Frankye Myers: From Riverside Health, this is the Healthy you podcast where we talk about a range of health-related topics focused on improving your physical and mental health. We chat with our providers, team members, patients and caregivers to learn more about how to maintain a healthy lifestyle and improve overall physical and mental health. So, let's dive in to learn more about becoming a healthier you.
Frankye Myers: Well, I'm really excited to have with me today in the healthy you studio, Dr. Eric Stone. Dr. Stone is with Riverside Hayes Medical Group and we're going to be talking about living with diabetes, insights on prevention, management and everyday resilience. Welcome.
Dr. Eric Stone: Thank you. Thank you. Thanks for having me here. It's my very much a pleasure to be here. It's a big topic that I spend quite a bit of my clinic time trying to help people with.
Frankye Myers: Absolutely. So thank you. Thank you for that. It's a topic that's near and dear to my heart as well. We either know someone or, you know, have encountered someone who is living or managing the disease.
Dr. Eric Stone: Yeah.
Frankye Myers: So welcome back. Or welcome. And you always can come back to the studio at any given time. This podcast is going to give valuable information for individuals to live a healthier lifestyle, more empowered lifestyle, because knowledge is power. I'm Frankie Meyers and I'm your host and I look forward to talking more about this with you. This condition actually affects over 37 million people in the United States alone. Diabetes. Whether you're living with diabetes, know someone who has it, or want to understand more about it, this episode is for you. So, Dr. Stone, tell me about how you ended up in medicine and then specifically what drove your passion around diabetes.
Dr. Eric Stone: So ended up in medicine. My dad was actually a healthcare administrator, so I always grew up around the medicine world and he was in the military, so I became a military doc and did that for 25 years and took care of healthy, athletic people who break things and not a whole lot of diabetics. And then I spent about 15 years doing executive medicine, spending more time in the boardroom than the exam room. And when I went back to clinic, I realized I didn't know much about diabetes. It was kind of my weak point. And so I decided to make my weak point into my strong point.
Frankye Myers: I like that.
Dr. Eric Stone: And studied up on it quite a bit because it's the people I was taking care of, that's what they needed and continue to study on it and actually just finished a course in reversal of insulin resistance and in managing type 2 diabetes. So I'm excited to be here. Interestingly, part of the Course I was at last week, they mentioned even scarier numbers than the 37 million. They kind of estimated that 13% of Americans now have type 2 diabetes or diabetes of any kind. And another 36% of Americans are pre diabetic or insulin resistant.
Frankye Myers: Wow.
Dr. Eric Stone: When you add that up together, that's 50% of Americans. This problem is huge.
Frankye Myers: Yeah, absolutely. Absolutely. To give our listeners a little bit more of a perspective, let's start out by first just defining what is diabetes?
Dr. Eric Stone: Okay, so diabetes is the body's inability to regulate its glucose. It broken down into two main types. We have very interesting names, type one and type two. Yes. So type one is basically the. What most people consider childhood diabetes because it happens more in younger individuals before age 30. It is the lack of insulin. Your body's no longer producing insulin because the organ, the pancreas that produces it, something has happened to it. Quite often it's an autoimmune disease where insulin is no longer being produced. Again, typically happens in people before they reach age 30. There's kind of a subgroup that happens in older people called latent onset autoimmune diabetes that happens in older individuals beyond age 30, tends not to come on quite as quickly as the juvenile diabetes and can often get missed. I know I have missed it before, but that's basically kind of the type 1 group and probably counts for 10% of all the diabetics. The bigger group, accounting for 90% diabetics, are your insulin resistant group. These are folks who. They're making the insulin. The body's just not sensitive to the insulin. Kind of the analogy I use is if your cell was a room and the room's got a door, the door has a lock on it, and insulin is the key that unlocks the door. In people with type 2 diabetes, there's something stuck inside that lock that the key won't work. And so that's kind of type 2 diabetes. Gestational diabetes happens in ladies during pregnancy and it tends to be more of that insulin resistance type, although it's treated with insulin because of the health risk to some of the medicine for the baby.
Frankye Myers: So when you and I know a little bit about this, because diabetes runs in my family, is something I've been tackling, you know, my whole life. I actually live like a diabetic. But I'm not to avoid or putting.
Dr. Eric Stone: It off as possible.
Frankye Myers: When you. Are there things that you can do? The lock is stuck. Are there things that you can do to get the lock open or for people to prevent their lock from getting Stuck. So, you know, most people think, I can never have a carb, I can never enjoy the foods that I love. What are your thoughts around that?
Dr. Eric Stone: So let me. I'm going to get to that. Let me just say that the type one diabetics, the people that don't have insulin, you can't undo that. They're gonna need insulin. There are lifestyle things that they can do to improve their health and actually make their insulin needs less. They can have. Because of what they do in lifestyle, they can have what I call double diabetes. They have an insulin resistance on top of type 1 diabetes. But to your, to your question, what can I do to maybe reverse the lock or prevent it? I think it has to come down to what we understand about insulin resistance, and that will kind of go with a strategy. There's actually lots of different processes going on. There's oxidative stress. There's what we call lipotoxicity. Basically, the fat cells in our body start creating this inflammatory, toxic cascade that eventually starts attacking the pancreas, the very cells that produce the insulin, and a whole cascade. But the thing that I think probably is the easiest for people to wrap their head around, and if you just kind of address that, everything else falls in place, the process of called inter myocellular lipids. Basically what we've discovered is what we think is causing the majority of the insulin resistance. And long story short, it's fat.
Frankye Myers: And I'm laughing because I just had my physical and she said. She touched my belly and she said, carbs, you know.
Dr. Eric Stone: Yeah. We've long known that, you know, having excess fat produces insulin resistance. And there's a belief that insulin resistance produces excess fat. So it's kind of the chicken and the egg argument. What we do know is excess calories and will kind of create that whole cascade.
Frankye Myers: That makes sense.
Dr. Eric Stone: And this happens actually quickly. It happens actually in one or two days of consuming the sort of excess calories that the insulin resistance happens. I've seen some studies that happens as quick as three hours. So I think to understand some of this, there's a great study that was done, actually a couple studies, but the one that really comes to mind was a study that was done almost 100 years ago in Texas among healthy medical students where they were trying to see kind of how diets affect insulin resistance. And so they took these healthy medical students with no medical problems and they fed them horrible diets. By the way, I do not recommend either one of these diets. So one group, they fed all these simple carbohydrates sugar, pastries, all these starches with potatoes and bread. And that's all they ate for two days? Yeah, that's all they ate for two days. The other group, they fed a high saturated fat diet. They fed them eggs, mayonnaise, whole cream, donuts, just all these, all these high fat diets. And then after that, they basically did the same test they do on pregnant ladies looking for gestational diabetes. They gave them a sugar drink and they tested their blood at intervals, like 30 minutes, one hour, hour and a half, two hours to see if they could get their, how they would respond on naturally getting their sugars back down to normal.
Frankye Myers: Right.
Dr. Eric Stone: No surprise their sugars went up right away after drinking a sugary drink. As you would expect, the carbohydrate group, though, at the end of two hours had returned their sugar back to normal at 100. The high. Really? I know, it's contraindicate. Counterintuitive. Yeah. Counter intuitive.
Frankye Myers: Yes, yes.
Dr. Eric Stone: And I think that's what confuses a lot of people. The man behind the curtain, the wizard behind the curtain, the high fat group, their sugars just kept going up and up and up. And at the end of two hours, it was twice normal. At 200, they had not been able to return to normal. So basically they showed from this diet that they, in healthy people, they caused insulin resistance. It would take us, you know, almost 100 years to figure out what's going beyond that. And like I said, there's lots of different processes going on there between the different oxidative stresses and mitochondrial stresses and toxicity to the, to the pancreas. But this intraomyocellular lipids, basically these fat molecules inside your muscle cells and your liver cells are gumming up the lock. They're producing the insulin resistance. And that basically comes from either your body carrying too much weight itself. And so it, even when you're asleep, it's kind of releasing these fat particles and. Or you're intaking excess calories, producing fat from those calories. Could be starches, could be fat, or you're consuming a high amount of mostly saturated fat. It seems to be the fat from the animal products, your cheeses, your dairy, your meats, particularly the red meats and your processed meats, bacon, sausages, lunch meat, etc. Yeah, and seems to be the bigger problem. The unsaturated or less saturated fats seem to be lesser of a problem. Those are some of your oils and stuff, your vegetable oils. The exception, I would say would be your tropical oils, your palm oil, your coconut Oil, those are fairly high saturated and probably need to be avoided. So, yeah, so those are some things dietary wise, that I think people can do to reverse or better yet prevent. By the time somebody starts showing signs of diabetes or pre diabetes, it's kind of estimated that they've already lost 50% of their ability to regulate their sugar. They've done enough damage that it's now starting to show up with our test. Our tests just aren't sensitive enough to see it that early. So if you want to try to turn the curve, you want to do it early. If you wait too long, there's no coming back. Well, it's less likely. I won't say there's no weight coming back. They certainly. We have proven that you can put diabetes, type 2 diabetes in remission, you can reverse insulin resistance. Your chances of doing that are much better the earlier you do it because of that stuff. So, you know, by the time your house is on fire, going around and burn, blowing out a couple candles isn't going to do it right.
Frankye Myers: You got to get out.
Dr. Eric Stone: You got it. You got to get real serious. So the, the further you are in the diabetes, the more intensive I would say the changes need to be. If you think you're at risk for diabetes and you want to play a little bit on the side with the stuff, you're more likely to be successful. But the closer you get to it, the more intensive it needs to be. And I talked about diet, talked about weight, a few statistics, just carrying weight. You know, BMI is a measurement we use for.
Frankye Myers: I feel like that range keeps. Every time I'm close to the target, it changes and it gets lower and lower.
Dr. Eric Stone: Well, I've got the numbers here. If you want to start comparing. If people want to know what their BMI is, I brought the chart. But, but, you know, so a normal BMI is 25 and below. But even at 25, or. Excuse me. Yeah, even at about 25, it's about. Your relative risk of diabetes is about twofold or two up less than a BMI of 23, which is kind of on the lower side of normal. That's sort of a one relative risk. When you start getting into the obese category, which is 30 to 35, it's about relative risk of 20, 35 and above is almost 40 relative risk. So there's definitely relationship. And you know, unfortunately, 43% of the American population is obese, and then the rest, 73% is either obese or overweight. So like I said, we've got a big Problem. There are other things.
Frankye Myers: Thank you too for breaking that down. That's very helpful. And knowledge is power.
Dr. Eric Stone: Yeah. Yep.
Frankye Myers: I'm sorry, you were going to add.
Dr. Eric Stone: Oh, I was just going to say, you know, so I focus on diet and. Absolutely. That. That is a factor. I think there's probably two other big factors that would be worth focusing on. I spent a lot of time on diet because. No kidding. That that's where the money is. I would say activity or better yet, inactivity is probably the other big factor. The. I've got it.
Frankye Myers: What is the activity goal? I mean, you know, age appropriate. Right. You know, but, you know, is it three to four days a week? Yeah. 30 minutes brisk walking. You know, you hear various things around that.
Dr. Eric Stone: Everything helps. The guidelines are Moderate activity of 150 to 300 minutes a week. Moderate activity to give yourself an idea would be a brisk walking to the point you can talk but you can't carry on full sentences. You gotta take some breaks with it. Whereas a vigorous activity would be like you're running and jogging. You're only getting a couple words.
Frankye Myers: Right.
Dr. Eric Stone: Okay, so that's kind of it. Now, if you're able to sing as you're walking, you're not walking briskly enough.
Frankye Myers: Okay.
Dr. Eric Stone: So 150 to 300. Certainly more is better. Is the target range combined with at least two or more episodes of resistance strength training. What's more interesting is the inactivity. Basically sedentary. Seems to have even a bigger risk of developing type 2 diabetes. They estimate each hour of sitting your odds increase by 4%.
Frankye Myers: Oh my goodness.
Dr. Eric Stone: So they. And they found that, you know, even doing small activity, just getting up and moving around during the day seems to help lower your metabolic risk. They say that people who are diabetic or pre diabetic, you know, after you eat, just get up and take a small walk. Okay. You know that the.
Frankye Myers: That's doable.
Dr. Eric Stone: Yeah. I talked about the insulin resistance. That door and that key. There's a secret passage that's independent of insulin. It's called exercise. It really does. The exercise through mechanisms I don't quite understand, activates that same glucose channel that lets the sugar in independent of insulin. We know that with type 1 diabetics who don't have insulin, whenever they exercise, they actually have to be kind of careful that they don't bottom their sugars out too much because they'll actually get their sugar down. So activity or exercise would be probably the second biggest thing. And then the third biggest thing I would say would Be sleep.
Frankye Myers: Wow.
Dr. Eric Stone: Now you had Dr. Givens on here. Can I just say something back?
Frankye Myers: Yes, you can, absolutely.
Dr. Eric Stone: It's just a quote that I want you to remember because I get a lot of people who come to me of I can't get my sugar under control because I can't exercise, or I can't get my weight under control because I can't exercise. You can't outrun a bad diet.
Frankye Myers: I like that.
Dr. Eric Stone: I mean, seriously, kind of there to stay, right? Yeah, I'm not, I'm not saying this to brag. I'm just saying this because I know how many calories I burn on the treadmill when, when I run 3 miles of 5k, I only burn 500 calories.
Frankye Myers: Oh, my goodness.
Dr. Eric Stone: That's. That's a medium French fry. You know, you can out eat your exercise in about five minutes. So diet is the key. Exercise is probably the second big one. And then sleep, which I gotta be honest, I'm. I'm guilty of not doing as well as I should, but sleep actually plays a big factor.
Frankye Myers: How much sleep are you. Are you averaging?
Dr. Eric Stone: I'm actually now getting probably seven hours is the.
Frankye Myers: Is the ultimate eight hours.
Dr. Eric Stone: Seven to eight hours is the sweet spot.
Frankye Myers: Okay.
Dr. Eric Stone: Dr. Givens was doing a podcast with you a little while I got a chance to hear it.
Frankye Myers: Yes.
Dr. Eric Stone: And I thought it was interesting that he said the six and a half is the absolute floor. And at least what I've seen in sort of the diabetic stuff holds that up. Yep. So they actually found that when people get a sleep debt below that by 30 minutes every weekday, their obesity risk goes up by 18%. That's why I'm gaining weight. That's over a 12 month period. And their insulin resistance goes up by 41%.
Frankye Myers: My goodness, 41%. It's huge.
Dr. Eric Stone: It is huge. And I didn't actually appreciate that until I started understanding a little bit more about sleep and the architecture and some of the restorative effects and the neurohormones that we need, our bodies need and our brains need to recover.
Frankye Myers: That's great information. Thank you, Dr. Stone. Now, for someone who does receive a diagnosis, what are the treatment options? And the information that you provide is very helpful if you have it. These are things that you can do things to avoid it, but talk a little bit about that and how it's evolved over the last couple of years.
Dr. Eric Stone: Yeah. So certainly of a type, type 1 diabetic, they're going to have to have insulin. There's just no around that we don't have any other solutions right now. I did mention lifestyle plays an important factor and their insulin resistance as well. For a type 2 diabetic, I'm a firm believer. Lifestyle, lifestyle, lifestyle is the foundation. And when you read the recommendations from the American College of. It's not really academy, it's clinical endocrinologist and the other sort of authoritatives on diabetes and even the heart association, they all say the same thing. Start with lifestyle. They don't say much about it after that. It's like, you know, it's the lead in.
Frankye Myers: Right.
Dr. Eric Stone: Eat good and exercise. Okay, thanks.
Frankye Myers: Yes, yes. Not that easy.
Dr. Eric Stone: So I actually, that's why I've actually been doing a lot of studies in exactly the science behind that lifestyle so I can try to help people and give them real goals to do because it does make a huge difference. I actually have a list on my wall in my exam, excuse me, in my office of my patients who have put their diabetes in remission. They've come off all their medicine and they're keeping their sugars under control and have been doing so for three months or longer. That's the definition of remission.
Frankye Myers: Well, you have a lot to do with that. So that's.
Dr. Eric Stone: I'm just the coach and I provide them information. It's up to them. They gotta do the hard work. And so that's first and foremost for type 2 diabetes. There are medications that try to help the underlying process. The insulin resistance. Almost everybody first gets tried on metformin. It's one of the first newer novel medications that gets at that insulin resistance. The older medicines of insulin and the sulfur ureals basically were just giving you more insulin, which wasn't the problem.
Frankye Myers: Right. You weren't solving a problem.
Dr. Eric Stone: You already had enough insulin, you had that insulin resistance. So metformin came out as sort of the first medicine and we still use it quite a bit. It's a relatively safe medicine, not always well tolerated because of some of the GI side effects. And it's cheap. There's a lot newer medicines now coming on the market. Anybody who has turned on anything of media knows about the injectable GLP ones that associated with the weight loss. They are a huge finding and very powerful in diabetes and the weight loss. Working on not only the insulin resistance but some of the other stuff that's happening in the gut and microbe. They're reducing your appetite, they're slowing down the digestion. Another big category is the SGLT2s that works on the kidneys. The, the way it's explained to me that I like to understand is, you know, when we have type 2 diabetes, our bodies basically our cells are starving because you can't get the sugar where it is. And as a defense mechanism, our bodies kind of go into the survival mode of basically trying to pull all the energy back in to include the sugar that should be in your urine. It's pulling it back into your body. And these newer SGLT2 is basically stop that from happening. Basically that you urinate out that extra sugar and that also gets your sugars down and causes a little bit of weight loss itself. And both these class of medicines also have a lot of secondary benefit for heart and other functions, but they're terribly expensive and they do carry some side effects that some people can't tolerate. So again, a plug for lifestyle. It's free and it's effective.
Frankye Myers: Yes. Just discipline, right? Yes, yes, absolutely. And a good coach. As a former athlete, that does make a difference. All right. Anything else, Dr. Stone?
Dr. Eric Stone: Yeah, so that's probably the gist of it. I do want to kind of leave people with a few things to consider. One, if you're diabetic or pre diabetic, please consider the Riverside Diabetes Education Program. They got a whole host of services to include weight loss. And they've been hosting a class on reversing insulin resistance and pre diabetes as well as helping type two diabetics. It's a month long, I think weekly class.
Frankye Myers: How do you get connected with that class?
Dr. Eric Stone: Get your pencils out.
Frankye Myers: Okay. All right, let me grab the pen for myself.
Dr. Eric Stone: The phone number is 757. 234. 4285. That's 757-234-4285. You can also see one of your providers who could refer you out there to them as well. If you can't make their classes or you just want to add something onto it. I often will direct my patients to a free website called fullplateliving.org that's full plate living, all one word dot org. It's a. It's hosted by the Ardmore Health Institute. They're running off of a grant, so it is entirely free. There is no gimmicks. They're not trying to sell you something. They don't have an agenda. They're not going to bug you what they have done. And it's not. This particular site is not diabetes specific. It's about healthy eating specific. They teach people through eight training modules. And mostly these are videos. And you can just rocket through the videos to get the idea ingest. Once you finish their initial training module, it opens up the website for a whole lot of dietary related health issues like weight loss, diabetes, things that people might be interested in and how different diets and strategies can affect that. But they want you to get the basic understanding before they'll open the website up to you. You just have to sign on. The most you'll get is a weekly email that gives you cool recipes. Okay, cool healthy, cool healthy recipes and some encouragement. This is a. No kidding, no gimmicks, a good deal out there. There are a couple other web organizations that will help coach people in diabetes, particularly in lifestyle stuff out there. They do charge a fee because that's how they make money. One's called Diabetes Undone. I think last time I checked, most of These are about 200 to $300 programs to do. The other one's called Mastering Diabetes. The first one, Diabetes Undone, is all training. There's no laboratory testing. The second one, Mastering Diabetes, has a lot of training and also includes getting some laboratory testing that you can do through whatever their third party lab is. That second one, Mastering Diabetes, also has a particular area in focus for type one diabetics because the host of this is actually type one diabetics. So that's just a couple other resources out there. And if people like watching documentaries, which I do, I'm kind of a nerd. There's a great Netflix documentary, not about diabetes, but about healthy lifestyles, which, spoiler alert, will work for diabetes too. It's called live to 100 secrets of the Blue Zones by Dan Buettler. He actually worked for National Geographic and they basically found these five zones in the world where you just had this high concentration of hundred year old people who are living healthy, very little dementia lifestyles. And they basically looked at what do they all have in common. It's quite interesting. So I actually got a chance to hear Dan Buettler talk last week as he recounted his stories. Again, not about diabetes, but after watching this little four series mini documentary. It's inspiring and it has the same principles that will probably help you with diabetes.
Frankye Myers: Great information. I'm going to actually go through all of those things you outlined.
Dr. Eric Stone: Okay.
Frankye Myers: For myself and I just want to thank you for your passion and your commitment.
Dr. Eric Stone: My pleasure.
Frankye Myers: And all the great work that you're doing. Thank you so much for taking time out of your busy schedule.
Dr. Eric Stone: Thank you. Thanks for having me.
Frankye Myers: You're welcome. You're welcome. All right, Dr. Stone, anytime you're welcome to come back. For those of you tuning in. We hope today's episode has been valuable in understanding diabetes and learning how to manage it effectively. Be sure to check out our show notes for additional resources. And don't forget to subscribe for more health insights on healthy you.
Frankye Myers: Thank you for listening to this episode of Healthy You. We're so glad you were able to join us today and learn more about this topic. If you would like to explore more, go to riversideonline.com.
