah, just everybody clicked on a thing. And we were all there together and had this nice conversation. That's awesome. Yeah, it's very cool. But

Unknown Speaker 36:19
But yes, supplements were typing. Yeah,

Scott Benner 36:21
yeah. So I mean, and that's, that's another part of this, that that I think people need to be aware of, especially with diabetes. There are supplements you you might need, like you know, your pancreas is part of your digestive process. Some of you might need like a digestive enzyme or something to help that along. I don't think it's something we're ready to talk about right now. But Jenny and I are looking into another supplement to try to like take to see how it goes. And by the way, I've ordered them. Oh, there's that piece of it. So just even just a good multivitamin, but even people go wrong there. They take their multivitamins as gummies or like, you know, it's just see Jenny's face, she would never take a gummy vitamin gummies are just like you brought her own food or birth.

Jennifer Smith, CDE 37:07
Know that gummy vitamins are I mean, unfortunately, even from what looks like it's a good company. And you can find online very easily multiple reports about gummy vitamins not being consistent in content of the micronutrients and macro and things that they're that they

Scott Benner 37:24
actually do people right. So in the gummy

Jennifer Smith, CDE 37:28
I mean, even even that, you know, if you're gonna if you're gonna take a multivitamin, also look at where, where those vitamin sources are coming from? Are they actually quality? Are they synthetic? Do they have some type of spray applied to the homeless, they're supposed to be absorbed, the better. You know, I

Scott Benner 37:47
think I was listening to something recently where someone said that one of the like, chewable vitamins has like something in it that at a certain parts per million would be deadly or something like that. And I was like, What the hell, they're more expensive, okay, but buying something cheaper, that's a waste of your time is a bigger waste of money. So I'll say that I stick to pure encapsulations or Thorne,

Unknown Speaker 38:08
those are those are great brands.

Scott Benner 38:10
Those are the two brands I stick to. So for things like vitamin D, zinc, I take an iron supplement from them, I mix it with a vitamin C from them, that kind of thing. multivitamin like that, that sort of stuff. So if you don't think you're getting it, I drink athletic greens, you can probably try to find a green drink that would you know, like help you with these things. But if your foods not giving it to you, I know nobody thinks of it this way. But if I found a random person around all day, I'm gonna guess that seven out of the 10 things they put in their mouth are not valuable to them. Nutritionally. I just think that I don't know how you could look at that stuff at that airport or in the grocery store and not come to the conclusion. Like there's a potato chip aisle. That is usually also the candy aisle. Literally nothing in there is helping your body stay alive, right, the soda aisle.

Jennifer Smith, CDE 39:04
If we're if we're talking about carbohydrates, to get rid of the majority of them live in the aisles of your grocery store. Yeah, they do. 100%

Scott Benner 39:15
and they're fun. I'm not gonna lie to you better than licking whatever that is off a Dorito. I don't know what it is. It's amazing. Jenny would know about it, but it's fantastic. And we all know it. Those are those things there. I mean, if you're going to eat those things, try to find a better way. I'm not saying like you should be sitting around growing carrots in your backyard. I know that's probably not reasonable for people. But I can tell you this, I can't eat potato chips. They make me nauseous because I don't really I don't, I don't consume oil. So like I only use either cold pressed olive oil, grass fed butter or coconut oil every once in a while. Those are the only three things that like I'll cook with or use. So if I have potato chips just out of a bag, I'll get nauseous from it. But if I were to make my own potato chips which is actually a thing I know how to do. I can, I'm okay. And not only that they hid Arden's blood sugar differently than a potato chip out of a bag. Yeah,

Jennifer Smith, CDE 40:07
you'll you'll notice and a lot of it, you know, in terms of oils, I think what you're probably noticing digestive Lee yourself. And what you probably noticed in Arden's response blood sugar wise, is that I mean, the seed oils are horrible. Yeah, you're talking about canola oil. If you're talking about any of the like sunflower seed oil in the safflower oil, and all of those that are, they are cheap. They're fillers. And they are what is used in the majority of process package, right? Let's call it snack food. And

Scott Benner 40:43
every restaurant is going to use it because it's cheaper. Yeah. So anytime you go to a restaurant, something's fried. It's basically machine lubricant, or whatever the hell that ends up being when you melted down. Listen, I think if you listen to the podcast long enough, you realize that I cut the oil thing out maybe three or four years ago. I've been making small adjustments to myself for years and actually making the podcast has helped me with that. Even watching my daughter's health and like, I think we should get rid of this or that like that kind of thing. But I was a person even as a child. If you took me out for pizza, I'd be sick to my stomach. And pee. And I know if you say that out loud, people would say, oh, that's celiac, right? Oh, that sounds like see, like, I do not have celiac. I don't have I don't have a gluten sensitivity. I've been tested. They've sucked things in both sides of me to look around. I don't have those things. Okay. But as a child, take me out to a pizza joint. You need to get me to a bathroom in about 90 minutes. I couldn't live like that. And I had a lot of moments in my life where I was like, Oh, I go to the bathroom. Like, like in an emergency situation. I have not gone to the restroom out of an emergent situation in years. years. I have never heard that Chinese food the other night notwithstanding. I have not. And even then I wasn't like, oh dear Lord, I need a bush. Like I was just like, oh, I don't feel good, you know. But yeah, that doesn't happen to me anymore. And so it's nothing wrong with my body. It was something wrong with what I was putting in it. Like my body was literally saying to me, this has to get out of here. Right? And doesn't work. Yeah, this doesn't work. And you we need it to go now. But

Jennifer Smith, CDE 42:21
you can make your own pizza at home. Can you? Oh yeah, I

Scott Benner 42:24
can eat forever. It doesn't matter. I make my own pizza, I use little double zero flour I haven't brought in from Italy or wherever they make that I don't know you overpay for it a little bit. You buy actual mozzarella cheese, not something that's wrapped in plastic, it looks like it was wrapped up nine years ago. And you open up an organic tomato paste and you're on your way. Like it's not. It's just not hard. And it doesn't even cost anything extra. Like I know people are like, Oh, it's more expensive. Yeah, I spent 10 extra dollars on the flour, and four extra dollars on the pound of cheese. And in return did not have diarrhea seems worth it to me. Like so like, you know, like, on and on didn't feel sick and nauseous and not good for days sometimes afterwards. And I know now, this it feels like it's devolving into like, seriously like something you'd hear online. And it's not it's just my experience. I've gone through it. And I've seen it. I think you're talking to Jenny who didn't go through it and doesn't experience this these things. So I just,

Jennifer Smith, CDE 43:20
I mean, I I think the other, you know, piece to think about too is when I think about kids. And I think about what goes into their body, they've got a lot of growing to do, right. And you can facilitate healthy growing, and healthy movement through all the periods and stages of their life that they're going to get to. And a lot of times, I think the easiness of a lot of the process stuff with the busy life that we have, and the fact that you're trying to just have them feel like a kid like normal, right? But they've already adapted to either getting injections, having a CGM put on their body having a pump put on their body. If you tell them they can't have Doritos anymore, they're going to adapt. Right? They may be angry for you know at you for an entire week. But you know what? You're the parent.

Scott Benner 44:13
Also just you get what you expect. Honestly, what I mean by that is Jenny has two little boys. They're like real classic little boys are big energy, like, you know, no need to look crazy. Like, right, they got the whole thing going on. Yeah, but I bet you they've never had a Dorito

Jennifer Smith, CDE 44:30
unless they had them at friend's house that I did not know about I have never in I can't say that. I've never had a Dorito I mean, obviously in my childhood teen years, I know that I've had Doritos, but And I'm sorry that I'm picking on Doritos. Like there's so many other like, I

Scott Benner 44:45
think what we're saying is that is like that every day when you pack your lunch is there a grab bag of chips in it? And for a lot of people there are and for you that's not a thing. Like I'm not saying you've never had a potato chip. I'm certainly not saying that. But I'm saying is your kids eat pretty clean. lifestyles and they're nice little well adjusted children. They're not like, like, I think it's possible people could like be like picturing. You know, like a homeschooled child that doesn't look like they've seen the sun. You know what I mean? Like, Oh,

Jennifer Smith, CDE 45:14
not at all. It's really funny. As this year, my fifth grader came home, and he's like, Mom, this is so funny. And I was like, Okay, what? I made homemade pizza on Saturday evening, it's our movie and pizza night. And then they have leftover pizza for Monday's lunch at school, right? Because there's usually several slices left. And I mean, their pizza is mostly like veggie toppings and I will make the crust and whatever. But there's a lot of greens on there pizza. I fifth graders, like my friends keep telling me that I eat green pizza. Like it looks like I've got alien pizza. And I was like, are you okay with that? He's like, Yeah, aliens are cool. I can do to go

Scott Benner 45:55
Yeah, well, that's a great, that's a great example of like, he's not being prepped, like, you said something earlier. I don't disagree with you, you want to be normal, you want to live your life like everyone else. But that in the end is a trade off. At some point, you're deciding to make a trade off. And so today, I've had a coconut milk yogurt, I've eaten two eggs. And I've had a bowl of chicken soup. This is what I've had to write. But I guarantee you when I go downstairs, I'm gonna have a couple of gummy bears, like saw them when I was coming up here. And I was like, I'm definitely having a couple of gummy bears later. Like, I'm not some person who's just like, you know, crazy lover side of it. I'm just saying there's, there's obvious things you can avoid that will really help you. And, you know, too many calories, too much processed oil. They are easy things to eliminate. Like it's a weird thing when you first go through your house. And like for us it was like, well, we make our own popcorn. What are we going to do? And it was always with canola oil. And so I said, Well, we're not gonna use canola oil anymore. We can make popcorn with olive oil tastes weird. And so like, my whole family was like, What are we like? There's just like a bone of contention. I spent six months buying different oils and making popcorn until one day I was like, I've got the answer. It's coconut oil. You can make popcorn. And it tastes good. Doesn't it? Like popcorn? Yes, I figured it out. Was fun. It was not fun. Did I throw away a lot of oil? I might have. Okay, but I figured it out. And I think you I think people could figure it out. Even I swear to you, this little girl came on. She has been on before her episodes called bugs in your belly. Oh came on first. Because she's talking about like, gut biome. She was like this, like 12 year old girl was like, Oh, my gut biome like, Oh my God, that's awesome. She's talking about all of it and everything I've had her back on since then. And she just turned me on to like organic grass fed butter. I think I spent $3 more on butter now than I used to. And I want to tell you, it's made a big difference. And I don't know another way to tell you like it's been it's made a difference in my life. So

Jennifer Smith, CDE 48:04
you don't eat. So you say you know, it's $3 more, but you're not eating stick after stick every day. The cost of it actually, it evens out to your favor. Even though the cost is higher, you're doing something better, health wise, and you're not eating so much of it that that $3 really makes that much of a difference.

Scott Benner 48:26
I could make the argument that I am saving in toilet paper what I'm spending in butter and I am not trying to be funny. So there you go, you're doing a good thing for yourself. And at the end. Listen if it's three extra dollars a week for butter, let's just say that okay, let's call it 10 Let's call it $150 A year for more butter 10 years from now when I'm not dying, all think that was worth it. And I think that's just sometimes the way you got to think about this stuff. Also, I know people can't afford everything and but there's still ways to do little things.

Jennifer Smith, CDE 49:01
Yeah, I say pick, pick your battles, right? Pick your things that if you look at where what are the 80% of foods that you eat over and over and over again? Where can you start to either decrease processed or decrease the brand this brand is better this brand has less ingredients where can you start to pick some things to introduce better you know everybody I mean things are expensive today and the price of eggs when I look at that man really, I honestly we've considered like getting chickens because

Scott Benner 49:41
they're expensive. It's weird to me you don't have chickens, but go ahead.

Jennifer Smith, CDE 49:44
We can have them and we've thought about it for a number of years that already but you know there is there is a trade off the quality of nutrients that go into something that has yes a higher price but again when You portion things out, you may actually be doing better in many, in many ways by spending a little bit more. Again, not on everything. Maybe you pick and choose. Yeah.

Scott Benner 50:10
So that's a great place to stop doctors, please put people on these paths. And I just wrote down that you and I should do a small series about how to remove processed foods from your life. Oh, I think that's a good idea. So hey, all right. I know you have to go. So I'll talk to you. Awesome. Thanks.

If you're enjoying the grant, if you're enjoying the Grand Rounds series, please share it with someone else who you think might also enjoy it. As always, thanks to Jenny for coming on the show. And I'd like to thank ag one for sponsoring this episode of The Juicebox Podcast and remind you that with your first order, you're gonna get a free welcome kit. Five free travel packs in a year supply of vitamin D. That's at AG one.com/juice box. Arden has been getting her diabetes supplies from us med for three years. You can as well us med.com/juice box or call 888721151 for the episode you just heard was professionally edited by wrong way recording. Wrong way recording.com. If you're looking for community around type one diabetes, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes, but everybody is welcome type one type two gestational loved ones. It doesn't matter to me. If you're impacted by diabetes, and you're looking for support, comfort or community. Check out Juicebox Podcast type one diabetes on Facebook. If you're not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.