Taking Control of Diabetes: Expert Strategies for Prevention and Management with Dr. Alex McDonald

Diabetes affects nearly 40 million Americans, yet millions remain unaware of their diagnosis. It’s a condition that knows no boundaries, touching lives across all ages, sizes, and socioeconomic backgrounds. With its growing prevalence, especially among younger generations, understanding how to prevent, manage, and thrive despite diabetes has never been more critical.

Joining us today is Dr. Alex McDonald, a Southern California Kaiser Permanente Medical Group physician specializing in Family and Sports Medicine. A dedicated advocate for health and wellness, Dr. McDonald brings insights from his experience as a member of the American Academy of Family Physicians, the American College of Sports Medicine, and other esteemed organizations. Tune in to discover practical strategies for taking control of your health, whether you’re managing diabetes or striving to prevent it.

Send us comments and thoughts.

Episode Transcript

Erin Brinker (00:06):
Erin, welcome everyone. I'm Erin Brinker, and
this is the making hope happenradio show, the holidays are in
full swing, and I hope yours areoff to a great start.
Thanksgiving is the biggestfeast day of the year here in
the United States, which can beboth wonderful and problematic.
My guest today is an expert indiabetes care. Yes, that skirts
that hit so many people from somany walks of life. It is a

(00:30):
serious diagnosis, but itdoesn't have to be scary. And Dr
Alex McDonald from KaiserPermanente is going to demystify
the topic and tell us how tolive well, here we go. I am
absolutely thrilled to welcometo the show another wonderful
medical health professional,medical professional from Kaiser
Permanente, Dr Alex McDonald. Heis core faculty and in family

(00:52):
residency, a KP at kp FontanaMedical Center. He's an
assistant clinical professor atthe School of Medicine. And Dr
McDonald is well, he's an experton diabetes. Dr McDonald,
welcome to the show.

Dr. Alex McDonald (01:05):
Thank you so much for having me. I appreciate
the time.

Erin Brinker (01:08):
So first tell us about your background, kind of
who you are, and then what ledyou into specializing in, among
other things, diabetes.

Dr. Alex McDonald (01:16):
Absolutely.
Thanks so much for having mehere. So I practice family
medicine, and I also did anextra year of training in sports
medicine. And so I'm verypassionate about lifestyle and
exercise. Obviously, I was anathlete myself before getting
into the sports medicine world.
And then as doing primary careand family medicine, I take care

(01:37):
of a little bit of everything. Itell people that I take care of
everyone from newborn babies allthe way to Grandma's and
grandpa's at all, all ages andstages of life, if you will. And
at this point, about about 15%of the population has diabetes,
or it's estimated about 15% ofthe population of the United
States has diabetes. And so thisis something that I see every
single day in primary care andfamily medicine. And used to be

(02:02):
historically, treated more withwithin the special sub
specialties with endocrinology,but there are just so many
people who have type twodiabetes in particular that this
is something now that familymedicine and primary care takes
care of on a daily basis. And sothat's a little bit about my
background. You know, I getbored easily, and so I do a

(02:23):
little bit of everything withinwith my family medicine hat on,
I work in the hospital, where Itake care of patients in the
hospital who are very sick,often with multiple
comorbidities and oftencomplications due to diabetes.
But then I also work in the inthe clinic, taking care of
patients on an outpatient basis,and then also putting my sports
medicine hat on, I take care ofkind of athletes of all ages and

(02:46):
stages. I think of not justsports medicine as sort of
athletes, but but people who dowho use their body for a living.
I have a lot of patients who arework in construction or law
enforcement, who do a lot ofphysical labor as part of their
job, which directly impactstheir health. Many of those
patients have diabetes as well,and we talk about how physical
activity is a big piece of that,but we I get ahead of myself.

Erin Brinker (03:11):
So so, you know, I had never thought it makes
perfect sense. I'd never thoughtof somebody who works with their
body for a living being needingto see a sports medicine doctor,
but I'm sure that, I mean, thatmakes complete sense now that I
think about it. Because theyhave repetitive injuries,
they're using their muscles andtendons and all of that every

(03:32):
day, as opposed to sitting likeI do in a chair all day long,
which is also not good,

Dr. Alex McDonald (03:36):
exactly. It's a balance, right? We know that.
We know sitting all day for eventhey've done good studies
showing people who arephysically active and healthy
and do exercise. But then ifthey sit at it, at a desk for
eight hours a day, they have amuch higher incidence of all
kinds of medical conditionsversus people who who move
around a little bit all daylong. But then there's also the
other extreme, where people whodo who do too much. You know

(03:59):
stone masons is, I have a couplepatients who have horrible
arthritis in their knees andbacks and hip from from doing
stone masonry work for for 30years, and so everything's a bit
of a balance.

Erin Brinker (04:10):
Wow. So you mentioned that 15% of, I assume,
is that adults, children, orboth of the population, has
diabetes. So that's,

Dr. Alex McDonald (04:19):
that's a recent estimate for the entire
United States. Now, the key,obviously, is, is there's only
about the estimate is all agesand stages, but, but only about
10% of those people actuallyknow that they have diabetes.
It's an estimated about 5% ofthe United States has diabetes
but doesn't even know it, whichis an even scarier fact.

Erin Brinker (04:39):
So, and are you defining diabetes as an A 1c of
six, one, 6.0 and higher? Areyou also including people who
are would be classified as prediabetic?

Dr. Alex McDonald (04:50):
So that's just people who have an average
blood sugar the the three month,a 1c of 6.5

Erin Brinker (04:56):
or higher? Oh, 6.5 or higher. Yeah. Which

Dr. Alex McDonald (04:58):
is the which is the diet? COVID range. So the
pre diabetes range is 5.6 to 6.4and then the diabetes range is
6.5 or higher. And so that'sonly people who have formal
diabetes 6.5 or higher on on twoor more blood tests. We don't,
we don't diagnose diabetes basedon a single blood test. It
requires, you know, a couple, atleast two different blood tests

(05:20):
separated by a period of time.

Erin Brinker (05:23):
Okay, so how many of these people? There's so many
things that impact diabetes, andyou know, it's your weight, it's
your lifestyle, if you're asmoker, it's the food that you
eat, but it's also genetics. AndI'll use myself as an example.
I'm a diabetic, and so iseverybody on my dad's side of

(05:43):
the family, and my I have abrother who is like, Mr. Keto,
Mr. CrossFit. He does SpartanRaces. He's, you know, eats
nails for breakfast, kind ofguy, but he has diabetes. He has
to, if he has any carbs at all,he gets a spike. But my dad was,
but has battled with his weighthis whole life, but he's gone on

(06:04):
a low carb diet that he's beenon for five years, and he's 80
years old and is at a healthyweight, but he has to fight it
every day. I mean, any carbs atall? And then there's me. I
tried being a vegan, which Ireally liked. Being a vegan, my
blood sugar, however, did notright, and I found that rice to
me, I might as well have sixcupcakes if I'm going to have a

(06:24):
bowl of rice. So, you know, itcan hit any family and any
person, even when they seem tobe doing the right things.

Dr. Alex McDonald (06:32):
Yeah. I mean, you hit the nail on the head
there with those examples, isthere are so many factors
involved, right? There's,there's there's age, there's
your diet, there's yourmetabolism, there's your
genetics, there's yourlifestyle, there's your physical
activity. There's so manydifferent factors which impact
someone's kind of health, butalso their their blood sugar and
their way their body responds toto carbohydrates and spikes and

(06:56):
insulin release and insulinsensitivity. And there's many,
many different factors, andthat's why it's such a difficult
you know, there's not a one sizefits all approach. It really
requires individual sort ofattention and details for for,
you know, the care team withwith nurses and physicians and
pharmacists and physicaltherapists and athletic coaches

(07:16):
and nutritionists to figure outwhat works for each individual
patient. And unfortunately,there's a lot of trial and
error. You know, some peopleit's really easy. They just sort
of follow the routine guidelinesput out by the American diabetic
Association, and they're, theythey're doing really well. Other
people really struggle. Andthere's, there's multiple
different there's multipledifferent factors which which go

(07:38):
into the diagnosis and increating patients risk and
elevated blood sugars. But thenthere are also multiple ways to
treat it, so it really becomesvery, very complex very, very
quickly.

Erin Brinker (07:50):
So what do you do?
Let's, let's say that I'm, I'mgained some weight, I'm really
thirsty and I'm really tired,and I come to you saying, you
know, what's going on with me?
How, What? What? How would youtreat me?

Dr. Alex McDonald (08:05):
Yeah. I mean, I think the first, the first
step is, you know, meeting withyour your family medicine and
your primary care physician, andjust doing kind of a, getting a
good history and a good physicalexam. That's always the most
important piece. A lot of peopleyou know like to turn to Dr
Google, which is a can be a goodfirst step, but also can go down
the rabbit hole very, veryquickly, and before you know it,

(08:27):
you know you have, you knowsomething terrible with you and
you're dying, which is notalways the case. So I always
encourage people to, you know,make an appointment with their
primary care physician. If youdon't have a primary care
physician, find a primary carephysician who you who you know
and you trust. That relationshipis so important between the
patient and your primary caredoctor. In this day and age, a
lot of people just sort of, youknow, want to get care, you

(08:48):
know, through an app or justthrough an urgent care, which
is, which is fine when there'sthere's an emergency or there's
an acute issue, but forsomething like diabetes or any
chronic medical condition, itreally trust and time, and that
continuity of relationshipbetween a doctor and a patient
is so important. So that's myfirst pieces. Is find a primary
care doctor who you like, whoyou trust, who fits your fits

(09:10):
with your personality and withyour needs. And you know not
every physician is going tomatch with every patient, and
that's okay. So so don't beafraid to meet with different
different physicians to find theright person for you. So that's,
that's the first step. Thesecond step is obviously just
getting getting some blood work.
You know, oftentimes we'll lookat kidney function, we'll look
at liver function, we'll look atthe average blood sugar, or the

(09:30):
the a 1c which is a three monthaverage. Sometimes we'll even
look at, like, instantaneousblood sugar, like, what's your
blood sugar right at thatmoment? And then we'll also look
at other factors, such as yourcholesterol, your your lipid
panel will look at your weight,your height, your body mass
index. There's multiple factorswhich we kind of all put
together, but But getting thatgood history and then some blood

(09:51):
work is sort of the first stepin the in the in the journey.

Erin Brinker (09:56):
So we, I. Uh, how long have we seen these high
numbers? Is it that people backin this, 50s, 60s, 70s, 80s,
were not tested appropriately,or because as I'm as I'm
processed, thinking about what'schanged and why these numbers
are as high as they are. Youknow, maybe it's that we're

(10:18):
eating more processed food,maybe that were more sedentary.
You know, kids are playing oneon playing video games instead
of being outside and playing allthe video games have been around
for 30 years or 40 years. So youknow, what has changed about
United States, our diets, ourculture that has caused this
spike in diabetes?

Dr. Alex McDonald (10:39):
You know, I think you hit the nail the head
on most of those factors. So, sothere's no one one thing, I
think, and there's multipleprobably, theories which, which
lead to this or potentialconflicting variables. I mean,
the first thing, like you said,the the highly processed foods,
the vast majority of the theAmerican diet, is this, highly
processed foods with a lot ofadded, salt and sugar and other

(11:02):
factors, which are just terriblefor our health. That's number
one. Number two is Americans aregetting larger. The amount of
individuals in this country whoare either obese or even
morbidly obese is significant,and it continues to grow and
climb every single day. And thenlastly, the sedentary
lifestyles. You know, a lot ofus, you know, we have

(11:24):
technology, which is, hasinnovated physical activity out
of our lives. You know, imagine,you know, 1000s of years ago,
and when we were Hunter Huntergatherers, we would would walk
around or or hunt animals allday long and have, like, maybe
one meal a day, if that even andso obviously that wasn't healthy
for us either, but we weredesigned to take any calories

(11:45):
and any nutrition we have andreally store store that as much
as possible for you know, wedidn't know when our next meal
was coming. Now, fast forward.
Today, we have just sedentarylifestyles. Our technology has
has made it even easier to beless physically active. You
know, great example, I send a, Isend a message down the hallway
to one of my colleagues, throughthe through the computer system,

(12:06):
versus walking down the hallwayand talking to them, you know,
just something as simple, simpleas that, not to, not to mention
a lot of the the machines, whichnow do a lot of the manual labor
for us. So I think it's acombination of all those
factors. As we, as we getlarger, we the population is
overweight or obese or morbidlyobese, that results in what's
called insulin insensitivity,where our bodies just don't

(12:29):
respond to the insulin in thesame way, and so our blood
sugars just go up and up and up.
And it's a, it's a multifactorial problem, but I think
those are probably the threebiggest, biggest contributors.

Erin Brinker (12:42):
So I have a question about insulin
insensitivity. So you know, ifyou are a type two diabetic, and
just say, for say, your BMI is39 I'm just making this up. And
you know you're trying tocreate, uh, create a more
healthy lifestyle. But clearlyyour body isn't using the
insulin correctly. Because, youknow, you're diabetic. How is

(13:02):
giving insulin to that patientif your body can't use the
insulin correctly, how is givinginsulin to that patient helping
them reduce their blood sugar?

Dr. Alex McDonald (13:12):
Yeah, great question. So let's, let's take,
actually, take a step back. Sowe have type one diabetics and
type two diabetics. And let mejust kind of explain the
difference there just forlisteners. So type one diabetics
do not produce enough insulintheir their pancreas, which is a
kind of a an organ near thestomach, kind of in the middle
of your stomach, releasesinsulin when you eat sugar. And

(13:33):
what that insulin does is it'skind of the key to help the
blood, the sugar, go from theblood into the cells, where it
can be used as fuel,essentially. And so type one
diabetics, they don't have theinsulin, they don't have the
key, which can kind of unlockthat trans transporter from the
sugar in the blood to the sugarin the cell where it needs to be
used. So, you know, hundreds ofyears ago, you know, type one

(13:57):
diabetic, children wouldactually be starving. They would
be emaciated, and they would dieof malnutrition, because
basically, they couldn't get thesugar from the blood into the
cell where it was used as asfuel for the machine, so to
speak. So that's type onediabetic. Type two diabetic is
probably a much more complicatedillness, and it has to do with

(14:19):
insulin resistance. Whereas yourbody produces the insulin.
However, for whatever reason, amultitude of reasons, the
insulin isn't as effective. Andso the the body can get the
sugar from the from the bloodinto the cell, but it doesn't
work as well. Typically, whenpeople who are who are
overweight, that really resultsin insulin resistance, just by a

(14:45):
myriad of sort of metabolicfactors which, which causes
that. So the the giving somebodywho's type two diabetic, giving
them more insulin, you basicallyare kind of giving a higher dose
so that, that way you can getenough of the. Blood from the
assuming enough of the sugarfrom the blood into the working
cells. Now there are multipleother different medications and

(15:07):
multiple other kind of pathwayswhere we can impact the blood
sugar production in folks whohave type two diabetes, but
insulin is just sort of one, onetool in our medication toolbox.

Erin Brinker (15:20):
So then that's Metformin, which impacts the
liver, and then the ozempic andmugovi, which impact your
society, so you're eating lesscorrect. Can you talk about
those two, those GLP one drugs,and kind of what they do, and
you know, long term, what theimpact is, if we even know yet?

Dr. Alex McDonald (15:38):
Yeah, that's a great question. So, so the GLP
one receptor agonist medicationslike, you know, ozempic or
wegovy or Victoza or semaglutideor lyraglutide or there are
multiple different differenttypes of medications out there,
both brand name and generic, andthey work in multiple different
ways. And honestly, we don'tknow exactly how they work, but

(16:02):
they work in multiple differentaspects. The first, first piece
they do is they, they, they helpprevent the stomach from
emptying. Right? Your stomach issort of a storage pouch, and
there's muscles in the stomachand and we know that they
prevent the stomach fromemptying as quickly, and so
people just a smaller amount offood make people feel more full,
which is part of the reason whyone of the side effects of those

(16:23):
medications is sort of nausea orheartburn or things like that,
where the food just doesn'tleave the stomach quite as
quickly. The second aspect is ithelps to people talk about sort
of the food noise, if you will.
It helps suppress something inthe brain about just that desire
to eat or to be hungry or thinkabout food on a on a regular
basis. That's the second piece.

(16:46):
And then the third piece also ithelps impact the pancreas and
how the pancreas producesinsulin. And so there's multiple
different sort of factors wherethese medications work. There
are several others, but thoseare kind of the big ones that
I've noticed overall in terms ofhow these medications work for
diabetes control, but then also,now this new indication for

(17:07):
weight loss,

Erin Brinker (17:08):
is it an effective weight loss drug long term? And
then I'll ask you the samequestion, if it's an effective
diabetes drug long term, butfirst of all, because there's so
many people who are using itessentially, off label to lose
weight, right? Is, is that? Isthat effective long term? Are
they going to put it on as soonas they get off the drugs?

Dr. Alex McDonald (17:26):
Yeah, that's a great question, actually, and
I think we don't know theanswer, honestly. So the there's
no question that some folks whohave started some of these GLP
one receptor agonist medicationshave lost a significant amount
of weight. We're talking, youknow, 50, 100 pounds, the the
studies really don't look outmore than a year or two,

(17:46):
honestly, and so we really don'tknow kind of the long term
benefits. There's some, there'ssome people that think there's a
school of thought that onceyou're on these medications, you
need to be on these medicationsforever. However, I'm not a big
fan of that school of thought.
Personally. I think, you know,once you, once you kind of
achieve your weight loss goals,trying to, trying to titrate
down off these medications is isprobably a better long term

(18:08):
solution, and and part of theissue also is it's not just
about medication, right? It'sabout diet, it's about exercise,
it's about lifestyle. Andmedications can be part of a
comprehensive diabetes or weightloss approach. But it's not the
only piece I have. Some patientswho said, I kid you not, they
sent me an email that says, Idon't have time to exercise. Can

(18:31):
you prescribe me weight lossmedications? That's no, that's
not. That's not how this works.
It has to be part of acomprehensive approach now. Now,
once you achieve, achieve yourweight loss goals, you you
basically you're giving yourbody a second chance to sort of
reset its metabolism, to resetthat those lifestyle factors. So

(18:52):
I've had a lot of patientswho've lost weight and maintain
their weight loss withoutmedications, just with diet and
exercise alone. Same thing withbariatric surgery. We're talking
about weight losses. It helpspeople lose a tremendous amount
of weight, but it doesn't do thehard work for you, the diet, the
exercise and the lifestylepieces are so critical to
maintaining that weight loss.
What the medications or thebariatric surgery help you do is

(19:14):
they help you sort of get asecond chance to help reset your
metal metabolism. Because whenwe know when folks become obese
or morbidly obese, their theirmetabolism changes, and it can
be very, very hard to to resetthat system. But I think
medication, surgery can helpgive people sort of a second
chance. But again, it's not areplacement or, or, or in lieu

(19:36):
of diet, exercise and the hard,the hard work of his daily,
consistent healthy choices. Sothat's for weight loss, for for
diabetes. You know, it's veryreasonable to be on these
medications, but if people canlose enough weight, they can
reduce their insulinsensitivity. If they can develop
these good healthy lifestyles,they can reduce their insulin

(19:58):
sensitivity. I've had a lot ofpatients who are diabetes, who,
excuse me, who have diabetes.
They've started some of theseGLP one receptor agonists.
They've lost a bunch of weight,and their blood sugar has
normalized. And then theymaintain their blood sugar
without the medication. I thinkone important factor is, once
you have diabetes, you alwayshave diabetes is just well

(20:19):
controlled. And again, thesemedications can be, can be part
of a comprehensive approach toaddress multiple factors.

Erin Brinker (20:26):
Stuff. What popped into my mind is that, you know,
once you're an alcoholic, you'realways an alcoholic, and you
know, you maybe need a meetingand so sorry, as somebody who
struggles with my weight, that'show I'm thinking about it, yeah,
and that's, I think

Dr. Alex McDonald (20:38):
that's a really important point, is,
again, there's multipledifferent avenues here, and we
cannot ignore the the mentalhealth and the psychological
component of having a chronicillness or obesity or blood
pressure or diabetes or you nameit. So finding, finding kind of
support, be it within the familyor professional help or support

(20:59):
groups online, however,whatever, whatever it is that
works for you, finding thatsupport group is critical to
long term success.

Erin Brinker (21:06):
So do you see, as people are wanting this kind of
long term weight loss, beingable to stick to it, long term
management of their diabetes? Doyou see that there'll be micro
dosing in these GLP one so thatmaybe they don't need quite as
much, just a little, becausethey're not that for whatever
reason, they're not successfulwhen they're off the medication.

(21:27):
Yeah,

Dr. Alex McDonald (21:27):
you know. And I get think that's where the the
individual, the individual, youknow, features of that person
and that patient, really need tocome into factors. Again, like I
said, there's no, there's no onesize fits all approach. My
preference is if we can minimizemedications, that's, you know, I
always tell patients when Ifirst meet them that diet,

(21:48):
sleep, exercise and stressrelief are going to do more for
you than any medication in theworld. But there is a role for
medications, and sometimes wecan maximize those lifestyle
factors and we can eliminate theneed for medications. My
favorite thing to do is stopmedications. But everyone's
different, and some people, somepeople, they're not able to stop
their medications or or they cango to a lower dose of

(22:10):
medication, or they can go to aa easier, less risky medication
that will better control theirdiabetes. And so, like I said at
the beginning, there's no onesize fits all, which is where
you know, developing arelationship with with your
family physician or your primarycare doctor, who you who you
know, who, who you trust, andthey know you is absolutely

(22:30):
critical.

Erin Brinker (22:32):
So let's say that I'm 22 years old. I'm getting
married. I know I have a familyhistory of of diabetes, and I
don't want that for my futurekids, you know, fast, you know,
I try to do my best to eatright, but sometimes I drink
Diet Coke or, you know, have Islip up a little bit? How do I

(22:52):
and maybe it's just, it's just aconsistent, healthy lifestyle
over time. But how do I protectmy kids? Because kids are out
there at friends houses, andthey eat whatever they're
eating, school lunches, youknow, how do I protect my
children?

Dr. Alex McDonald (23:05):
Yeah, that's, that's a great question. And
actually funny. You shouldmention that I actually had a
patient. I had a seven year oldwho I took, was taken care of
last week, who's, who's, youknow, at the 98th percentile of
their body mass index. Sothey're at the higher end of of
a healthy weight and height, andone of the issues is her parents
are divorced, and when she goesto her dad's house, sorry, Dad's

(23:27):
it's always the dad's fault.
When she goes to her dad'shouse, she eats a bunch of junk,
versus when she's at her mom'shouse, her mom cooks at home and
has a healthier, healthier dietfor so you know, there are
definitely kind of externalfactors involved when it comes
to controlling your weight andyour diet. But again, it you
don't have to be perfect. Ithink a lot of times I have

(23:48):
patients who are who are aimingfor a perfect meal, exercising,
you know, seven days a week,eating perfectly, never having,
you know, a soda or, you know, Idon't know, Thanksgiving is
coming up this week. So Right?
Christmas, the holidays comingup here. So, you know, it's,
it's not, it's not possible forus to be perfect. And so when we

(24:09):
psychologically set ourselves upto be perfect, we fail, and then
we feel like failure is and wejust give up. And so what I tell
patients is, I want you toadhere to the 9010 rule, 90% of
the time you eat, right? Youexercise, you do all the stuff
you're supposed to, and 10% ofthe time you can, I don't know,
have some pumpkin pie or a candycane or whatever it is you want,

(24:30):
because we can't be perfect. Andif we try to be perfect, we're
only setting ourselves up forfor failure. And that's where
that kind of psychology comesin, and giving yourself a little
bit of grace to to indulge,because we're all human, but
also knowing that there are sortof ramifications of

Erin Brinker (24:46):
that. So what do they say? Perfect is the enemy
of the good, absolutely. Sothere are also the philosophy.
So I have a I have somerelatives who are they have
children who are type onediabetic, and they all. Have the
monitors that hook up to thephone so you know exactly what's
going on with the child'sbecause they have children, the
child's blood sugar and but theyessentially take the attitude

(25:10):
that, well, my kid can eatwhatever he wants. I'll just
adjust his blood sugaraccordingly. It used to be
before we had all thismonitoring. You were just had to
be very, very rigid about whatyour child ate. Is, how do you
feel about that kind ofphilosophy, and, you know, What
should parents do? Yeah,

Dr. Alex McDonald (25:26):
I mean, I think so that's a bit of a more
nuanced approach. I think, youknow, definitely this technology
helps us to, you know, bettercontrol our blood sugars. And
for type one diabetics, youknow, when you have this
instantaneous blood sugarreading, you can adjust insulin
to keep blood sugars in thecorrect range. Now, does that

(25:47):
mean that there are kind of longterm problems over time with
that health Absolutely, justlike, you know, a normal,
healthy kid who doesn't havediabetes, I wouldn't tell them
it's okay to eat a bunch of junkfood, there are there impacts on
our health overall long term.
And so it's not a it's not anexcuse to eat whatever you want
and do whatever you want. Youknow, again, like I said,
medication is part of acomprehensive lifestyle approach

(26:09):
where you know whether you havea chronic disease or not, you
maybe need to be a little bitmore mindful of diet, sleep,
exercise, stress relief if youhave a chronic health condition,
but it, but if, even if youdon't, doesn't mean you can just
ignore that entirely, becauseeventually you will develop a
long term health condition ifyou don't, kind of stay on top
of those good habits oflifestyle medicine, as we call

(26:31):
it.

Erin Brinker (26:33):
So back to the 9010 Yep. So let's talk a little
bit about, you know, on a policylevel, if you were, if you had a
magic wand, and you could, wecould talk about about food
policy and food availability,and, you know, and I'm thinking
about the how ubiquitoussweeteners like corn syrup and

(26:55):
sugar and others are in ourfood. And you know what that?
Because I think it absolutelywhat do we all as human beings
in this country have in common?
Well, we are all subject to thesame food system, so that has to
have played a role in this, inwhat's happening, you know, what
would you say? You know, if youwere to advise a member of
Congress, and this is a littlebit outside the scope, but if

(27:16):
you were to advise a member ofCongress about that, what would
you say? Oh,

Dr. Alex McDonald (27:22):
wow. How much time do we have? No, I think you
know when it comes to to, like,you know, food labels and
nutrition, basically, I tellpeople when the most important
thing when it comes to readingfood labels and understanding
nutrition is you should each eatfoods which don't have food
labels on them. Yeah. So really,really focusing on sort of

(27:44):
naturally, minimally or not atall processed foods, right? We
can, we can drink some applejuice, or we can eat an apple.
Apple has a lot more fiber. Ithas more more nutrients, has
more nutrition in it, versusapple juice has been highly
processed and often, you know,they added sugar and other
things like that andpreservatives. And so, you know,

(28:05):
if I had my if I had my dream,people would only eat, you know,
minimally or non processedfoods. I tell people the most,
anything that comes in a box, abag or a package probably has
added salt, sugar and chemicals.
And so really eliminating thosefrom our diet as much as
possible, I think, is theimportant piece. Now, the trade
off with that is it takes, it'smore expensive, it takes a lot

(28:28):
more time, oftentimes, toprepare those foods. And so I
tell people, you know, try totry to do meal prep on the
weekends. And so that way, youknow, you make a big salad, you
make a big something on theweekend, and then you eat that
throughout the throughout theweek, because with our busy
lives, the time for for healthycooking and eating and even just
sitting down and having a familymeal, which is good for our

(28:51):
mental health and eating moreslowly and not feeling rushed,
which are all important thingsFor our satiety, are are very,
very hard to come by in this dayand age. So there are multiple
factors involved. But I think mybiggest thing is avoid anything
which comes in a box, a bag or apackage,

Erin Brinker (29:12):
yeah, and maybe as as we're thinking about farm
policy and what subsidize andwhat isn't, taking a look at the
at the systems that that causethe processed food to be so
harmful. Now, we've heard a lotof and I'm not sure if you'd be
an expert in this or not. I'veheard a lot of brouhaha and the
internet. So it may not be true.
Probably isn't. Is seed oilsafe, like the oils and things

(29:35):
that people eat, just vegetableoil?

Dr. Alex McDonald (29:41):
Yeah, I mean, I think there are multiple
different types of oils, youknow, I'm not an expert in that,
so I don't want to kind of speakout of line. But again, a lot of
the the least processed foodsare probably better for you. We
know that, you know, olive oilis probably one of the best that
you can use for yourself interms of just, you know. Heart
healthy oils versus things whichare more processed, like the

(30:04):
grape seed oils or like coconutoil, has a lot higher saturated
fat in it. I'm not an expert inthose overall, and so I don't
want to, I don't want to shakeout a turn or give our listeners
a false information.

Erin Brinker (30:16):
Well, so it will be, it will be a rarity on the
internet. We're going to onlyhave true information.

Dr. Alex McDonald (30:22):
Well, we'll do what we can.

Erin Brinker (30:24):
Now, I'm just kidding. I you talked about Dr
Google, Google, and I think thatpeople are they know that
they're not well. And you know,metabolic syndrome is so common,
and metabolic issues andhormonal issues are so common,
people are desperate to andthey'll, they'll define what the
answers are, and they'll,they'll follow whatever rabbit

(30:45):
down the hole that they can. AndI think it's important that they
be given, that people hear thesolid, correct information.
Yeah,

Dr. Alex McDonald (30:52):
well, and I talk to people about this all
the time, is, is I definitelywant my patients engaged in
their health, and I want them tolearn more and to be interested,
but I want them to make surethat they're getting their
information from from good,credible resources. And so I
often will tell patients, hey,if you if you hear something or
read something which sounds toogood to be true. It one, it
probably is. But two, come like,like, send me an email, or come

(31:15):
see me or ask me about it. So wecan put it into context. Maybe
there was a study that showedthis one small population
benefited from from this oneintervention. But maybe that
doesn't necessarily apply toyou, and so I think that's
really where, where physicianscan be extremely helpful in
terms of helping a patientunderstand information and

(31:36):
putting into context for themand their individual individual
body, because you can findanything you want on the
internet. These days you can andso I think it's really important
to make sure that you you have atrusted individual who you can
kind of rely on to help vet someof this information and
understanding how it, how it,how it, put it, put it within

(31:56):
context with your individuallifestyle.

Erin Brinker (31:59):
So we've talked about the kinds of foods and
having, you know, basicallyshopping the perimeter, the
perimeter of the store. Youknow, you go to the butcher, you
go to the produce section, yougo to the dairy section. Do you
have a preference personallyabout keto diets versus
Mediterranean, versus plantbased? Or are you kind of

(32:21):
agnostic about that?

Dr. Alex McDonald (32:22):
Yeah, you know, that's a great question.
And I think part of the issue iswe have this sort of phase diet
mentality that, like, you know,it was the Atkins diet, and now
it's a keto diet, and then it'sthe South Beach diet, and
they're all just, there's theblueberry diet and the ice cream
died. And, like, literally, youname it, there's an ice cream
diet. No, I'm just using. I'mjust teasing. But, like, the
point is, there's so manydifferent sort of, quote,

(32:44):
unquote diets out there, surethat you need to sort of think
about it. There's anythingthat's, again, sounds too good
to be true, or that has sort of,you know, a flash in a pan, I
think, is not as beneficial oras much more suspect. So what I
tell patients is, look, youshouldn't be be going on to sort
of a quote, unquote, you know,diet with a with a big D. You

(33:07):
should have a lifestyle change.
Now, if that means you want tohave a low carb diet and eat
mostly, you know, protein. Andif that works for you, and that
is sustainable for you know, thelong term, then I'm okay with
you trying that. But we, what wecan't do is every six weeks
being trying something new anddifferent. And so I tell people
that if you want to try acertain, you know, quote,

(33:29):
unquote, diet, I'm okay withthat, we just have to make sure
that one, it's sustainable, andtwo, that we kind of check, you
know, these sort of metabolicprofiles, you know, from time to
time, every, every six months orso when you're on that new
lifestyle. Because there can be,there can be trade offs, you
know, maybe if you're on theketo diet, you're losing weight,
except your cholesterol is goingthrough the roof, which puts you

(33:52):
at higher risk of heart diseaseand strokes and heart attacks
and things like that. So again,it needs to be taken within
context. So that's the firstpiece. The second piece is the
diet that I recommend isactually kind of, what's called
a whole food, plant based diet,right? So it doesn't necessarily
have to be vegetarian, but itshould be mostly, again, mostly
Whole Foods, non processed, andmostly plants. I tell people

(34:15):
that about half your plateshould be fresh fruits and
vegetables, a quarter of itshould be some kind of healthy
lean protein, and then a quarterof it should be some kind of
whole grain carbohydrate. So theMediterranean diet is sort of a
very common one which is verywell studied and very evidence
based that balances sort ofthose risks and trade offs for

(34:39):
most people, but there's moreand more evidence showing that
eliminating animal proteins fromyour diet can really improve
your overall health, not justfor sort of cholesterol and
heart attack and stroke risk,but also for some people with
diabetes. You know, theyfollowed the very traditional
sort of diabetic. Diets aredoing all the right stuff, but

(35:00):
when they when they move to awhole food plant based or even
vegetarian diet, they find theirblood sugar improved
significantly. But again, it'sreally individualized. So, you
know, it's

Erin Brinker (35:12):
interesting because, you know, I said that,
I mentioned that I had been avegan, and I did. I liked being
a vegan, and I didn't do it forI did for health reasons. I
didn't do it for, you know,spiritual reasons, or, you know,
I mean, I love animals, butanimals eat animals, and so I
don't have a problem eatinganimals, but I found that there
were that my blood sugar wouldspike tremendously. And for me,

(35:36):
it was just rice. And I didn'tknow it at that time, but it was
just rice. So had I not eatenrice, then I probably would
still be on that diet. And Ithink that, you know, we as
diabetics being proactive andand kind of owning your disease
is you, you have to payattention to what spikes your
blood sugar and what whatimpact. And even if somebody
else is saying that shouldn'tdo, that doesn't really matter

(35:58):
what should or shouldn't, that'swhat your body's doing. So
that's what you have to listento.

Dr. Alex McDonald (36:02):
Yep, exactly.
I have a lot of patients whocome see me, and we're working
through, sort of their theirnutrition, and we're making
recommendations. And they say,well, but I met with the
nutritionist, and they saidsomething different. And I said,
Well, that's again, that's thehard part. Is it's not a one
size fits all when it comes tosort of, you know, dietary
guidelines, the their recentguidelines that came out a

(36:23):
couple years ago that reallyput, really emphasize sort of
personal preferences, like whatfoods you like. I mean, if, if
the recommendations are, you eatnothing but brussels sprouts all
day long, but you hate eatingbrussels sprouts. By the way, I
love Brussels sprouts, but youhate eating brussels sprouts,
then that's not really going tobe a good diet for you. So
really, for you. So reallypersonal preference and what

(36:43):
foods you like are reallyimportant. Cultural and
religious traditions are reallyimportant to make sure eating
foods which kind of fit withyour culture and the traditions.
And then, thirdly, those foodswhich are not going to impact
your health or will minimize theimpacts to blood sugar,
cholesterol, you name it. Soagain, highly individualized.
There's no one size fits all,and unfortunately, there's a lot

(37:06):
of trial and error, which needsto go into that work to figure
out what's going to work for youand your individual body. And
that's why having a team withnutritionists and physicians and
nurses that can be reallybeneficial for you. So

Erin Brinker (37:21):
is type type two diabetes an autoimmune disease?

Dr. Alex McDonald (37:27):
Not technically no. So type one
diabetes, diabetes can beassociated with an autoimmune
disease. It depends typically,but type two diabetes, I
believe, is not so someone outthere who maybe was smarter than
me might be able to correct me,but my understanding is there,
there may be some implications,but not directly, an autoimmune
disease for type two diabetes.

Erin Brinker (37:47):
So, and I asked that I have, I'm just being very
open. I have, I have Hashimotos.
And so this, this kind ofhormonal imbalance that I'm
trying to walk a tightrope. Andsometimes it's great. My blood
sugar's just dynamite. And thenthen it's not, and it's
frustrating, because there's,it's, it's this kind of up and
down, and up and down. Is thatrare? Is that, you know, do

(38:09):
other people have the sameexperience?

Dr. Alex McDonald (38:14):
Yeah, you know, I think a lot of people
have, you know, when it comes toany chronic disease, there is
not a sort of set it. And forgood mentality, you know, if you
have high blood pressure,oftentimes you can take a medic
blood pressure medication, andthen, you know, within reason
that's pretty well controlledyour blood pressures, but it
needs to be adjusted from timeto time. For diabetes, there is

(38:35):
so many more factors involved.
And so we know, for example, ifsomebody is really stressed at
work, and they're not sleepingas as well recently, because
they have all this other stuffgoing on. It causes your
cortisol, your your blood bloodstress hormone, to spike, which
causes your blood sugar to goup. And so there's multiple
different impacts. And so therereally is not a there's not a
one size fits all approach. Soif things are going well, I tell

(38:57):
my patients who have diabetes,hey, I want to see you about
once every six months, just tosort of touch base and make sure
you're doing okay. Do blood workevery six months just to make
sure you're doing okay. However,people who are not well
controlled, I want to see themmuch more regularly to help get
them under better control,because we can't just sort of
rest on our laurels. You knowwhat? Worked last year may not
work this year, unfortunately,

Erin Brinker (39:20):
well, you brought up sleep, which is huge. I mean,
I know so many people who arenot getting they're getting, you
know, six hours or less a nightbecause of stress, because of,
you know, maybe they're caringfor an elder, aging parent.
Maybe they have stress at work,you know, all kinds of stuff.
You know, how do you, from whatit sounds like, that plays a
huge role.

Dr. Alex McDonald (39:40):
Oh, absolutely. And like I said
before, diet, sleep, exerciseand stress relief, those four
things are absolutely criticalto maintaining and improving
your health. And even if thoseare not the sole features and
you need medication on top ofthat, they have a huge and a
disproportional impact. So.
Sleep is absolutelyfoundational. There is most

(40:01):
people, the vast majority ofAmericans, need about eight
hours of sleep a night. Now, ifwe get by at seven on average,
that's probably enough. When westart getting less than seven on
a regular basis, there aredefinitely metabolic and
cognitive impacts. They did agood study showing people who
had got less than seven hours ofsleep on a regular basis, they

(40:23):
just their brains were slower.
They would literally thinkslower than people who got more
than seven hours on a regularbasis. And so that's just kind
of one kind of cognitiveexample. But we know there's a
whole bunch of factors involvedwith with metabolics and
cortisol and stress, and youname it. So if you're not
sleeping, you're not likerecharging your phone overnight,

(40:46):
essentially, and eventually, thebattery's going to run dry and
you're going to damage the phoneand have all kinds of other
issues and and you can't use thephone, right? So I tell people,
sleep is just like you. Youcharge your your battery on your
phone every night so that itworks better the next day.

Erin Brinker (41:00):
Yeah, yeah, you do have to, you have to reboot. You
know, you you talked aboutcognitive issues from a lack of
sleep, and in long term, youhave to think that, that, you
know, all of these play into howwell your brain works as you
age. I've heard some people, andI don't know if this is true or
not, but I've heard some peopledescribe Alzheimer's, for
example, as type three diabetes.
And I don't know if that linkhas actually been made, or

(41:24):
people are just kind of watchingthings and making that
assumption. What do you think?

Dr. Alex McDonald (41:31):
Yeah, you know. I don't know exactly. We
know for a fact that elevatedblood sugar, or just sugar in
general, causes inflammation inthe body, which can make
multiple other factors worse.
And so if you already haveinflammation or narrowing of the
blood vessels in the brain, andyour blood sugar goes up, that
can cause inflammation of theblood vessels, which can cause,
you know, increase the risks ofstrokes and heart attacks or

(41:52):
even even what we call vasculardementia, right? The blood
vessels just are not able toprovide enough blood, and the
brain stops working as well,because the just the chronic
inflammation that happens withinthose arteries throughout the
entire body, right? One of thebiggest side effects of
uncontrolled diabetes is visionloss, because the small,
sensitive blood vessels in theback of the eyeball get damaged

(42:15):
from the chronic blood sugar.
Same thing with the kidneys. Thelot of folks who have
uncontrolled diabetes end upgoing on hemodialysis because
their kidneys stopped working,because those little, tiny,
sensitive blood vessels in thekidneys stop working from the
from the inflammation and thesugar over time. And so the same
thing happens in our brain,whether we can make a direct

(42:37):
correlation or not, you know, Icouldn't say but, but there's no
question that elevated bloodsugar significantly increase
increases your risk of multipleconditions, dementia being one
of them.

Erin Brinker (42:49):
So we've talked about people who have diabetes,
and certainly there are a lot ofpeople who don't know they're
diabetic. I would imaginethere's even more who don't know
that they're pre diabetic. Canyou talk about pre diabetes, and
kind of what, what that lookslike in it, and what might be
the hint that somebody's bloodsugar is not where it should be.

Dr. Alex McDonald (43:08):
Yeah. So, you know, the kind of the medical
industry has kind of developedthese kind of terms, you know,
there's, there's pre diabetes,and there's, there's pre this,
and there's pre that, and I'mnot a huge fan of that. So
everything is a spectrum, and wehave to sort of draw the line at
some point. And so for averageblood sugar, the A, 1c or the

(43:30):
three month average blood sugar,the line for when you're
technically have diabetes ornot, is 6.5 with at least two
different blood blood, bloodmeasures over time. And so
that's kind of where we draw theline normal blood sugar, as I
said before, is is 5.6 or less,or 5.5 or less. So that middle
range between those two is whatwe call that, that pre diabetes

(43:52):
range. So what do we do withthat? There's some people who
are in the pre diabetes rangewho never go in and develop
diabetes, about five to 10%percent of people per year who
have pre diabetes will go on todevelop full blown diabetes.
However, we know for a fact thatpeople who have pre diabetes,
you know, are often higher riskof high blood sugar, high

(44:14):
cholesterol, strokes, heartattacks, you name it. So it is
sort of a, I sort of use it as aas a learning opportunity to
change your lifestyle, to helpreduce your risk of going on to
further conditions. And so I'mnot a huge fan of the term pre
diabetes. I often don't startwith medication. When someone

(44:35):
has pre diabetes, I start withdiet, sleep, exercise, stress
relief. I feel like a brokenrecord, but I start with those
lifestyle pieces first, and it'ssort of a point to have a
conversation about, hey, whatare we going to do here? Let's,
let's focus on on keeping youhealthy and preventing disease,
because ultimately, my job as afamily physician is to prevent

(44:56):
disease, rather than just treatit. And so I think, sort of
having somebody. They get theirtheir blood sugar checked on a
regular or routine basis basedon the risk factors. Is, is just
sort of a point to have thatconversation to prevent future
issues down the road.

Erin Brinker (45:12):
You know, it just it drives home the need for a
medical home to have a primarycare physician that you work
with who gets to know you andyour lifestyle and your family,
and can really be a partner andso much of what we you know,
people show up in the emergencyroom when something is reaching
a critical level and they'venever seen a doctor to mitigate

(45:34):
the problem from way back, yep,

Dr. Alex McDonald (45:37):
exactly, exactly. You know, an ounce of
ounce of prevention is worth apound of cure, and there's no
difference when it comes tohealth conditions. And like I
said before, the top of thisconversation is when I work in
the hospital, I see all thesedownstream consequences of
poorly controlled diabetes andblood pressure and cholesterol

(45:57):
and you name it. But a number ofthose patients either didn't
have access to a primary carephysician or didn't have access
to medical coverage. And how canwe how can we help prevent this?
Unfortunately, in this day andage, our our healthcare system
is really not a healthcaresystem. It's a disease care
system. We are sort of set up totreat things once they've

(46:21):
already occurred, versus versuspreventing them. And that's, I
mean, I'm a little bit biased,but that's one of the reasons I
love being a part of KaiserPermanente, is we are set up to
prevent illness. We really valueprevention. We really value
community outreach in ways thata lot of other medical systems
and a lot of medicalorganizations just will treat

(46:42):
you once you're sick, versushere at kp, we invest a huge
amount of time and energy tohelp people stay healthy or get
healthy, versus just treatingthem once they're

Erin Brinker (46:52):
already sick. So I know that you all have classes
in weight loss and diabetesmanagement and asthma, in
quitting smoking, all kinds ofstuff. Can you talk about what
that you know, the about thoseclasses, whatever you know about
those classes and and what abenefit that has been in your
practice? Absolutely.

Dr. Alex McDonald (47:10):
So I have the the average patient sees their
their family doctor for 20minutes, maybe once or twice a
year, right? And how mucheducation can I really do in
that time? So that's where I theKP Center for Healthy Living is
so important, because knowledgeis power. If I can help someone

(47:30):
learn what to do or not do, whatto eat, what not to eat, how to
exercise, that is so much morevaluable than just simply
prescribing them a medication.
Now, like I said, medication hasa role, but if we can educate
our patients regarding diet,sleep, exercise, stress relief,
and help them build thosehealthy lifestyles and healthy
foundations, and not just theindividual, but the entire

(47:52):
family, oftentimes, I use theexample of smoking, if one
person in the family is tryingto quit smoking and the other
one is not, that's, that's, youknow, not as beneficial as both.
They're trying to quit together.
And so that's where the Centerfor Health Living is so
critical, because it can reallyeducate couples and families

(48:13):
together to all work and improvetheir health. There. There's no
way that I can do enougheducation when my in my 20 or 40
minutes per year with all of mypatients, but being being there
to support them, sort of beingtheir coach. You know, sometimes
patients will send me emailsbeing like, Hey, Dr McDonald, I
just went to the gym six daysthis week, right? And just

(48:35):
knowing those things and givingthem some positive
reinforcement, and being that,that accountability for partner,
partner with some patients isjust so valuable, and that's
where I think our organization,with the Center for Healthy
Living, is just so so well setup to help people help
themselves, versus just givethem a pill or give them a
medication or give them aprocedure, which is not a good
long term fix.

Erin Brinker (48:56):
You know, I use an app called glucose. What's it
called? Oh my gosh, I justforgot the name of it. It is the
gluco glucose partner. Anyway,you can add in all of every time
I check my blood sugar, I canadd it and every time I eat
something, I can add it in.
There's a place for notes andall of that. And when I was
first diagnosed, I actually mybrother had been diagnosed, and

(49:19):
I thought, well, I hadn't been Iknew I was pre diabetic, and so
I just bought a meter, and Istarted tracking it myself, and
I was able to send, send her areport glucose buddy, that's
what's called, send her myprimary care physician a report.
And said, this is all the thingsthat I'm doing. This is all
these are all the things thatI'm eating. And together, we had
a really informed conversationabout what I could do or what I

(49:40):
should be doing. And it hasbeen, it has been tremendously
helpful. Now it takes somediscipline to be able to enter
all of that stuff, and there aretimes where I'm more disciplined
than not, or less disciplinedthan before, but it's, it's been
very helpful, and certainlygives her information to help me
make. The right decisions.

Dr. Alex McDonald (50:01):
I think that is such a valuable tool. There
are so many different apps outthere that where you can kind of
keep track and keep food logs,and it can tell you, you know,
not only just kind of calories,but but you know micronutrients
and you know, see how itresponds and how your body
responds to those individualpieces. I agree, keeping a
keeping a food journal or a fooddiary is exceptionally

(50:22):
challenging, but I tell people,if you can just do it for three
days, just do a food diary forthree days. Write down
everything you eat, how much itis. If you can put it into an
app, which will tell you kind ofnutritional and caloric value,
even better. But just do it forthree days, and you will you
will be blown away by by whatyou are or not eating. Maybe

(50:45):
people, people often will say,Oh, I'm having I eat a healthy
diet, and I have them do a threeday food journal, and they're
like, oh, geez, I'm not eating ahealthy diet at all

Erin Brinker (50:51):
that happened to me. Like, oh, oh geez. I
shouldn't have had this, or Ishouldn't have had that. And
maybe I wouldn't. I shouldn'tget the coffee, the fruit,
coffee drink. I should just getthe regular coffee drink

Dr. Alex McDonald (51:02):
Exactly. So I think we have, you know, in this
day and age, we have sort of,you know, portion distortion,
right? We all go to CheesecakeFactory, and we have, like, you
know, a week's worth of calorie,caloric in a heavy cream laden
pasta dish. And we just don'teven have any concept of that,
because that's how much we eat.
And so sometimes, if you if youmeasure how much a serving of
cereal is, you know, often ahalf or three quarters of a cup.

(51:25):
No one has one serving ofcereal. We always have, like,
two or three minimum, right?
Because that's the sort of whatwe're used to seeing. So I think
learning, learning what actuallya portion size is, is really,
really valuable. And then alsothe next level, that is how your
body responds to that, and it'sa tremendous amount of work, but
I encourage my patients, just doit for three days, and you will

(51:47):
be be blown away. So

Erin Brinker (51:49):
we have just a couple of minutes left. Talk to
me about getting started on anexercise project, because we
think, you know, I have, youlook at those super toned bodies
on TV and think, Okay, I have toget out there and and run a
marathon. But it doesn't have tobe all that you can just get up
and take a walk. Correct?

Dr. Alex McDonald (52:07):
Correct? I tell people, you know,
oftentimes we, you know, doctorswill tell people to to to go
exercise, right? But, but howoften do you do? Do doctors tell
patients, oh, here's, here's apill of metformin, just take
some here and there, right?
Like, we don't actually do that,yeah. So no, I am. I'm a huge
advocate of what's called theexercise or the physical
activity prescription. Sometimeswhen you say the word exercise,

(52:30):
people think of like sweatingand being uncomfortable, and
that's not, it's really aboutbeing physically active. And so
I often will give people what'scalled a physical activity
prescription, and it will say onthere, it will say on a piece of
paper, walk five minutes threetimes a day, right? There have
been good studies showing peoplewho have diabetes. In
particular, if you walk for fiveminutes after breakfast, five

(52:52):
minutes after lunch and fiveminutes after dinner, you have
better blood sugar control thanif you walked for 15 minutes
once a day. Seriously doing,yep, doing it even, even as
little as two minutes ofphysical activity or walking
after you eat can significantlylower your blood sugar. And the
reason for this is that,remember, we talked about
insulin being the key to helpsugar go from the blood into the

(53:14):
cells. Exercise bypasses thatthat need for the insulin key,
it uses a different pathway. Andso by being physically active,
we are actually lowering ourblood sugar, whether whether
we're diabetic or not, whichwill often help us be, you know,
get those blood sugars underbetter control, regardless. And
not only that, it's good for ourhearts, our lungs, our muscles,

(53:38):
you name it, our mental health.
If I had one medicine, of allthe medicines in the world, if I
had just one medicine, it wouldbe 30 minutes of physical
activity, five days a week,right? It doesn't have to be all
at once. It can be five minuteshere. It can be taking the
stairs instead of the elevatorat work. It can be parking at
the far end of the parking lotinstead of right next to the

(53:59):
door. Every step we take, allhelps build stronger muscles,
bones, our lungs, our improveour blood sugar, improve our
mental health. And so I'm thisis kind of how I got into sort
of the lifestyle medicine worldis through sports medicine and
through exercise. Because, youknow, physical activity is not

(54:20):
just for athletes. It's foreverybody. It's for everyone. If
we, if we had a, if we had abetter understanding of how we
can make sure we stay morephysically active, and that can
just be more steps throughoutthe day that is going to overall
make us a much, much healthierpopulation as a whole.

Erin Brinker (54:35):
Well, Dr Alex McDonald, this has been such a
great conversation as I diabeteshits every family. It's it is it
hits every every race, everydemographic, every you know,
rich, poor and everybody inbetween and and so I know that
this is really helpful,especially right before the
holidays, when food iseverywhere. So thank you so

(54:56):
much. How do people find andfollow you on social media? Or
are you on social media andlearn more about Kaiser
Permanente,

Dr. Alex McDonald (55:04):
yeah, absolutely. I'm so glad, glad to
be here, and I'm grateful forthe opportunity to share some of
my my insights. So I'm onInstagram at Alex Z McDonald.
You can, you can follow methere. I do a lot of social
media work in terms of just tryto educating, educating my
patients. You know,collectively, as opposed to
individually, check out theKaiser Permanente Center for
healthy living. You can justGoogle it, and there's tons of

(55:27):
information and ways to getinvolved there. So I hope
everyone takes a little bit awayfrom this, and especially
heading into the holidays, wedon't be perfect. We just have
to do something. And then youknow that 9010 rule is so
important, and I encourage mypatients just to stick to that
as much as they can.

Erin Brinker (55:44):
Well, thank you so much. Sorry. My alarm, my we're
right on time. My alarm justwent off. So thank you so much
for joining me today. You havebeen a delight. Happy holidays
to you and and I'm going torecommit to being healthy.

Dr. Alex McDonald (55:58):
Awesome.
Well, thank you so much. Iappreciate the time, and I
appreciate everyone out therelistening.

Erin Brinker (56:03):
Well, that is all we have time for today. The
glucose buddy app that wementioned, or that was mentioned
in the conversation with DrMcDonald, can be found in the
Apple App Store or the GooglePlay Store. It's not free, but
it's very helpful while you'relearning about how to best
manage your blood sugar, andthen you can export reports that
you can give to your doctor,which are very helpful for your

(56:26):
physician, so you can learn howto manage your blood sugar.
They're not a sponsor. I'm justa user. And it was helpful for
me as I was learning to navigatethis so it helped a lot. So for
more information about themaking hope happen Foundation,
please visit Making hope.org.
That's making hope.or. O R G,got a great idea for a show
topic. Email me at show atmaking hope.org. That's S, H, O,

(56:48):
W at making hope. Dot O R G,have a great week, everyone.

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Erin Brinker (58:33):
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