(gentle music) - [Narrator] The region's premier medical information program, "Call The Doctor."

- It's important to listen to your doctors when it comes to treating injury or illness, but nutrition can certainly play a role in how healthy we are, and maybe how quickly we recover.

What the experts have to say about food as medicine, in this episode of "Call the Doctor."

Hello, thank you for being here.

We're so glad you're with us for this episode of "Call The Doctor."

We have another great panel for you tonight, so we're gonna get right to them.

And we'll let them introduce themselves.

Thank you so much, all of you, for being here.

I'd love for you to tell everybody who you are and a little bit about yourself.

- Sure, sure.

My name is Walter Wanas.

I am the Director of Lifestyle Modification and Preventative Medicine at the Wright Center for Community Health and Graduate Medical Education.

I'm a licensed and registered dietician nutritionist.

And I practice lifestyle medicine as part of our integrative medicine at the Wright Center.

- I can't wait to hear a little bit more about that.

Welcome to you.

- Julie, thanks for having me.

My name is Karen Howard.

I'm a registered dietician, a registered nurse, and a certified diabetes care and education specialist.

I work for Geisinger in their Food is Medicine Program called the Fresh Food Pharmacy.

- I'm looking forward to hearing about that as well.

And welcome to you, Gael.

- Thank you.

My name is Gael Germain.

I'm a clinical dietician consultant in the Scranton area.

And I have experience in acute care and skilled nursing as well, and some teaching experience in different programs in the community.

- Great, and I can't wait to hear what you have to add to the conversation.

Now, the first thing we'll say right off the bat, is to say that no one means to suggest that we're not going to listen to our doctors, or take that prescription medication.

Food's not going to take the place of that.

But I think we can all agree that nutrition is a really big important part of overall health.

So I think my first question for you all would be, maybe I don't wanna know this.

By and large, how unhealthy are we in America?

What are we doing wrong?

What are we doing right?

What do you see most of, Walter?

- A lot of times we see a big thing in obesity.

And we also see a big in diabetes, especially type two diabetes and cardiovascular disease.

And it seems like we're a nation that's over consumption.

We consume a lot of too much calories and we consume a lot of foods that don't have much nutritional value.

So we see a lot of refined carbohydrates, a lot of easy snack foods, very low on fruits, vegetables, fiber.

And as Gael probably mentioned, a lot of what we call phytochemicals or phytonutrients.

So we seem to be lacking a lot of that in the diet.

- What would your observations be?

- Yeah, I totally agree with Walter as well.

I think we are a fast-food generation.

It's a quick and easy thing.

Often, you need to get to a game after school and running through a fast-food restaurant might be quick and easy.

But those foods are processed, they're high in sodium, they're high in saturated fat, and really overall not healthy.

So that's one thing I think we can all do better.

- All right, what are your observations?

- I agree with them completely.

I think one that hits home with me is sodium.

We have just way too much sodium in our culture.

And a lot of it goes back to what they were both mentioning, convenience foods.

A lot of our choices as busy people are based on convenience.

And a lot of those processed foods is too much salt, too much fat, like Walter and Karen said.

- We'll stick on this topic just for a little bit longer just to say, and there's no one right answer for this, I'm sure.

But how much is too much?

That you do that once in a while, is that okay?

That you do that every day, I'm sure that's not okay.

But what do you tell your patients?

- No, that's a good point.

Usually if you do it once in a while, that's not a problem.

It's just that we're doing it.

We're seeing patients who do it several times a week.

And then when they're doing that, it's, what is it replacing?

Is it replacing fruits?

Is it replacing vegetables?

Is it replacing what we call omega-3 omega, fatty acid.

Is it replacing fiber?

And also, again, all these phytonutrients that we're not getting in the diet that we need.

So a lot of times when we're talking about convenience food, or even fast food, it's not so much we're getting all that extra calories and fat we don't need.

It's what we're not getting.

So it takes the place of many of these nutrients that our bodies need.

- And you both mentioned sodium.

What does too much sodium do to you?

- So it increases your blood pressure, it increases your risk for heart disease.

There's so many things that sodium does.

For certain patients as well, it can cause fluid retention in the body.

- [Julie] And sugar.

I imagine sugar is another big one.

- And just again, touching on the sodium.

Some people don't realize they have some chronic kidney disease and the sodium is a big issue there.

- Hmm.

A big driver of that.

Who, I'll stick with you here, Gael.

Who typically are the people that you see?

Who's a typical patient?

- Well, there's a lot of diabetes type two, cardiovascular problems, obesity, as Walter had mentioned.

I'd say those are some of the primary chronic diseases that you see a lot.

- [Julie] Would you say they're common around here?

- I'd say they're fairly common, yes.

I'd have to agree with that.

- Who would you see typically?

- So I work generally with patients that have type two diabetes.

So that is very prominent in our area, as it is in the world.

It seems to be the numbers are growing and growing.

I think a lot of it is based on our diet.

Type two diabetes, there's a genetic link to it.

But we can help to prevent or delay that from happening if you do lifestyle changes like eating healthy and exercising.

- We just did a whole show on diabetes.

But I'll guess I'll have you one more time explain the difference between type one and type two in case people don't know.

- Sure.

So type one diabetes is something that generally happens when a person is younger.

It's an autoimmune disease.

And what happens is the cells in the pancreas, they become destroyed.

And a person with type one diabetes generally is going to require insulin for the rest of their life 'cause their pancreas does not produce insulin.

With type two diabetes, often when I ask patients if they have a history, a family history of diabetes, 95% of them tell me yes.

A mother, a father, a grandparent had it.

There's a strong genetic link with it.

And what happens is it kind of comes out a little bit later in life, as we maybe have gained some weight as we got older, we don't eat as healthy, we're not as active, and the pancreas is still producing insulin, it's just not producing enough.

And that insulin that it is producing is resistant to getting to the cells to be utilized.

So with type two diabetes, you have what's called insulin resistance.

- And same question to you.

Who do you typically see today?

- We call it the Big Three.

It's type two diabetes, obesity, and cardiovascular disease.

They go hand-in-hand.

And as we were discussing earlier, it seems like when we have more obesity, it usually ends up with more type two diabetes, and then ends up with more cardiovascular events or risk.

So we really see that as the Big Three.

- So it's typical that you might see others if you have one.

- Yeah, exactly.

- If you see one, I should say.

- True.

- I'm always curious if it, kind of a left field question, but is there a difference between a dietician and a nutritionist?

Can you use those words interchangeably?

- We prefer you don't.

(all laugh) As a dietician, we're registered and licensed as a dietician nutritionist in the state of PA.

So you wanna make sure if you're seeing somebody, they're registered and licensed in the state of Pennsylvania.

So what that means is someone can call themselves a nutritionist if they just have a nutrition degree, but they might not have the schooling and the educational background that we have.

And that's not only involves with doing our undergraduate work, but a lot of times, it's doing graduate work, in addition to an approved internship where you're working in a acute care facility and also other facilities where you're getting the education and also the experience you need from the clinical perspective.

- I was gonna ask what kind of schooling that takes.

People might not understand exactly what you might need to learn in there.

So we've went over a couple of the diseases, the Big Three, as you say.

What are some of the others, maybe the not so common ones?

Or the ones that people watching might not even realize can be helped by a dietician?

- Well, a big one is any type of GI disturbances or such as Crohn's disease, IBS.

They're very prevalent also.

So we do see a lot of patients for that.

Also, food allergies.

We see a lot of people now with more food allergies, it seems like, than we did in the past.

So there's some of the other ones I happen to see quite a bit.

- You two are both nodding.

Do you see more food allergies than you used to?

- [Gael And Karen] Absolutely, absolutely.

- Talk about that a little bit.

- I think that a lot of the scientists aren't even sure why there is such a predominance of allergies compared to years ago.

But it's an area that needs more study.

- [Julie] What are some of the big ones?

- Well, peanut.

Peanut is a huge one.

Sometimes you hear soy.

Soy has become an allergy.

Well there's always the wheat allergy with gluten-related gastrointestinal diseases.

And so you could have celiac disease, or you could have a gluten sensitivity, which people are developing, which isn't the full disease state.

But people have developed an intolerance to maybe some of the extra gluten that has entered our food supply over decades.

So there's things emerging that have emerged as a result of the ever-changing food supply and how foods are manufactured and genetically changed and everything, so.

- Sure.

Do you find that people come to you, I don't wanna say last resort, that's not what I'm trying to get at, but they've tried lots of different things and they're really not sure where to turn.

- Sure.

I think that's very normal.

I think there's a lot of misinformation out there.

A lot of confusing things, especially in the nutrition field.

So when they do seek us out, we're delighted to try to help them because it's just so confusing to be the consumer now.

And then throw in a health issue that could be helped by diet, but you're not sure where you're going wrong.

Yes.

- You're right about it.

It's confusing for anybody really.

- Yes.

- What do you counsel your patients through?

They must really need your help when they get to you.

- Sure, sure.

So, like I said, I generally work with patients with type two diabetes.

So that's very responsive to diet and lifestyle changes such as exercise.

I always tell my patients, "When you go on the Internet, and you're Googling certain things," they'll come in to the office and say, "I Googled and I read that cinnamon, for example, helps diabetes."

So the message that they get is if, maybe you go and you buy cinnamon and you put it on all your food, that that's gonna help your diabetes.

Whereas that's not the true fact of it.

Now, cinnamon, there's been some studies that say that certain types of cinnamon and certain amounts in their capsule forms may help with insulin resistance.

But it's limited studies.

But the message that the consumers are getting, or the patients are getting, is cinnamon helps with diabetes.

So we're here to help kind of explain some of the things that they might be seeing on the Internet that isn't actually true.

- I actually like this topic.

What are some of the miscommunications or, guess what I'm trying to say.

- A lot of times when you see a patient, you have to really listen to them and find out all the things that they may have thought and you have to go back and pretty much reeducate the patient and let them know, "Wait a minute, that's not necessarily the case."

So I hate to use the word deprogram, but sometimes we have to go back to help a patient understand what's going on here.

Because a little information is okay.

But when you have so much information, and it's coming from so many different avenues, it's very confusing for the patients.

And they wanna really get clarification.

So a lot of times, it's sort of clarifying the information they have.

- Did that get worse with the Internet?

- It did.

It really, no, it really did, because there's so much information out there and you have to sort of put everything together.

And always, when you read something, you gotta take it with a grain of salt because we have to find out what studies are done.

And also too, is when people take a supplement, it's not gonna make much of a difference if they don't change their diet patterns.

That's one thing I think they think that if, "Oh, if I take this, this is an anti-inflammatory."

But if they're eating foods that are all inflammation type foods, well, that supplement's not gonna really do anything for them.

- Supplement might help in conjunction with other things.

- Exactly, exactly.

- Can certain diseases be reversed?

Can they be prevented?

I mean, using food?

I understand it probably can be helped.

But how far can food go, when it comes to healing you from the inside?

I'll start with you there.

- Sure.

Sure.

So I see it every day with our patients with diabetes.

They come in with very uncontrolled diabetes and that puts them at risk of complications as far as heart conditions, with their heart or their kidneys.

It can cause blindness, it can cause the need for amputations.

There's so many things that happens when you have diabetes.

But when they make the lifestyle changes and they get their numbers to where they are at a good level, we help to prevent or delay those complications.

So I always say, "If you're diagnosed with diabetes, are you cured from it?"

Maybe not so.

You may always have that diagnosis, but can you be controlled and say that I have diabetes, but I'm well controlled?

Absolutely.

And then that's helping to prevent further complications later in life for them.

So that's the whole point.

- Can you get off medication?

- I have a lot of our patients that have medications reduced.

Some of them removed, due to just eating healthier, losing weight and being active.

- Being active is another one.

I know this isn't necessarily on topic, but go ahead and talk about that as well.

I mean, you all enthusiastically nodded there.

Talk about being active as part of this.

- Well, for heart health, it's wonderful.

For weight control, it's wonderful.

And I think when you think about wellness, we have to talk about stress relief.

And exercise is a great way to get those endorphins going and maybe lower that stress level and just feel better.

So, it's multi-faceted.

- You really have to take into consideration a lot.

- A lot of different things.

- Someone's history and background.

- Exactly.

- Am I missing something?

What else do you look at?

- Well, I mean, I think we all have a genetic profile that's going to maybe, unless you're extremely lucky, maybe, we're all gonna be maybe predisposed to some sort of heart disease or maybe type two diabetes.

But I think if you really make the effort to include healthy foods in your diet, anti-inflammatory, anti-carcinogenic, this could really work in your favor to turn things around and kind of fight your genetic background, so.

- Can we talk about certain foods here, just because, you hear that a lot of the same foods end up on the 10 best for this, and 10 best for that list .

And you don't put too much stock in that, but it's a lot of whole grains and fruits and vegetables and the good fats.

So could you discuss a little bit about overall, what those really good healthy foods are?

And I know you're gonna say vegetables, but why?

I wanna know why.

- And that's a great question.

'Cause when we're looking at lot of plant foods, especially our fruits, vegetables, nuts, seeds, legumes, what we find out is they have high concentrations of what we, well first of all, they have the macro, what we call our macronutrients.

And that's our calories, such as proteins, fats, carbohydrates.

And then we have what called our micronutrients, which are vitamin and mineral compounds.

But then there's a whole classification of compounds that these foods have, which we sometimes call phytochemicals, or also we call them phytonutrients.

And this is a class where we're finding the anti-inflammation properties, the anti-carcinogenic properties, the anti-mutagenic properties, and the antioxidant properties.

So if we look at these foods, what we're finding out is they have medicinal properties in them.

And there's so many, I think there's about 500 identified now.

And there's thousands of them.

- [Julie] 500?

- Yep.

That we identified now and there's thousands of them.

- [Julie] Wow.

- So what we're finding out is we're just at the tip of the iceberg of what these foods have in them.

Just example of carotenoids, they're a type of phytonutrient.

And we know lutein helps with eye health, plus UV, or blue light.

And we know that, okay, increasing lutein in a diet will help with your overall eye, your vision, to make sure it stays optimal.

So what we're doing is we're finding out these nutrients.

Beta-carotene is another one, which is just a provitamin A.

But we find these as these phytochemicals or phytonutrients, which are in these foods, and this is why we need to make sure we're including them in the diet.

So it's not just about the calories, the fat, the protein, or even the vitamin C, which is all very important.

It's also about this whole class of compounds, which we call our phytonutrients.

- You were discussing those a little bit earlier, Gael.

What's happening in your system when you get enough of those nutrients?

- Well it's amazing how much is in a lot of the plant-based foods, it's incredible.

You've got antioxidants, okay?

Which is, as Walter was saying, it's like a classification of these phytochemicals.

They have their whole own job.

Vitamins A, like beta-carotene, C, E, and the mineral selenium.

These are very powerful.

And they fight what we call free radicals.

And you're thinking, what are free radicals?

Well, free radicals come from normal digestive processes.

Okay.

They can oxidize part of our important cell membranes.

They kind of go on like an attacking spree.

- Okay.

- You can also have free radicals from pollution, the environment, whatever things you're using.

Sometimes even on a daily basis, okay?

However, these foods contain these antioxidants, which can be so powerful.

Antioxidants, which can prevent that from happening.

So the antioxidants are just one category of these phytochemicals.

- So you walk into a grocery store, can you just pick any fruit and vegetable, and you're gonna be okay?

- Well, they all give their own great nutrition, but berries are getting a lot of attention.

They are finding a lot of phytochemicals in strawberries, blueberries, raspberries, blackberries.

All fruits are good for you.

I wouldn't say one is better than the other, but the berries especially, have a lot of nutritive qualities, anti-inflammatory, that you may wanna think about incorporating into your diet, even slowly.

- And making sure that everybody has access to this type of food, as I know, something that you are working on.

Tell me about the fresh food pharmacy.

- Sure.

So Geisinger has a Food Is Medicine program called the Fresh Food Pharmacy.

And the program is for patients with uncontrolled type two diabetes that are also food insecure.

So what our program does, it provides the patient, as well as all their family members.

So if they're a family of four, we provide enough healthy meals for the patient and the family, enough for 10 meals per week.

And the concept is that we want the patient to eat healthy, to better control their diabetes.

But we're also seeing that the family is making a lifestyle change as well.

So keep in mind that type two diabetes has a strong genetic link.

So we hope to also educate the children of these parents and even sometimes grandchildren, to eat healthier, to prevent chronic disease later in life.

So some of the things we provide at Fresh Food Pharmacy are a lot of the foods that we've been talking about.

So we do whole grains, we do lean proteins, low-fat dairy, and of course fruit, variety of fruits and vegetables.

And that's really, we go by the standards of the American Diabetes Association and they're really the things that help with not only diabetes, but really any kind of healthy eating or any kind of chronic disease.

- You see people be successful in this?

- Oh yeah, our program's very successful.

Overall, somebody that comes into our program.

So the measurement of how well you're controlled with your diabetes is what's called a hemoglobin A1C level.

It's a blood draw.

So somebody would be considered well-controlled if that level was at a seven.

We've had patients come into our program at 15, 16, is very high and we've gotten them to seven.

And maybe other patients made smaller changes, but overall, on average, we move patients at least two points, which is preventing them from having complications later in life from diabetes.

So it's an awesome program.

- Hopefully teaching future generations not to get there.

- Yeah, exactly.

Exactly.

- And Walter, what about what's going on at the Wright Center?

I know you have a different approach.

- Yeah, actually, it's similar in some regards, 'cause we do a lifestyle medicine, we call it.

And it's really looking at making those changes in lifestyle habits that people do, in order to not only eat healthier, that's why we go with really more of a plant-based or a plant-predominant diet.

Because of not only the nutrition factors in there, but also too, is we want to reduce our reliance on animal products per se.

Just because it could be the cholesterol, could be the saturated fat.

And also too, is we wanna make sure it's not replacing or taking the place of some of these fruits and vegetables, legumes that we could also get proteins from.

So with the lifestyle medicine program, we also look at not only nutrition and a person's nutrition plan.

We look at things such as trust management.

Because we know as people have stress, increased cortisol levels, and then also the spiral will happen.

So that's a big thing we want to address with them.

We look at things such as what we call restorative sleep.

How well is somebody sleeping?

Because we know if they're not sleeping well, well that's gonna lead to more bodily stress.

And then that stress could sometimes affect their appetite, what they're going to eat.

So it sort of goes hand-in-hand.

So that's just the three there.

But then we also look at, we wanna make sure people are avoiding what we call unhealthy substances.

A lot of times we usually think of tobacco, but that, in my book, it could be fast food.

If somebody's eating fast food five days a week, then that's a very unhealthy that we want people to stop, stop eating.

And then we also look at a person's social connections.

Especially from a positive, we want people to have a positive engagement with other people, especially when we have people who are isolated.

And Gael probably knows this, working with the geriatric community, that they usually have, their health outcomes are not as good if they don't have a vibrant social network around them.

- [Julie] Absolutely.

- And also to keep them busy.

So when we look at it, we look at all those pillars, because we wanna find out how to treat the whole person.

So that's sort of our integrative medicine model, even though they're there for lifestyle changes, nutrition's a very important part of it.

But we also have to look at those other factors to find out, oh, are they impeding them to get well?

So that's very big on our part to look at that.

And we also have what we call community health workers.

They'll help if somebody doesn't have the resources.

So they'll look out to the community to find out what kind of resources are out there for people.

Because we see patients from all different walks of life and their goals can be completely different.

And we really look at what's the best goal working with them.

And it can be something, a small change to lead to bigger change.

But we have to go at their pace.

So one of the things is, as Karen was saying, you might have somebody coming in at hemoglobin of 15, you wanna get them done down to seven, but if you can get them down to 11, that's a great improvement.

- Yes.

- So that's what we look at.

Where can we make some of those improvements?

And then also, we'll bring in other specialties that we have, especially behavior health is a big component that we use a lot of.

Chronic care management, where they can monitor a patient every week or every two weeks.

So we do have a lot of other services.

But the whole goal is to treat the whole person and to treat them under one umbrella.

- Do you find if you improve one of those areas, then a lot of the others automatically improve?

Maybe not automatically.

That's wrong way to say it, but.

- Yes, because you know what?

They can build on that success.

And they also have trust in you because they realize you're there to help them.

Because a lot of times people come to the doctor, right, when they're sick.

And they're really just managing that current condition, where we have to look at, "Okay, what else do they need?"

Because the whole goal is to get them healthier.

And a lot of times, when they have that little success, it snowballs.

And then they'll want to be doing a lot of other things to improve on it.

And as long as you work with a reasonable goal and you help them establish goals.

So we don't give them a goal.

We help them establish the goal to find out what's appropriate.

We don't want them to be too aggressive, right?

But we want to make sure that they find something that they can do that'll actually have some type of improvement.

Sometimes with obesity, a lot of times I tell 'em, "Don't weigh yourself."

Because you know what?

They might look at success as what that scale number has.

- Right.

- Right?

And I say, if you change your eating patterns, if you change your eating habits, if you're eating a lot healthier now than you did.

If you're walking, and that scale didn't move a dime, well, look at the success you've had.

- [Julie] Right.

- So that's one of the keys, is you have to look at all those other parameters as being successful.

- Thank you, all of you, so much.

I can't believe that time has flown.

I really appreciate your comments.

It's been a great conversation.

That's gonna do it for this episode of "Call the Doctor."

If by chance there's something you missed, you wanna listen to again, you can find the whole show at our website, WVIA.org.

For all of us at WVIA, we'll see you next time.

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