Diabetes doesn't wait.

It doesn't wait to give you that two-week reprieve after the holiday season to get some habits and emotional stuff with food tidied up before it will hit.

You know, it's not patient.

It's not going to give you a second chance.

[music] Welcome back to another episode of the The Fasting Method podcast.

This is Coach Terri, and I am super excited this week because I am here with Megan Ramos.

And Megan, it has been a long time since you and I have done an episode together.

Way too long, Terri, but it's great to be back.

It feels like the old days, us being able to chat, get deep in the weeds, and then realize, oh, we should have recorded that on the podcast.

[laughter] But no, I'm excited and I'm really excited to be here today talking about today's episode topic, which is type two diabetes.

I realized, as you and I were talking about what we should share today, that it's a topic that I talk about, almost incidentally, with clients all the time and in the Community, but I haven't talked about it on the podcast.

I'm excited for us to get to talk about it today, because November is Diabetes Awareness Month in the United States, and so it's a great time for us to kind of refocus on this for many of our listeners, and our Community members and clients.

It's something that, as The Fasting Method, we're always so focused on at this particular time of year, helping to supply people with strategies and tips and things around eating and navigating all the holiday parties and things coming up.

And I we kind of get a little bit lost in the weeds with that, year after year, I've found.

And as we've started to embrace some of these more monthly theme concepts at The Fasting Method, just sort of thinking about November, what are we going to focus on in November?

And all the regular themes came up, you know, how to handle holiday parties, social pressures.

And, of course, those are things that we're going to be covering in The Fasting Method Community, with coaching clients, and, of course, we'll touch base on it here with these podcast episodes too.

I was lying there thinking about it, and then, during a great team discussion, someone said, "Hey, every year we get a little bummed out, you know, that we don't put as much of a highlight or focus on National Diabetes Awareness Month, which is November." And I thought, oh, you know, that's such a great thing because it does require a lot of attention.

I know not everybody in our community is a type two diabetic, but most people in our community are there because they have insulin resistance, which is the underlying cause of type two diabetes.

And we're working to prevent it.

And, you know, going into this holiday season, something that I've heard back from people over the years that they've heard myself, or you, Terri, or someone else on our team say is that diabetes doesn't wait.

It doesn't wait to give you that two-week reprieve after the holiday season to get some habits and emotional stuff with food tidied up before it will hit.

You know, it's not patient.

It's not going to give you a second chance.

You never know when it's going to hit.

And the holiday season does put a lot of people at risk for developing insulin resistance, for developing type two diabetes, or worsening type two diabetes, just because it's a lot of, quote-unquote, festive foods, ultra-processed foods in a short period of time.

And one of the things that I love, that you always ground our community with, is coming back to your WHY, and having a WHY that is more than just about how those jeans fit and how you look in them in the mirror that drives us.

And I think the combination of both - thinking from a disease risk perspective, and really regrouping on your WHY and what that is - as we go into the holiday season can very much empower people to make some better choices, or come up with a better balance at certain meals so they can enjoy things and escape the holiday season unscathed, you know, from worsening insulin resistance.

You're reminding me of something.

It made me kind of reflect back, of checking in with your WHY, knowing why you're doing this, what's important to you in your health, what's important to you in your overall well-being.

I also talk a lot about our identity, and I think our WHY can kind of create our identity around, who am I as to how I eat?

Who am I as far as how I take care of my body?

Once we have our WHY really clear and we develop that identity, it makes making the decisions that support us so much easier to make.

So I was thinking about this decision in how I navigate the holidays now, and I was thinking back to one of my grandmothers and she was type two diabetic.

I was a teenager at the time, maybe I was in my 20s, and I somehow already knew I was going to have type two because everyone had told me, "It skips a generation, so it's you Terri." But she asked me one day to bring her the box of chocolates, and I stopped and I just looked at her and I said, "Grandma, I don't think you're supposed to eat chocolate being diabetic." And she says, "Oh no, no, no.

I can eat two." She had made up in her mind that, because she was on medication, it was okay for her to eat two.

And so I think I kind of had that in my mindset, as I was diagnosed diabetic, and thought, well, it's okay.

It's all right if I still eat pop tarts, I'm taking medication.

Fast forward to where I am now and I think of going into the holiday season.

It makes no sense for me, as someone who struggles with my blood sugar control, eating those desserts.

Eating those highly processed foods isn't worth what it does to my health.

And I knew it back then.

I knew she shouldn't have had those chocolates, but I heard that old belief, like, it's okay because I'm on medication.

And I have really learned that differently in my journey with it.

What would a person who takes really good care of this health concern, what would they eat on this day?

And that's how I try to frame it when I'm having to make these tough decisions.

One of the most inspirational conversations I've had over the years, since sort of switching careers into this and learning so much about functional health and insulin resistance and the, you know, disease prevention in general, was from a younger cousin of mine.

I think she's around 27 now.

I'm the old fart in the family.

Emma's one of the babies.

And this was about ten years ago.

She was just old enough to drive.

She came into the city to pick me up and take me out for lunch, and sort of pay me back for all of the spoilage she had from me growing up.

And it was a pretty cool.

We went out and she ordered water.

I was so expecting this young 21-year-old to order just this sugary beverage, especially in Canada, being of age, to sort of drink and have a cocktail, and here she is with her older cousin, even though I was just ordering water.

And I made a comment about it and she said, "Well, I really don't want to become diabetic or sick like our family." I asked her to share more on her thoughts on that.

And she's like, "Well, our grandmother.

And then it was your dad.

Now, it's like my mom, and on my other side of the family it's my dad, but it was his grandparents first." And she's like, "How we're treating diabetes just really isn't working, right?" She shared a very similar thought to her parent's perspective - you just take a medication.

Her parents just took a medication, but she's like, "That didn't really help our grandparents, right?

And then my parents are getting diabetes so much younger than any of my grandparents developed diabetes, and it's really not helping them.

And now they're talking about injections, and they're young and they still want to travel.

You know, trying to manage all that.

And what does that look like?" And she's like, "And I know people in my 20s that have type two diabetes.

The system, just how we treat it, it doesn't make sense." And she's like, "I think you talk about this stuff at work." She's like, "I'm not really sure." And I said, "No, it's exactly what I talk about." And this is what they're even preaching today in Western medicine is that you just take a pill and it helps manage it.

And this is just kind of your fate.

So it's okay to continue your lifestyle.

And then of course, all the diabetes education classes talk about making sure you keep your blood sugar so high so your medication doesn't crash in the first place.

But this is all new for our grandparent's generation, for adults that are going through this.

This is still pretty new for a lot of them.

So, okay, you know, you just follow the guidelines and advice.

We haven't seen generations of this, but then we get this 20-something-year-old now who's seeing three generations of this and saying, "Oh, hey, this doesn't make sense." And it's getting worse and worse and worse as time goes on.

So we need to do something about it.

We need to act differently.

The advice clearly doesn't make a whole lot of sense.

She's in social justice.

I don't know if she's taken a biology class in [laughs] a really long time.

So I thought that was kind of neat and it gave me a lot of hope.

You know, I feel bad for my parent's generation because they didn't know.

Diabetes, type two diabetes is such a new illness, right?

And all of the information is just so crazy - enjoy your holiday season, eat lots of this, keep your blood sugar high.

In Ontario, where I hail from in Canada, there's this rule called "5 to Drive".

So if your blood sugar is below 5 mmol/L and you're a type two diabetic, you could face penalty.

So in the United States, that's 90 mg/dL.

We know we're largely all targeting numbers in the 80s, so imagine having to be '5 to drive' or '90 to Drive' or feeling at risk.

And the reason why it exists is because they don't want people taking their medication and becoming hypoglycemic.

But then, if your blood sugar levels are good, why are we eating to make them worse, to take medication, to bring them back down?

Why can't we figure out ways to mitigate that a little bit better?

So it's really inspiring that some younger kids now are starting to ask, although, when you do look at the statistics, there's an alarming number of kids under the age of ten being diagnosed with what they call "adult onset diabetes," which is just type two diabetes in their juvenile years.

So, I mean, it is a scary time in that sense because, unlike Emma, who is in her 20s and can formulate these decisions with her prefrontal cortex-- you know, most ten-year-olds are still very much halfway through development of their prefrontal cortex, and they have a lot less control over what it is that they eat, versus a 20-year-old who has a lot more input, definitely a lot of input at that point, probably solely responsible for what she eats at that age.

Well, you know, Megan, it makes me think about who do we see in our community, who listens to our podcast, who do I work with as clients.

And yes, I have a number of people who come to me already having been diagnosed type two, but I have a lot of people coming to me and a lot of people in the Community that now are aware that pre-diabetes is a really important time to address what is going on.

They know that they don't want to get to the stage where it's full-on diabetes.

And I try to always emphasize it's all about a progression, and before you even have someone identify that it's prediabetes, it's insulin resistance.

And that that starts even before the prediabetes, well before the type two diabetes.

I was diagnosed, I think I was 32, and, you know, by some standards, that was pretty young.

Now, as you mentioned, we have even younger people being diagnosed with it.

But the idea that, when I was diagnosed, my HbA1c was 13, it was over 13.

How long do you think I had insulin resistance before I was diagnosed?

15 years, 20 years?

So that idea that how my lifestyle was working with what I was eating, my lack of movement, stressors, and whatever I wasn't managing, I had this developing over many years.

And I sometimes, of course, wish I could turn back the clock and go back, knowing what I know now.

I might have stopped eating Pop-Tarts a little bit sooner in my life had I known that I was developing this serious of a concern, and how much better things may have been for me had I started to manage it in the very early stages.

So I get very excited when I get clients or I get consults with people who say, "You know, I found out that I have insulin resistance." And I'm getting a little bit giddy and they're like, "Terri, this isn't fun." I'm like, "No, but changing it now helps you not have to go through the stages of developing into type two diabetes.

We can do something about this now." It's really great that they come, I think, especially to see you [laughs] on our team because you can focus a little bit more on behavioral, mindset aspects.

And I think that's what the pre-diabetic population with insulin resistance struggles with so much.

I'll say one of the most defeating things in nephrology (Nephrology is the study of kidney disease.

Jason's a nephrologist.

Jason and I have a background in kidney disease.) is that it's usually a slow burn, developing kidney disease.

Really slow.

Every now and then it's just rapid fire, but usually it's a really slow thing to develop, and it can be like watching a train wreck in slow motion.

Especially when we would have a younger patient who has a very full life and young kids, I would plead with them about their diet, and nutrition, and all these factors that could help slow down their kidney disease and improve their lifestyle.

"Oh, but, you know, we've got soccer practice three nights of the week," "It was so-and-so's birthday," "There's eight kid parties coming up," It was a night out with my girlfriends, and I don't get that very often." One thing after another, and I'm watching their kidney function go from 60% to 45%, 30%.

And I'm pleading with them, but they feel good.

They don't feel unwell.

No one's dangling words like "transplant" or "dialysis" in front of them.

As it starts to get lower, you know, we'd start saying, "Well, if it does drop more, we have to start talking about these things." Well, it's now taken a few years for it to go from the 60% to 30%, so, "We'll be fine." And then it hit 15% and they come in, and that's when dialysis comes up, and that's when transplant comes up.

I believe in a lot of places (it might vary with insurance in the United States) you can be eligible for a transplant without being on dialysis.

That's not the case in Canada.

You have to go on dialysis first (which is a big deal) before you can qualify for a transplant, even if you have a live, living donor that's a good match.

And then this is when they come in and they're willing to do anything.

They will never look at this food again, they will never drink another beer again.

They will exercise, they will take care of themselves.

And it's just like, the damage is done.

You blew up the building with the kidneys, over time.

There's not a whole lot we can do at this point, these are realities.

We can try to do all the lifestyle stuff now.

You absolutely should, 10,000%, because this is in the future.

If you want to be a good candidate and have a successful transplant, you want to live a good, long life on dialysis, we need to do all these things, especially the dialysis, because we're just going to fill you up with sugar a few times a week, or every day, depending on the type that you do, so we need to implement these things.

We can maybe slow it down by a few months, but we're not going to slow it down by a few years.

And so I've found, in my experience, I tend to worry so much about this pre-diabetic population at the holiday season because they do feel well, their medications aren't crazy, they're not injecting themselves and having to monitor their blood sugar levels so much.

So then it becomes more about habits and food emotions, and traditions, and then the uncomfortable feeling of not participating, or turning things down, or eating differently.

And then it just ends up being more focused on the scale for a lot of this population, because they're not getting their fasting insulin levels checked once a week, or their A1c checked once a week by most clinics.

And that always kind of terrifies me at this particular time of the year.

And what I've always found is, you know, we have a lot of people who are diagnosed diabetics.

They go through the holiday season, but they have this bigger motivation to reverse this condition for a whole bunch of reasons, and come off of medications, and, you know, they tend to get through the holiday season with a modified approach.

It's not always giving up every tradition or not eating a certain food, but eating it differently or a smaller portion, or just being more thoughtful as they approach holiday meals.

And they tend to come out with lower A1cs, with some weight loss, and medication reduction, or at least hang steady.

And I find if we're not really empowering people to do the deeper work with their WHY, and really excite them, and say, "Hey, this is the time you can stop all of this damage.

Your A1c's 5.6, 5.7.

This is a gift of finding that out.

You don't have to get the eye damage.

You don't have to get the kidney damage.

You don't have to ever have these conversations about medication, let alone dialysis." You have so much power right now because of the knowledge that we're able to provide you today to make a different change for themselves.

I find it can be really difficult during those holiday parties and events to instill some motivation and inspiration to help them escape the holiday season unscathed.

And that's why I really like that November's Diabetes Awareness Month, because I think it is a really good reminder of the bigger WHY here.

I was just thinking earlier, it's not lost on me that it's November as we're heading into the thick of a holiday season for many of us, and winter here in the US, where we're celebrating that this month.

You know, it's not July is Diabetes Awareness Month or, you know, something, it's right now when keeping it front and center is really important.

And again, going back to this identity piece, I think it's important to think about how do I want to feel, even during those holiday occasions?

Many of us are a little over-controlled by that lower brain that wants to just feel the fun of the sugary beverages, and the desserts, and certain foods.

But how do you really want to feel, as far as brain fog, being able to be present with the people, or do you need to go in the living room and take a nap after the meal because of the sugar crash that you're on?

And so just to really, again, think about taking good care of me.

Not being perfect, not being rigid, but taking good care of me.

What does that look like?

How do I want to feel while I'm celebrating, while I am navigating this?

And as you said, Megan, you know, diabetes, insulin resistance, it doesn't wait.

It doesn't say, "Oh, I know, never mind.

You have a holiday right now.

I'll just go on pause for a while and give you time until January." And so how do I proactively take care of myself during this time and still enjoy it?

I think oftentimes people think there's one choice over the other.

We think that we are stuck with

one of the options: either I have fun or I take care of myself.

And the reality is we can do both.

For example, I no longer eat suger, but I will have a good time when I gather with people to celebrate holidays because the good time that I am having isn't related to the sugar, it's related to the laughter, it's related to the sharing memories, making new traditions, sharing new foods that they're not familiar with.

So it's not as though we have to choose either I have fun or I take care of myself.

We can take care of ourselves *while* enjoying being socially connected with others and celebrating.

There's a lot that you can do.

I remember thinking-- well, feeling, rather, a lot of dread going into one particular holiday season.

My grandmother had passed, although she hadn't been in good health in a while, and the family could use the boost in morale.

And there was all this, and I was the one going to be hosting a lot of holidays.

And I thought, "Oh, my grandmother had this baking tradition." And I could always do that and do it healthier, or I could try to come up with a different spin on it.

And I started thinking.

You know, I was born in '84, so not old, not.

young, but I was born not too long after food guidelines started to shift, and ultra-processed food was sort of the main staple.

And I remember, in those very early holiday days, you know, my family would eat dinner and then we'd play games all night together.

We wouldn't be eating all night.

There'd be coffee, and sometimes there'd be something passed around, but the focus was on the game.

The focus was on rummy or whatever we were playing.

And the kids were all involved and it was always so much fun.

And then, as the years changed, it became just super food-centric.

And we had enough food for like eight families, you know, just for the one family.

And it was all garbage.

And we would just sit around and eat, and no one would feel well.

And then we'd go home in our comatose state.

So I started thinking (you know, I had to do an event with my cousins leading into the holidays), well, let's do games.

Let's bring that back.

I can have charcuterie items and those type of things because people will want to eat when we come together with our communities over food.

And it was actually a huge hit.

People didn't notice that they weren't stuffing their face with garbage.

No one left feeling awful.

People commented the next day, younger cousins who were sort of in their early adult years, grateful that they didn't gain weight.

And so we transitioned that cousin night to when my husband and I hosted our big family Christmas Eve party.

We brought back some of the games that we used to do, and everybody had so much fun.

And nobody noticed that we weren't stuffing our face with cookies and cake after we had the big main meal.

Everybody shifted and everybody talked about how that was great and we needed to do it at more holidays.

Winter in Toronto is not pleasant always.

[laughs] You know, we're not always going to be going out for a walk after dinner, but it was another great way to distract ourselves, and really connect and bond.

We still had our food, we still had our meal, but then the focus started to shift away from food and other ways of connection and still facilitating conversation.

And it was really great.

The traditions shifted back, and the older generations loved it because it reminded them of some good old family memories, too.

And I thought that was fantastic.

So thinking about your own family and different shifts...

If you do live somewhere where it's pleasant during the holidays, going for a walk after a meal is a fantastic idea.

Even 20 minutes at a slower pace can reduce your glucose levels by 25 or 30%.

So if you do end up consuming a little bit more, choose to have that little piece of dessert, then you do have this option of taking some control and some input into your own health and your own glucose levels.

That's not something we necessarily did at Christmas, but it was a thing that would be more common during Thanksgiving.

Canadian Thanksgiving's in October, but still, in November, a lot of places in the United States it's palatable, or tolerable, rather, to go outside.

You can just have a nice family walk, and hang out, and have your coffee, go and explore.

That's another great healthy tradition that you can start.

So if you do have a little bit of that sweet potato casserole and that slice of-- you know, a little sliver of pumpkin pie, then you can go out and do your walk, and reduce your glucose levels that way.

And I'm someone who-- [laughs] I'm always-- if you've been around, you've heard me talk about my mother's crispy, roasted potatoes.

And I learned that, at Christmas time and Thanksgiving, if I had a little bit at the end of a meal, I could be in control.

It was when I had them at the start of the meal that I'd lose control because I would be immediately spiking my glucose and insulin and ghrelin, and then I'd become kind of ravenous, and the meal would go downhill.

But I filled up on good protein, good fat, and good fiber, and then allowed myself to have the small portion.

And I was able to keep it a small portion.

In fact, I blew my mind several times because I left parts of the potato on my plate and I didn't think that was possible.

I would have bet everything against me.

So there's a lot of these little strategies: the order in which we eat the food, getting up and doing some good movement, shifting connection to not just sitting around eating desserts or cakes, doing a puzzle, playing a game, finding other ways to connect as a family, but still having food as a component of it too.

I think they're all great ways that we can start to shift the dynamic a bit while still participating in some of the core family traditions, but making it a little bit more favorable for us so we can escape the holiday season with a better A1c and a lower weight without having to have that diabetes diagnosis being the primary thing that's driving us there.

We can actually prevent the diagnosis throughout the holiday season.

I think it's also important to keep in mind there are many days in the months of November and December.

If you're really socially active, it might be seven days in that month that you're going to be engaging with neighbors, or family, or friends, or whatever in some of these more food-focused things, but there are so many other days where staying really congruent with the foods that support you well, doing your fasting, keeping up with your movement can also help mitigate the impact of those specific days.

You know, the actual holiday itself is one day, and you may have, like I said, several other times that you celebrate it, but lots of other days that month.

So don't lose sight of all of the good self-care that you could do in a whole month.

One day doesn't ruin that.

One holiday doesn't ruin that.

So I hope people can keep that in mind as well.

Well, more on this to come from The Fasting Method throughout the month of November.

Hopefully, we'll inspire people and empower them with knowledge and tools and skills to help them remain diabetes-free or reverse type two diabetes, even during the holiday season.

And I look forward to being back and doing another episode with you again, Megan.

Yeah, it's good to be back.

I'll see you soon, Terri.

All right.

Take good care.

Happy fasting, everybody.