Dr Rupy: So, I'm often asked by colleagues and patients for a full breakdown of what I say in clinic with patients with either type two diabetes or those who are at high risk of this condition to help them better manage it before medications, but it does take time and no GP in the NHS or elsewhere has over an hour to explain this in enough detail such that people can understand how to take action themselves. This is sort of the genesis of the Doctor's Kitchen in and of itself because I remember this is the reason why I started doing recipes online and putting out content in the first place so I could refer people to a trusted source of information back in 2014, 2013 when I was working as a GP in the NHS for the first time. The recommendations for medical professionals is for them to explore diet and lifestyle options before turning to pharmaceuticals for the management of type two diabetes and many other conditions as well. But with less than 10 minutes per appointment, this is an absolute impossible task. We are setting ourselves up for failure. And so this is the basis of today's podcast and we're going to be doing some more of these kind of podcasts with different conditions as well, ranging from gastritis that we've already done, PMS, menopause that we've already done as well, but other conditions that I think would warrant a lot more attention in the diet and lifestyle realm. If I had an hour with you or a loved one, this is how I would explain what type two diabetes is, why sugar control is so important and what things you can do to prevent or better manage the condition and even potentially put it in remission. This is before we get to the pharmaceutical stage, but also something that you could do alongside pharmaceuticals as well. I'm not going to talk about the different types of pharmaceuticals which are very effective that we have at our disposal. Your own physician can talk to you about that. And I would also hasten to add that you should always personalise this and always check with your own personal physician before you make any significant changes to your diet and lifestyle, particularly if you're already on medications. But today, I'm going to be focusing on what I would do generically in front of someone who is at risk of this condition that is going to be affecting so many more of us in the future if we don't take action now. I'd love to know your comments and feedback on today's episode. So if you have any suggestions, please leave a comment on YouTube where I'll be looking at some of these comments in a bit more detail because unfortunately via the podcast, I don't actually have direct feedback with you guys unless you are a subscriber to the Doctor's Kitchen newsletters where we have a feedback option right at the bottom of every single email that we put out and we do go through every comment as well and try to get back to as many as we can as well. Please also share this with anyone who you feel could benefit from this information. And if after today's episode, you feel like new recipes, you want to start experimenting with things that I'm talking about, check out the Doctor's Kitchen app. You can either download it directly from the App Store or Google Play or just go to the doctorskitchen.com and just hit recipes. We've got a huge selection of recipes. We're adding new ones every single month, but the best thing and the new thing is our search function. So now when you hit search, you'll be able to filter according to cuisines, how much time you have in the kitchen, the number of ingredients you want to use, or even type in some of the ingredients that you've got in your fridge, in your cupboards, and we will suggest recipes using those ingredients for you. It's one of our favourite functions and we are revamping it and getting it better and better every single month and users appear to absolutely love it. It is game changing for a lot of people. For now, this is my conversation with myself about how to improve sugar control and potentially put type two diabetes into remission with diet, exercise and lifestyle medicine.
Dr Rupy: You might think that if you don't have type two diabetes, you don't need to worry about sugar control, but everyone needs to learn about the importance of sugar if you want to look after your brain, your heart and your metabolic health. Now, over 500 million people in the world suffer with type two diabetes. That's approximately 10% of the global population, but it's growing and millions more without even realising it are at high risk. We also used to think that type two diabetes was a one way street. You get it, it gets worse over time, you take medications, but now we know it can be improved and even put into remission through key lifestyle changes. So as a doctor, I've seen probably hundreds, thousands of people with type two diabetes. And if you know someone who is dealing with pre-diabetes or yourself, I'm going to give you an insight into exactly what I would say to a patient in clinic if I had 60 minutes to talk about all the diet and lifestyle measures that we have at our disposal. This pod is going to be perfect for sharing with loved ones, family members, but remember, this is not personalised medical advice. I always advise you to speak with your own physician, especially if you're already on medications. But here's the way I approach managing blood sugar levels in order to prevent serious complications and possibly put type two diabetes into remission.
Dr Rupy: So what even is type two diabetes? Well, essentially it's where your body cannot regulate sugar properly anymore. Well, why do we even have sugar in the body? I thought sugar was just something you put in cakes and into your tea. Well, sugar or glucose, and I'll be referring to sugar and glucose throughout this podcast interchangeably. They're not exactly the same thing, but for the purposes of this podcast, they will mean the same thing, is the preferred fuel source of every cell in your body, from brain cells to muscle cells. Your body needs a fuel source and it prefers to use sugar. It converts this into energy in the form of ATP, which powers cells around your body. It powers all these different biological processes around your body. But too much of this fuel can be a bad thing. Now, think of it in a very simplistic way, like a house plant. Now, I'm terrible at keeping my house plants alive. I either don't water them enough, so they wilt and they die, or I give them too much water and that again leads them to wither and die as well. So you have to get the fuel source, in this case for my house plants, at the right level and it's the same thing for your body as well. Now, this is a very simplistic explanation, obviously, there's a lot more going on, but the toxicity, and I use that word intentionally here, the toxicity of having too much sugar in your body cannot be overstated. The sugar in your blood is tightly regulated. To put some numbers on this, I just want you to consider the following. So in the total volume of blood pumping around my body right now, at the moment, on average over 24 hours, I have around one teaspoon of sugar in my bloodstream, just one teaspoon of sugar. If I was type two diabetic, the average amount of sugar in my total volume of blood around the 24 hours, let's say, would be around two teaspoons. So just that perturbation, that very slight perturbation of one teaspoon extra average of blood of sugar in my bloodstream is enough to put me into that diabetic range. We have evolved these very strict, tight mechanisms to regulate sugar in our bloodstream because prolonged exposure to this crucial fuel, it is crucial, is problematic. If sugar hangs around in your bloodstream at high levels for too long, it can cause inflammation, it can lead the blood to become sticky, and it can predispose to narrowing of blood vessels that could cause strokes and heart attacks. It can lead to the creation of something called advanced glycaemic end products. This is essentially rusting that creates this inflammatory environment. I just want to state that this is over time, this is an average over years and years, if you were to continue to have these high levels of blood sugar on average over time, this is where you get this inflammatory picture. It is not a mild perturbation. So if I was to have a piece of cake right now, my blood sugar would shoot up and I have adapted mechanisms just like everyone who is otherwise metabolically healthy to make sure that that sugar goes into cells and it clears away from my bloodstream. But prolonged insults of high sugar, this is where it can lead to the diagnosis of something called type two diabetes. That is essentially what is going on. So after a meal, I've just mentioned that I've had a piece of cake here, but let's say after a meal, in an ideal scenario, you want your blood sugar to rise, which by the way is completely normal. You should have a blood sugar rise after eating, but you want that rise to be shallow and return to normal quickly. What we don't want is a large rise and a slow return to normal. And the blood tests we do to look at this, typically an oral glucose tolerance test, would demonstrate this in someone who has got type two diabetes, whose mechanisms for clearing sugar from the bloodstream is impaired. This is essentially how we diagnose type two diabetes. The aim of the game is to essentially ensure that we don't have prolonged exposure to this crucial fuel source in our bloodstream because unfortunately, if we do get prolonged exposure to sugar, that's where you have those downstream effects that I mentioned earlier, the inflammation, the high risk of cardiovascular disease and all the other complications that we know about with regards to type two diabetes. Why does it happen in the first place? Well, the reasons why type two diabetes occurs is still actually being researched, but we know it's a mix of several factors, including genes. So if you have family members with type two diabetes, your risk is higher, but genes only explain a small part of the risk. Lifestyle and environmental factors may actually trigger or influence your your genetic predisposition. So if I have a genetic predisposition to type two diabetes, which I actually do because I come from an Indian background, then the lifestyle that I enjoy, the lifestyle that I lead can actually trigger those genetic predispositions. So I might have the genes that put me at higher risk, but ultimately it is my lifestyle that will pull the trigger on that genetic predisposition. Ageing. So as we get older, our ability to regulate blood sugar often declines, especially if we gain weight, we lose muscle mass or become less active. As we age, unfortunately, we have a higher likelihood of a number of different conditions, one of which is type two diabetes. It's probably most closely related to the fact that we are losing muscle mass, which is a very important store of sugar, as we're going to talk about a little bit later. Another factor is excess body weight. So fat in cells, these lead to inflammation which impacts the signalling of certain hormones that we'll get to a little bit later, and that can put you at higher risk of type two diabetes. And the main stay of what we're going to be talking about today is lifestyle. Lack of physical activity, not using your muscles enough and not having a healthy diet. These are things that are going to put you at higher risk of type two diabetes. And we're going to go into exactly what types of products in your diet could be putting you at higher risk and what types of foods that you should be introducing into your diet to ensure that you're protected as well. And the other thing that perhaps doesn't get as much attention is the environment. So this includes everything from where we live and work to our social relationships and the contamination of food available to us. This all play an important part. And I use that word contamination quite intentionally as well. This broader picture is known as the exposome and that includes all non-genetic factors driving health and disease, but also the environment and pollution too. Now, this all sounds fine and well, but I often get this question, Dr Rupy, is there actually any evidence that it's possible to prevent type two diabetes if you have the genes, for example, let alone put it into remission? Well, my answer is always this, absolutely. And yes, there is a lot of evidence. So from the perspective of prevention, published in nutrients in 2019, there was a systematic review and meta-analysis of prevention trials that show lifestyle change can lower the risk of type two diabetes by up to 47%. Additionally, in cohort studies, those with the healthiest lifestyle, so those who are able to maintain a healthy body weight, follow a healthy diet, exercise for at least 30 minutes a day, avoiding all the factors that we everyone should know about, smoking and alcohol drinking, they had a 75% lower risk of incidence of type two diabetes. So there is plenty of evidence out there from multiple different trials about how we can prevent type two diabetes. This should not be affecting 10% of the global population. In terms of remission, well, there's results from the original diabetes remission clinical trial, the direct trial, and they found that almost half, so 46% of participants with type two diabetes who received this weight management program essentially, achieved remission to a non-diabetic state and they were off anti-diabetic drugs for at least two months without glucose lowering medication. This is a huge, huge number. So it's absolutely possible to put this condition into remission and keep it in remission if you can stick with a healthy lifestyle and this this weight management program, the direct trial, but there are lots of other ways in which you can put it into remission as well. And there's also evidence that just doing some of these things that I'm going to be talking about today, even if you don't put your condition to remission, it can lower the risk of complications of type two diabetes. And there are tons of different complications of type two diabetes, including increased infection risk, potential amputation, dementia, cardiovascular disease, all these different complications of type two diabetes can be mitigated against. You can lower the risk of them. Cohort studies show that among those with this condition, a healthier lifestyle lowers the risk of these different complications, including cancer, death of all causes by up to 56%. So even if your numbers don't change, even if we don't put this into remission, you can still lead a healthier lifestyle by adopting some of these lifestyle changes. Guidelines around healthy eating and exercise and all these other things can feel pretty vague. And this is one of my bug bears around this whole idea around lifestyle medicine. So today I'm going to walk you through these lifestyle changes that I think have the biggest impact on type two diabetes based on the current evidence. What I'm going to be giving you today is almost like a buffet of prevention and management. Obviously, I want you to have as much as you can from this all you can eat buffet, and I want you to take as much value from what I'm serving up here, but ultimately it's up to you and you need to choose what you can build up on slowly so that all of these things can eventually become second nature to you. So try not to jump in and grab everything on this buffet I'm serving up. Try and choose one, ensure that that's habituated and then go back to the buffet. The buffet is always open and you can you can add a few other things to your plate here. So the first thing I'm going to talk to you about today is physical activity. You might think that's a bit weird given that this is the Doctor's Kitchen and I have obviously a bias towards food and nutrition and how we can use that as a powerful lever for lots of different conditions. But physical activity is probably going to have the biggest impact on type two diabetes. How does exercise, physical activity, these are terms I'm going to be using interchangeably, improve type two diabetes? Well, when we exercise, many downstream effects occur in the body, even if you don't see immediate changes in weight or fitness levels. It leads to better glucose uptake. So your muscles start pulling sugar or glucose from your blood by moving key transporters. This is actually called a glute four transporter. You don't need to know the names of this, but they bring it to the surface of your cells, which lets them pull in the sugar from your bloodstream without the help of other hormones that drive sugar into the bloodstream. I haven't talked about insulin just yet. I'll talk about that in a second, which is a hormone that's directly responsible for pulling sugar into cells. But even without the use and the help of hormones, exercise encourages your cells to take in sugar from your bloodstream. It's almost like a straw being moved to the surface of a cell and it sucks in the sugar, sucks in the glucose in from the bloodstream to the cell where it can be utilized for energy or storage. And this boost in sugar uptake, glucose uptake, it doesn't last forever, but it will last anywhere between three and six hours after the bout of exercise, but you also get longer term benefits as well. So just think about that. Without the use of any hormones, without the use of insulin, which a lot of people understand the use of in in late stage type two diabetes where you become reliant on taking insulin from externally and inject it into yourself, without the use of insulin, exercise can encourage sugar to be taken out of the bloodstream, which is where we measure blood sugar, into the cells where it can be utilized for energy. This is really, really important. I don't want you to forget the the benefits of exercise. The other thing is that exercise improves your sensitivity to the hormone insulin, which is responsible for pulling sugar from the bloodstream and driving it into cells. Your cells become more sensitive to this hormone once you've done exercise. What is insulin? Okay, so insulin is a hormone made by the pancreas that's found in the central right side of your abdomen that helps your body use or store the sugar from the food that you eat. So when you eat and your blood sugar rises, insulin is released from the pancreas and it acts like a key, sort of unlocking the door to different cells in the body so they can absorb the sugar from your bloodstream and use it for energy. The key cells for sugar utilization are fat cells, muscle cells and your liver cells as well. If there's too much sugar, insulin can encourage that liver to even store it in the form of glycogen that you use it for later. It sort of packs it away like a suitcase for a rainy day. When we exercise, our cells become more sensitive, i.e. more responsive to this hormone insulin. So essentially what happens is we need less insulin to have the same desired effect of moving sugar out of the bloodstream. And this insulin sensitizing effect, as it's referred to in the literature, can stick around for up to 48 hours, depending on how intense the workout was and what you eat and how well you slept and other factors like that. But this this phenomena of improving your responsiveness to the hormone insulin is brilliant. It is this is one of the reasons why I feel exercise is sort of the under talked about, it's underutilized as a tool in this fight against type two diabetes and better management of type two diabetes as well. The other thing about insulin is, let's say you didn't do anything, you didn't do any exercise whatsoever and you just relied on your pancreas to produce insulin and drive that into your cells. What happens is your cells become used to insulin just rocking up at the door and letting in sugar in. And so what happens is you you start to ignore insulin as a hormone. You're like, this insulin guy just keeps on turning up. We'll just sort of ignore him for a while. And so more and more insulin needs to show up at the door to have the same desired effect. This is referred to as insulin resistance. So you need to have more insulin released from the pancreas to have the same desired effect. And you might not think that's a bad thing, but more insulin actually has other unintended effects. It's known as an anabolic hormone. It can actually cause weight gain as well. And so you have this derangement of all these other metabolic markers of health. So you don't want too much insulin, you want the right amount of insulin being released. So if you can get away with having the minimum dose of insulin by exercise and all these other things that I'm going to talk about later, that's going to put you in better in a better stead. It's going to put you in a better position metabolically as well. The other, so we've talked about how it drives sugar into the cells. We've talked about how it improves your sensitivity to insulin. The other thing that exercise does is lower inflammation. Exercise lowers pro-inflammatory molecules and increases anti-inflammatory molecules, also called exerkines. These are sort of like signalling molecules that help improve glucose control. And the aim of the game is to try and reduce inflammation. I've talked about inflammation on other podcasts before. It is not necessarily, quote unquote, a bad thing. Insulin is a very important process that our body relies on to fight infections, to signal, etc. But the imbalance of inflammation is something that is underpinning a lot of conditions of the modern era. Hypertension, dementia, type two diabetes, cardiovascular disease, they all have insulin at the foundational level that drives that condition. So if there's anything that we can do to readdress that balance through food and exercise, this is something we should be leaning into. And exercise is a powerful inflammation lowering activity. It is a powerful lever to pull that reduces inflammation that can improve your body's ability to tolerate sugar. The other thing that exercise does, kind of goes without explaining is it lowers the fat stored around vital organs. So it can increase the amount of fat fats that you burn off as energy. And the fat that you store around vital organs, which is sort of like the last place that you would want to store fat. So when I say vital organs, I'm talking about in your liver, around your liver, around the pancreas, you don't want fat there. This is the metabolically active fat. This is the worst type of fat you want. Exercise, even independent of weight change, can lower the fat stored around those organs. And the fat stored around these organs can also impair insulin signalling that can lead to insulin resistance. So if you can exercise, you'll reduce the fat that's coating the these these vital organs, it will improve your sugar regulation abilities. There are many more beneficial effects of exercise, like improved pancreatic cell function that actually releases insulin, vascular function, muscle strength, bone health, memory, stress, anxiety. We're not going to talk about that today, but lots of other impacts of exercise. Just remember those things I talked to you about with regards to sugar regulation specifically. This is why you should be a big fan of exercise. Human evidence, Rupy, what what's the human evidence that we have around exercise and improving sugar control? Gosh, there's just so much. These effects are seen in multiple clinical trials. Improved blood glucose control, including lowering an average marker we have of your sugar levels over the preceding three months. It's something called hemoglobin A1C. It's something that's used diagnostically as well in as well as management. So to to monitor how well your sugar control has been over the preceding time period. And exercise can lower your average glucose levels over the preceding three months. It can improve insulin resistance, as I've explained. It can improve waist circumference, it can lower your blood pressure, it can lower your cholesterol levels. It is uniquely, uniquely beneficial for us. But here's where we go into the detail because it's very easy for me to just say exercise is great, everyone should exercise. Specifically, what should we be doing for type two diabetes? Well, each form of exercise has advantages to your muscle health, your mitochondrial health. So mitochondria, the sort of powerhouses of every cell, they do a lot more than just energy production, but this is how I'm going to explain it to you today. So the best approach is to mix up your exercise routine because all different types of exercise have benefits to all these different areas. And broadly, we can categorize them into aerobic or cardio, resistance training or weight training, and high intensity interval training. There's also flexibility and balance exercises, but these are the three buckets that I think probably have the most bang for your buck. High intensity exercise, resistance or weight training and aerobic or cardio training. So we'll start with aerobic because I think it's sort of fallen out of fashion and I think it's very, very important for for folks with especially with established type two diabetes. Aerobic exercise includes things like walking, jogging, cycling, swimming, aquatic activities, dancing, all these different things are aerobic or cardiovascular activity. I'll get to the crux of what you need to do. You need to aim for 2.5 to 5 hours of moderate cardiovascular cardio aerobic activity each week. Spread this out over several days. I'll talk to you about why that's important, but two and a half to five hours every week is the sweet spot. If you can do more, great. As long as you're not overtraining, that's fine. But you want to be looking at a minimum of that across the week. This is something you really should aim for. A lot of most of us do not get to this level of activity without really putting some some effort into organizing your your time over a seven day period. The way I would split this up is having 30 minutes every single day of some form of aerobic exercise. It could be brisk walking, cycling, could be jogging, could be a spin class, could be rowing, whatever it is, make sure you're doing it 30 minutes every single day, at least five days. The way I advise people to to look at this is 30 minutes every single day of a brisk walk, cycling, jogging, rowing, whatever it is that gets your heart rate up and putting a little bit of sweat on, you want to be doing that every single day, at least five days of 30 minutes. You don't want two consecutive days without exercise because you have this insulin sensitizing effect for 48 hours afterwards. So you want to make sure that you're pulsing it regularly throughout the week. This is essentially a dose of medicine that you want to take regularly. If you look at exercise through the lens of it being like a pill, like something that you want to make sure you're getting a regular dose of, this is why you want to have it on most days and make sure that you do not go two consecutive days without taking your exercise drug, without taking your exercise pill. I explained to you a little bit earlier through the mechanisms as to why exercise has this impact on blood sugar regulation because it sensitizes your cells to insulin better. So instead of being a weekend warrior and doing all your exercise on Saturday and Sunday, like some people do, just to fit around their schedule, so I understand why that becomes intuitive to think like that. But now you see exercise through the lens of taking a regular pill, you want to make sure you're doing it throughout the week. Ideally, if you can do it Monday to Sunday, as long as you're not overexerting yourself, that is wonderful. But at least five days a week and ensuring that you're not going two consecutive days without taking your exercise medication. If someone is completely untrained, so I want to be sensitive to the fact that not everyone is going to be used to going to the gym or doing regular exercise at home. You definitely do not need to go to the gym. I want to should say that at the start actually, you do not need to go to the gym to exercise. But if someone is completely untrained, walking is usually the first thing I recommend, just doing a brisk walk or as far as you can tolerate every single day and getting yourself into the mindset of someone who exercises daily. So that's aerobic or cardiovascular training. There's lots of benefits to your mitochondrial health and your muscle health. It stresses your muscles in a different way to the other thing that I recommend, which is resistance or weight training. So this is using free weights or machines, but it also includes things like elastic bands or your own body weight and even, you know, everyday items that you have at home, a backpack filled with books, bags of rice, water bottles. These are all things that I've actually used personally, either at home or when I'm traveling to ensure that I'm still doing some resistance training. Now, what resistance training does is it improves muscle strength, it improves bone density, and it improves insulin sensitivity as well. And you want to be aiming for a dose of two to three days a week, doing 10 to 15 repetitions of each exercise for one to three sets. Now, these exercises should be focusing on your major muscle groups. So things like squats and lunges for your lower legs, chair dips for your back, and standing calf raises as well for the the back of the legs, your your calves are major muscle sets as well. These are the big muscle groups. And the reason why I'm focusing on the big muscle groups is because your muscles are big sinks for sugar. You store sugar around your body in your liver, in your fat cells, but also in your muscle cells as well. So it stands to reason that the healthier your muscles and the more muscle bulk that you can take, you don't need to be a bodybuilder, you don't need to purposely put on muscle, but the more muscle material you have in your body, the better your metabolic health, the more area, the more storage you have essentially, if you want to think about it like that, that you have to keep sugar onto your body without it being in your bloodstream. The aim of the game is to keep the sugar out of the bloodstream and ensure that it's appropriately packaged in different areas of your body. And your muscle groups, the major muscle groups are a big area of storage for your sugar as well. So ensure that you're doing resistance training. I just want to repeat this, two to three days every single week. Do a collection of different muscle groups, but do not forget your major muscle groups, your legs and your back. The third exercise type is hit training, high intensity interval training. This has been popularized by a number of PTs and physios online, including Joe Wicks, famously in the UK. I love this type of training because not only does it have these unique metabolic benefits, but it also is really time efficient for folks who are time poor, someone like myself, for example. And it involves doing short bursts of intense exercise, so anywhere between 10 to 4 minutes. So there is a Norwegian, I believe, training regime where it's four minutes on, four minutes off, which is really, really intense. And then at the other end of the spectrum, we've got Tabata, which is 10 to 20 seconds on and then 10 seconds off. But it's these alternating bursts of intense exercise up to 85, 90% of your maximum output with brief periods of rest and then repeating as well. And doing that multiple times. Like I said, it's time efficient. It really does improve your cardio respiratory fitness, but it also stresses your muscles in a way that is uniquely beneficial for their metabolic capacity. So it improves your sugar regulation capacity. A one way in which you can do this at home, particularly if you're untrained, is climbing stairs vigorously for 45 seconds and then taking a two minute break and then going back in again. You can also do things like jumps or burpees for a minute. There are lots of ways in which you can alternate the exercise intensity and then the resting period as well. This is a training type of training that I feel, whilst it's popular and whilst it is time efficient, you want to be quite careful of, particularly if you are untrained. So if you're untrained, you start doing these exercises straight off the bat, you're probably going to injure yourself because your muscles need to be resilient and supple to ensure that you're doing this sort of training and not and not putting yourself at risk. And that's the the main thing you want to be careful of with exercise. You want to stay in the game for as long as possible and you want to minimize risk that can take you out of doing exercise. That's probably the most dangerous thing, not doing any exercise whatsoever. This kind of high intensity interval training is something that I would recommend only doing once or twice a week. This isn't something that I would suggest doing five or six times a week because what happens is it's quite a big stress to your muscles and you want to ensure that you're not overexerting your muscles in that way. So I would mix this in with resistance training and cardiovascular training, but this would only be once or maximum twice a week that I would suggest doing this for. Um, again, this could be a way of just getting people who are time poor to get into exercise and it's part of an identity piece that I'll talk about in a second, but certainly something that I would recommend not overdoing just for the for the risk of exercise as well, of injury as well. I mentioned flexibility and balance exercises. You might not think that yoga and stretching and chi gong, tai chi, these gentle movements, you know, that that are essentially a lot more around muscle suppleness would do anything for sugar. But there is actually evidence that tai chi, in particular, may lower blood glucose and HBA1C levels again. There are many videos online for chi gong and yoga, tai chi, and I think this is a very good entry point for folks who are untrained, who haven't done any exercise and they don't really know where to start. Tons of videos online just to get yourself moving and get yourself into the habit of doing something every single day. On the subject of habit, if you're sitting for more than eight hours a day, make sure you stand up and take three minute quick walks or three minute, do a couple of lunges or squats. No one's going to look at you funny, I promise, because you are looking after your metabolic health. You want to make sure that you are not sitting for long period. We are designed to constantly move around. We are designed to be bipedal on our feet, walking for long stretches of kilometres and miles. You have to keep your body moving. It is very unnatural for me, for example, to be sat here on a on a chair for for hours at a time. So make sure that you're leaning into these this idea of movement snacking, making sure that you're getting up every hours during waking hours, obviously. Okay, so the ideal program for exercise, I told you I wanted to keep this as actionable as possible, is to combine cardiovascular and strength training each week. It's to make sure that you're moving regularly and particularly after meals, and it's to really lean into this self-identity piece as well. So, if I was in front of someone and they were like, okay, I get it, you've convinced me, exercise is something I should be doing every single day to improve my blood sugar regulation, to either prevent type two diabetes or better manage my type two diabetes or pre-diabetes, what should I be doing? You want to combine your cardiovascular and strength training each week. This is where you do your 30 to 60 minutes of cardiovascular training every single day, brisk walking, swimming, tennis, crossfit, whatever it might be, rowing, cycling, that, make sure you've got that dialled in. Strength training, two to three times a day. So, and if you are unfamiliar with how to strength train, I would highly recommend you get a coach or a PT to give you at least the exercises and correct your form to make sure that you are challenging your muscles in the correct way because you want to minimize injury. Couple that with one training day which is just purely dedicated to high intensity interval training. So that's five to seven days of cardiovascular training plus two to three sessions of your resistance training plus one training day of hit training as well. This is your perfect buffet of exercise. You don't need to do everything at the same time. Even if you start off with just one walk a week, that is great because that is going to put you on the path to getting to those levels of exercise that you want to be doing to best maintain your blood sugar levels and improve the management or prevention of of type two diabetes. Moving off the meal. So instead of sitting after eating, take a short walk or do light activities around your home. It forces the sugar from your bloodstream into muscles where they can utilize it. It's like taking a dose of medicine after your meal to better encourage the blood the sugar from your bloodstream to go into cells where it can be utilized. It's very well known that this is a good way of stabilizing blood sugar levels and it's something that I do recommend for type two diabetic patients as well. And the third piece is that self-identity piece. Just like brushing your teeth, we all brush our teeth every single day. We don't, you know, have to tell everyone about it. We just do it because this is something that over time feels natural and an essential part of your day. You want to feel like that with exercise. It is essentially something that you just do. So whether that means that you start squatting whilst you're doing your teeth or you start doing lunges whilst you're making your coffee, you've got to lean into that self-identity piece as someone who exercises every single day. I do not start my day, I don't leave my house without doing some form of stretch or some form of exercise. This is just something that has become so natural to me. And if I didn't and I left my house without moving, I would feel the same way I would if I hadn't brushed my teeth. That is literally how I would feel. And you can do that as well. It just takes that that small smitch in your brain to identify as someone who exercises. That is exercise. This is the reason why I'm such a big fan of it. All right, let's talk about eating for better blood sugar. Diet has a big impact. Many studies show that eating more whole plant-based foods can improve glucose control, can improve your hemoglobin 1AC, can improve insulin sensitivity and help lower the use of medications. For example, a six-month study showed that a group-based nutrition and lifestyle intervention program focused on eating more unprocessed whole foods, lowered these markers of metabolic health, lowered their use of glucose lowering medication and at six months, 49% of the participants had reduced their medication or eliminated it completely, just after six months. In another study, a meta-analysis of nine randomized control trials published by Nature, involving over a thousand patients that used the Mediterranean diet, they found that it lowered their average levels of glucose significantly, improved their body weight and improved their cardiovascular risk factors compared to the control diet. Mediterranean diet, fantastic. In another study, a systematic review of 52 studies, they found that diets high in plant protein such as the low carbohydrate Mediterranean diet was effective in achieving diabetes remission, particularly when accompanied by weight loss as well. So this is absolutely possible. That that last study was from 2024. This is absolutely possible and everyone should be aware of this and I don't think many people are. There's a lot of diet tribes out there. There's lots of people saying you should do, you know, low carb, you should do vegan only, you should do keto. But I'm going to talk initially about what every diet tribe will absolutely agree with. The first thing is swapping out ultra-processed foods. And I'm a big believer that actually, if this is the only thing you did, this is the only thing that you could actually lean into without counting calories or macros or doing anything funky with your diet, this is probably going to give you the biggest bang for your buck. This is going to probably be the biggest lever that you can pull, just getting rid of ultra-processed foods. These are foods that have undergone heavy industrial processing that tend to have lots of added sugar to them, artificial colours, stabilizers and emulsifiers and other additives, looking back to our description of the exposome, other additives that could be obesogenic and promoting of type two diabetes as well. We know that those who have more processed foods in their diet are at higher risk of type two diabetes. There was a large cohort study that found that participants with a higher intake of various foods with additive with high amounts of additives and emulsifiers are more likely to be diagnosed with type two diabetes during follow-up. They're more likely to have more weight gain. Human trials show a robust causal relationship between ultra-processed diets and increased energy intake and weight gain. For example, there was actually one trial that found that people who consumed ultra-processed foods took in an extra 500 calories in a day compared to an unprocessed diet. Now this sort of is really easy for people to understand. If you've ever had crisps, Pringles, chips, whatever it might be, it is so easy to over consume them because they don't have fibre, they don't have any nutrients in, your body doesn't recognize anything that you've actually given to it. And so your body is always like, well, just feed me some more, feed me some more. This is really easy for people to understand for anyone that's had any junk food whatsoever. It is easy to over consume. And we know that if you over consume, you're going to be taking in more sugar, you're going to be taking in more energy, and your body's going to have to process that and unfortunately that can lead to a higher risk of type two diabetes. And that's without even talking about the other negative health effects of ultra-processed food, including higher risks of heart disease, mental health disorders, something that does not get enough air time, obesity and dying from any cause, according to a recent meta-analysis that was published in the BMJ in 2024. Hidden ultra-processed foods is something that we also need to be aware of as well. They make up a huge chunk of our daily intake, up to 42% in Australia and over 56% in the UK. And unfortunately, a lot of that is in healthy, quote unquote, healthy food as well. So lots of healthy foods that have high fibre on or pictures of farms and nuts and seeds on the front are actually classified as ultra-processed foods and we are consuming them in droves. And unfortunately, that is not going to be beneficial to us. In fact, it's going to be at the detriment of our sugar regulating capabilities. The top one though is processed meat in my opinion. So things like bacon, ham, sausages, dried meat, what these contain are high amounts of nitrate or nitrite additives. And what these can do is increase the production of these advanced glycation end products. I've mentioned them a couple of times now, I should really clarify what I mean. They're abbreviated to AGEs and they essentially create inflammation by banging into red blood cells, they cause stickiness, they cause excess inflammation, they can increase oxidative stress and potentially even lead to insulin resistance as well, in addition to putting you at higher risk of cardiovascular disease and the narrowing of arteries as well. Research from the University of Cambridge involving two million people found that eating just 50 grams of processed meat every single day, a couple of slices of ham for example, could raise the risk of type two diabetes by 15%. And that's just a couple of slices of ham and most people are not just having a couple of slices of ham, unfortunately, it's a lot more than that and it sneaks in to everything from bacon butties to rolls, to pasties, you know, most of what you see in train stations, unfortunately, is just a platter of processed meats. And it's estimated that reducing processed meats by just 30% could prevent 350,000 type two diabetes cases in the US alone, which is just phenomenal. So this is something that really, really should be addressed. So that's processed meats. That's one of the the main culprits of ultra-processed foods. Other elements are refined grains, so pastas, flowers, breads, unfortunately most breads in supermarkets are ultra-processed, polished grains like white rice for example, that are added to multiple different products. I'm not saying that you never have to you never have these again, but these are certainly not great from the perspective of sugar balance. Sugary drinks, this sort of goes without saying, but even fruit juice, sweetened lemonades, energy drinks, I would classify them in the same bucket as your ultra-processed drinks, your sugar sweet beverages. Now, whilst fruit juice definitely do contain things like polyphenols and other beneficial elements, the fact that they are refined to remove the fibre can have a detrimental impact when consumed in excess or daily to our ability to regulate sugar and puts us at higher risk of type two diabetes as well. If you're drinking a lot of sugar in liquid form, it is absolutely linked to type two diabetes, whether that's a fruit juice or a sugar sweet beverage. And unlike sugar containing solid foods, liquid sugars have an extra impact. They disrupt hunger and fullness cues and they make it harder to regulate your appetite, which makes it harder to regulate how much energy you consume in a 24 hour period as well. And other thing that I have a bug bear of, ready-made meals and meal deals and package snacks, instant soups, vegan meat or faux meat, breakfast cereals, cereal bars, these are all ultra-processed foods. If you were to just remove these, like I said at the start, I believe we could go a long way at improving people's blood sugar regulating capabilities and preventing things like type two diabetes. How do you spot them? Look at the ingredients list, beware of instant and ready-made options, and watch out for those health buzz words, labels like low fat, sugar-free, diet. These are things that should always raise a red flag. I'm not saying that every single product with these labels is ultra-processed, but it's a big indication or it's definitely an indicator to me that something's going on with that product and something's funny about it. And if I was to remove all of these from your diet, if I was to effectively be your spokesperson for what goes onto your plate and ensuring that everything was unprocessed and whole, that could simply be enough to improve your body's innate ability to protect against high sugar, to protect against metabolic disease, to protect you against type two diabetes. In the realm of diet, I often get asked this, which carbs are best for type two diabetes and should I be removing all carbs from my diet? Now, I think carbs are lumped in very closely to ultra-processed foods. When people think of carbs, they think of breads and pastas and refined grains, which are processed foods. So it goes into that category. It doesn't necessarily mean that the whole foods, the beans, the lentils, the root vegetables like parsnips and sweet and sweet potato, these are all still carbs, but these are not the ultra-processed carbs. And I believe that you should be eating these types of carbs because anything high fibre is great. So steer clear of the refined grains and the breads and the pastas and the flowers, but do lean into the other carbohydrate foods that are high in fibre because they are packaged in nature's perfect form. These are things that we should be consuming, not in excess and not at the expense of other macronutrients in our diet, but certainly something that we shouldn't be scared of even if you do have an established condition as well. There are some suggestions that we should be removing these completely because of the GI index and the GL indices. So what is the glycemic index, the GI and the glycemic load, which is the GL? Well, these are two measures that help people understand how foods that have carbohydrates in them or are largely carbohydrates affect blood sugar levels. The glycemic index or the GI is a ranking system that measures foods based on how quickly they raise your blood sugar. So foods are scored from zero to 100 with high GI foods being higher. So these are like white bread or pure sugar. These cause a rapid increase whilst the low GI foods, so anything between zero and 50, let's say, things like lentils, these cause a slower rise. So choosing more low GI foods can actually help maintain stable blood sugar and glycemic load takes into account both the GI index, but also the amount of carbs in a typical serving of food. So it provides a bit more of a complete picture of how a food's actual impact on blood sugar could affect you. And putting some examples onto this, like I said, high GI food would be something like white bread or refined cereals. A low GI food would be green vegetables, most fruits, raw carrots, kidney beans, chickpeas, lentils. Medium GI would be things like sweet corn, bananas, pineapples, raisins. And this is where I actually think that the measuring system kind of falls down because this is just one element of food that we're looking at and it doesn't give you an indication of the other health benefits of said food. I wouldn't want people to stay clear of sweet corn, for example, because of the fact that it is a medium GI food, when actually there are lots of benefits of sweet corn in the diet. And actually, when you combine these foods, it can have an impact on your overall sugar levels that you experience after consuming them. So the GI index doesn't really take into account the combination of foods that you put onto your plate as well, which is going to have an ultimate impact on your blood sugar levels. So just be careful about leaning too much into the GI index, but it is something I get asked about a lot, so I thought I'd bring it up here as well. So don't be scared of carbs, but if you are interested in going for lower GI carbs, then beans, legumes, those sorts of things are useful for for type two diabetics and people who are pre-diabetes and looking after their sugar levels as well. Why should you eat more plant foods for type two diabetes? Well, the current evidence points towards eating more whole plant foods, particularly high in plant protein. So reducing animal protein and actually eating more plant-based protein, you don't need to go completely vegan or vegetarian, but it has been shown to lower diabetes risk because of things like saturated fat. So high saturated fat diets can increase the risk of type two diabetes, potentially by interfering with insulin signalling. The other sort of Occam's razor approach, the simplistic explanation as to why plant proteins and high amounts of plants in the diet can improve type two diabetes is that it's far easier to overeat calories and energy if you have meat and animal-based products in your diet. If you're focusing more on plants, it's very hard to over consume in the in the form of calories. And calories, whilst I don't I'm not a big fan of calorie counting, overall, it will have an impact on your risk of type two diabetes. So if you over consume calories, it can put you at higher risk as well because you have to do something with the sugar that it's everything gets converted into sugar essentially. You have to do something and your body. So if you're over consuming energy, then it can lead to a higher risk of type two diabetes. So having more plant protein in the diet, reducing animal protein is a really easy hack of getting ensuring that you're in energy balance, but also reducing saturated fats that can increase the risks as well. They also tend to have a lot more fibre. Now, fibre, apart from improving digestion, will improve the population of gut microbes in your body. Your gut microbiota is essential to regulating sugar as well and glucose control, as well as body weight, as well as your cholesterol levels, as well as inflammation. Your microbes thrive on different types of fibre. So ensuring that you're getting a good collection of different fibres that you can get on a more unprocessed whole food plant focused diet, the better for your metabolic health. So always think about fibre and always think about your food through the lens of how you're feeding your microbes as well. With the increased amount of plants in your diet and hopefully you're getting variety as well, you're going to be getting more things like polyphenols into your diet. So polyphenols are these wonderful plant chemicals that we find in not just colourful foods, but also beige foods as well, like onions and mushrooms. These all have different types of plant chemicals in and they can increase your antioxidant defenses, they can lower inflammation, they can improve your gut microbiota, they can improve the signalling of your insulin levels. They can improve the sensitivity of your cells to insulin levels as well. So don't sleep on polyphenols and don't sleep on the benefits of having a plant predominant diet because of all these extra benefits that you get from those as well. There is also an argument for more unsaturated fats in your diet, including linoleic acid and oleic acid. These you can get from things like extra virgin olive oil, nuts and seeds. These are great for you. There's been a lot of fat shaming for the previous 30, 40 years and we haven't had as much of a nuanced conversation around the good quality fats that we should be having in our diet that could actually improve our sensitivity to the hormone insulin and improve our blood sugar regulation as well. When you replace when you replace saturated fats like butter for example or or the type of fats you find in meat products with unsaturated fats isocalorically, so the same amounts in terms of calories, you improve your body's ability to regulate sugar as well. So lean into unsaturated fats. I'm not saying that you never have butter or you never have some sort of meat. You can tolerate small amounts of these foods in your diet, but you want to be leaning more into the plant-based spectrum of foods. So in the spirit of making this as actionable as possible, these are the key foods that I would suggest for for folks with type two diabetes. They're minimally processed, they keep their whole intact form, they're packed with nutrients, fibre, antioxidants, and they are great for better blood sugar control. Legumes. So beans, lentils, peas, try and go for around two servings a day. They provide essential plant protein and fibre that help with blood sugar control and they keep you feeling full. Colourful vegetables. I tend to go for three portions per meal. So go for any seasonal vegetables, roast them, toss them into your meals. And three portions per meal, which is around 80 grams per ingredient per meal, is something that seems quite hard to get. But if you look at most of the Doctor's Kitchen recipes in cookbooks or even on our app, you will see that we are purposely ensuring that you have at least 80 grams of each key vegetable. So whether that's onion, the mushrooms we use, the certain beans and that kind of stuff, we're always getting three portions of vegetables in your meals as well, particularly greens as well, which is the next thing. Leafy greens. I try and go for at least a serving with every meal, but two servings a day, think spinach, Swiss chard, kale, collards, beet greens, bok choy, broccoli, obviously, these are all sources of things like potassium, vitamin K, fibre, carotenoids, lutein, these all have strong antioxidant and anti-inflammatory properties that could be beneficial for blood sugar control as well. And in terms of whole grains, this is probably the most controversial area from the diet tribe point of view. I'm a big fan of whole grains, but proper whole grains. So things like quinoa, or quinoa is a pseudo grain, barley, buckwheat, wild rice, as long as we are not over consuming these products, they belong in our pantries. Teff, amaranth, freekeh. If you want to go for higher protein grains, then things like teff, which is something that might be harder to source, but you can definitely find it online. It's the probably one of the highest protein grains that are out there. Amaranth and quinoa, which is a pseudo grain, these are the high protein whole grains that are also high fibre. And I am a fan of brown rice, as long as we're not over consuming them. The way I see these products is that I wouldn't recommend more than 75 gram serving per person of any of these whole grains cooked. Um, some people go for less than that, 50 grams. That means over a 24 hour period, you're not having more than 100 to 150 grams of any of these whole grain products, which is fine, as long as you're having enough of the other vegetables and other leafy greens as well. Seeds and nuts. So two to three tablespoons a day, sprinkle flax or pumpkin seeds, chia, as long as they're soaked on yogurts and salads, and nuts, a handful a day. These have been shown to improve type two diabetes as well and even prevent it. Perhaps from the unsaturated fatty acids and the fact that you are competing out the other saturated fats as well. Um, these are the the the foods that form the main stay of my diet personally as someone who's interested in blood sugar control and making sure that I, as someone who has a higher risk of insulin resistance, can prevent it for as long as possible and hopefully never never have to suffer with type two diabetes. The other element which is perhaps the one with less evidence are fermented foods. Yogurt, kefir, sauerkraut, the doses of these is sort of uncertain when we're looking at the academic literature, but certainly a handful or a couple three tablespoons of these products every single day would be something I would say as a minimum. They contain live microorganisms which help improve the diversity of your gut microbiota and lower inflammation. And in some trials on people with type two diabetes and pre-diabetes, eating fermented foods improved their glucose control, including fasting blood glucose. So that's where your sugar level is determined when you have not consumed any food whatsoever. And also measures of something of Homer IR, which is a measure of insulin resistance as well. And obviously get your herbs and spices in too because of the wealth of benefits that those have to not only flavour but also functional benefits to foods as well. As a daily minimum, you've probably heard me say this before, is get your BBGs in. That's your beans, berries, greens and seeds. Every single day, you want to be making sure that you're ticking off, have I had my beans? Have I had my berries, frozen or fresh? Have I had my greens? Have I had my seeds and nuts? Get those into your daily diet. It will be satiating, it will ensure that you're getting enough fibre, and it is it will ensure that you're getting your good dose of anti-inflammatory products that could help with blood sugar regulation too. This is your key playbook. This is your cheat sheet for the foods that you should be consuming to improve blood sugar control. And I get asked this question a lot as well, why low carb works? Now, the reason why low carb or any diet works is probably primarily number one, the first thing I said in this diet section, it removes ultra-processed foods. That's why most diets, whether you want to go on Dukan or 5-2 or vegan or vegetarian, the common denominator across all these diets is that they remove ultra-processed foods. The other reason why low carb as a strategy that has gained popularity for people with type two diabetes, um, works is because it's not it's easy to not over consume calories. It removes a lot of these processed foods. It's very simple to follow and it ensures that you're not going to be consuming too many calories. And it's it's a very simple straightforward method for folks, which is why I'm actually a fan if you want to go low carb, as long as you're not over consuming high saturated foods, which is often given the green light across some of these low carbing strategies. So bacon and fatty streaks of of meat, in the short term, you might not see the damaging effects of long-term consumption of these different products. Long-term consumption of high saturated fats would not be advisable in my opinion because of the inflammatory effects, because of the ultimate impact on insulin signalling as well. So you might actually be prolonging type two diabetes or just pushing it further into the future. Um, and obviously the impact on cardiovascular health as well. I cannot be over understated. I honestly think a plant predominant approach is better as long as you're not under consuming protein, but and it doesn't necessarily need to be vegan or vegetarian, but it just needs to be inclusive of animal products, but in appropriate doses. So a judicial amount of animal-based proteins, not something that is a daily staple and certainly not high saturated fat versions of those as well. Um, I'd be remiss if I didn't talk about not only what to eat, but when to eat. And eating an earlier dinner as a strategy is something that I advise everyone to do, actually. There is some evidence in patients with metabolic syndrome that intermittent fasting can improve body weight, glucose metabolism, blood pressure, insulin sensitivity, cholesterol levels. It seems like every month there is a new paper bestowing the virtues of some form of fasting. Uh, but which form of fasting is best? Well, I think fasting itself is a very vague term and the common fasting methods that you will see out there sort of bundle this all together. There's time restricted eating, which is where I'm going to put most of my focus in. There is twice per week fasting, so something like a 5-2 diet, which is where you under consume calories drastically for two days and then you eat within a normal calorie balance for five days. And then you also have alternate fasting or water fasting, which is where you completely remove all food and you just have water for a number of days, whether that's 24 hours, 72 hours and beyond as well. I think time restricted eating, which is not changing the amount of energy that you consume, but just when you consume that energy, uh, is probably the best, most pragmatic strategy for for people. And it involves only eating within the set frame each day, like eight hours, and fasting for the remaining number of hours in which case that would be 16 hours. And that has been shown to improve blood sugar levels, insulin resistance, independent of any change in any calorie consumption and in people with type two diabetes as well. Um, there's also within this strategy that we'll talk about in a second, there's the early versus late eating window. So a cross-sectional and experimental studies have shown the benefits of consuming meals earlier in the day rather than in the evening for glucose levels. And the reason why is because your body is more attuned and better ready to absorb calories in the form of food earlier in the day versus later in the day. And so this is a sort of a win or a a green light for an earlier dinner. There's lots of potential mechanisms for how fasting works. Everything from autophagy to giving your gut a rest, to increasing nutrient sensing. There's lots of mechanisms that have been proposed, but the elephant in the room is that it just helps you consume less calories. And consuming less calories has been shown to prevent and even reverse diabetes independent of diet quality as well. And I obviously I'm not a fan of just reducing calories, like I've mentioned earlier, but it is the elephant in the room and that's basically how fasting would work. So here's what I would do. I would adopt a time restricted eating method. So it's where you start eating, let's say at 8:00 a.m. or whenever is most appropriate for you to have your breakfast. You would keep that eating window open for 8, 10 or 12 hours, depending on where you want to start. And I would close that eating window early, so at least two to three hours before bedtime. So if your normal bedtime is, let's say, 10:00 p.m., you want to make sure you're closing that eating window by 7:00 p.m. This is essentially a time restricted eating window. There was lots of debate about how long a window should be to have the maximum benefits. And the honest answer is no one really knows because there is so much variation in different individuals and different people and really what you want to know is that this is applicable in the real world to you. So if you can start your eating window at 8:00 a.m. and close it a couple of hours before bed, you're probably going to be getting at least a 10 or a 12 hour eating window. And that is good enough because most people over 50% of people eat across a 12 hour plus period. They're eating for most of the day, 16 hours plus per day because we tend to just eat out of boredom. And when we do eat out of boredom, we tend to crave and over consume the high calorific snacky like foods as well. Um, this is where I think uh, time restricted eating can actually have a a positive impact as well. Are there any risks? Well, fasting in this method is generally safe. You might feel hungry or irritable at first in the hours where you are restricting yourself from eating. Those symptoms usually go away after a couple of weeks and your body just gets used to it. But it's really important that if you're on medication for type two diabetes, you do speak to your healthcare provider before starting any fasting regime, particularly anything that's 5-2 or alternate day fasting where you can completely remove all food because that can definitely impact how your medication work and even put you at higher risk of uh low blood glucose as well, which you definitely want to avoid. Um, so please, please make sure that if you are on medication, you do speak to your own physician about that. My recommendation, start slow, set a dinner time and stick to it, set an eating window and stick to that, stay hydrated and monitor your body. Pay attention to how you feel during a time restricted eating method. If you experience any dizziness or weakness or unusual symptoms, do consult your doctor about that as well. So that's exercise, diet, sleep, stress. Now, stress alone does not cause diabetes, but there is some evidence that exposure to chronic psychological stress may increase the risk of type two diabetes and worsen your glycemic control, including your average levels of of sugar, which is your HBA1C levels. And we're talking especially about stress building up over time or if you face severe ongoing stress. Now, obviously life events occur and there's not much that you can do about that, but finding ways to lower stress day-to-day could have a positive impact on managing type two diabetes. And there are some things that I personally pay attention to and I always advise patients to pay attention to. Um, when you eat on the go, uh, when you eat distracted, when you eat too late, this is a signal to your body that you are stressed, uh, and it can lead to stress signals being generated. So before we even get into psychological strategies to mitigate stress, you've got to think about the physical things that you are doing that signal to your body that you are stressed as well. So please avoid eating on the go, avoid distractions in front of your phone or on your screens, avoid eating too late and avoid eating too fast as well. This is a stressed state when you are eating and your body will recognize that as a stressed state. The second thing is to take breaks as much as you can during the day. Now, I mentioned exercise snacks earlier, so making sure that you're not sitting down for too long a period during the day. Even a few minutes of walking or stretching can help manage stress levels and get your muscles moving as well. I always try and take a moment to do some deep breathing during the day, moments where I'm not on my phone, moments where I'm undistracted and I just allow my mind to wander. Not only is that great physically for my body and moving my muscles and my mental health, but also from a an ideas perspective, uh, a creative creativity perspective, a mindfulness perspective. The sort of things that I've talked about on the podcast before when it comes to ensuring that you are leaning into boredom because boredom is a very important part of being human. We are uh constantly being entertained and constantly seeking entertainment, but boredom is something that I think uh is very, very natural for us to enjoy and something to to really re-engage with in the future. In the same way, we also need to re-engage with hunger. Uh, it's no longer appropriate or sort of considered to be uh acceptable to be hungry anymore. We need to re-establish a positive relationship with hunger and we need to establish a positive relationship with boredom as well. And the other thing is if you are struggling with stress, therapy, talking with loved ones about it, being a lot more transparent and open is very easy to say this, but I think therapy and CBT and speaking to your practitioner is something that uh we should be encouraging as much as possible because it is very hard, particularly if you find yourself getting into spirals of negative self-talk to escape uh that that that spiral downwards of of stress and that can manifest in a number of different ways both physically and also in the way we um we speak and we interact with people on our day-to-day, especially our loved ones as well. And I'm experiencing that because of sleep deprivation currently, uh that can also be another reasons why reasons why we do experience stress, uh but on a serious note, CBT and therapy is definitely something that I would uh recommend. So my tips would be slow down your eating time, fork down in between mouthfuls, create non-negotiable eating environments, so no screens, try and lean into deep breathing during the day and try and recognize those stress signals as much as possible. Go for walks, stretch during the day, micro stretching has also been shown to help manage stress and it gets your muscles moving as well. So you're getting a twofer instead of just uh a one for. To exemplify what this buffet of lifestyle strategies are to help better manage blood sugar levels, to prevent type two diabetes and even put it in remission. This is what I would think of in terms of 24 hours in a day. And to be respectful and to to shout out some some people who've already put this into action like many of my patients, but also many people who are using the Doctor's Kitchen app and Doctor's Kitchen cookbooks have simply done the simple thing of removing processed foods, increase colour variety, a lot more plants into the diet and put their type two diabetes into remission. These are the champions of this whole field. They are showing what is possible. They are brave enough to lean into these things. They're not reliant on medications, not that that's a bad thing, but they are doing the best that they can within the confines of their day-to-day. And it is absolutely possible and I see this every single day. So, if I was to put this into a 24 hours of what this looks like of leaning into exercise and diet and stress reduction and uh sleep hygiene, this is what I would recommend. So, morning routine, get up, hydrate as soon as you wake and try and fit in some light exercise, whether that's a walk outside, expose yourself to the uh bright lights of the morning. I know that's not the case uh uh during the winter months in many countries like the UK, but trying to get outside as much as possible and get some of that sunlight is a way to train your circadian rhythm as well and get your sleep hygiene in order. A few minutes of stretching, a short burst of activity. Maybe this is your resistance day. You're like doing some body weight exercises, or maybe it's your hit day and you're doing jumping jacks for one minute on, one minute off, or squats, whatever it is, you're doing your exercise as soon as you've hydrated. Now, a lot of people like to uh eat before they exercise. So maybe you want to do this later on in the day. I personally exercise in a fasted state because I want to lean into uh getting it done right at the top of my day. It's the most convenient for me. Um, and there is some evidence, not great, but some evidence that if you are training in a fasted state, you're more likely to dip into some of those fatty acid stores, deplete your glycogen stores, so you're using up all that glucose so your muscles can actually store more glucose from the day. Um, and uh there there are some uh potential performance benefits from that perspective as well. But each to their own, some people prefer to exercise later in the day. But this is just one example of 24 hours in a day. Then it's breakfast time. Breakfast time is around 8:30 or 9:00 a.m. This is where your eating window starts. And if you want to have a black coffee in the morning, that's not going to disrupt your fasting window. We've talked about fasting, um, uh, sort of rules or routines on a separate podcast. But if you want to have black coffee in the morning, as long as you're hydrating appropriately with water, um, then that's what you want to be, uh, making sure you're doing first before you have your black coffee. But black coffee shouldn't disrupt your fast. Breakfast is going to include protein and fibre to keep your blood sugar nice and steady. Something like a tofu scramble, white beans, avocado, hard-boiled egg with some veggies. This is an ideal glucose focused breakfast that is going to put your metabolic health in the best stead. Work or do your daily activities whilst taking as many breaks as possible to move around, making sure you're doing your lunges every hour, making sure you're getting up from a seated position, maybe you're doing some micro stretches, maybe you're doing a few squats whilst you're taking a phone call, whatever it is, make sure you're getting your body moving as much as possible. If you want to have a snack, you probably won't feel like snacking because you've had a high protein, high fibre breakfast. But if you do want to snack, lean into the nuts and seeds, go for a full fat yogurt. We've talked about the benefits of fermented foods in a separate podcast, but these are the kind of snacks you want to be having, whole food, plant focused snacks. Lunch is going to be something like maybe it's oily fish with side salad and some beans, a bowl of lentils. It does not have to be fancy, just aim for a balanced meal with whole foods in it, making sure that you are removing ultra-processed foods as much as possible. No refined breads, no refined grains, no added sugars, no fruit juices, no sugar sweet beverages. You want to lean into the whole foods of which there are plenty and being prepared and maybe even meal prepping is one way in which to lean into that as well. Again, remember to lower stress by taking your breaks, micro stretching, breathing, doing your deep breathing exercises. If you want to practice some of those breathing exercises, there are plenty of videos online in which you can try and do that whilst washing your hands or taking a walk out, uh, staring into the distance and just being bored. This is all part of a mindfulness strategy that could actually improve your uh glucose regulating ability. Avoid snacks in the afternoon and the way you avoid snacks in the afternoon is ensuring that you're getting enough protein and fibre at lunchtime as well. And leaning into some of that hunger as well for an early dinner because you're going to have an early dinner because you know that's not going to disrupt your sleep a little bit later on and you are leaning into this time restricted eating window, this time restricted feeding window and ensuring that you're not going to be over consuming calories outside of that window as well. Dinner is going to be an early dinner, two to three hours before bed, a light protein rich option like a bean stew or a curry with roasted vegetables, a small amount of whole grains rather than white rice or pasta, and you're going to be having no alcohol. I didn't actually mention that, but alcohol is a very calorific and can be quite sugary as well. So you want to avoid alcohol as much as possible. And because you're eating two to three hours before bed, and because you're going to have a wind down routine and a cool environment that's going to be dark, uh, with blackout blinds or a sleep mask and it's going to be nice and calm, you're going to fall asleep like an absolute baby. Maybe not like my baby, but uh, definitely a baby that is well sleep trained. Um, and that's going to be your dose of metabolic medicine overnight because you're going to be having a quality sleep. So these are the things that you've done, all the lifestyle things I've talked about today, which are part of your metabolic medicine strategy. It is giving you your exercise medicine, your food as medicine, your stress relief as medicine, and your sleep as medicine as well. There are so many other supplements and other things that you can do as part of this, but those are the cherry on top. These are the main stay, these are the big levers that can improve your chances at preventing type two diabetes and improving your management of type two diabetes to the point where you can even put it in remission and come off medications as well. If you want to look at some of the sources that we've used for today's podcast, please look on the Doctor's Kitchen website, look at the Doctor's Kitchen app. We've done tons of recipes that really fit the criteria for not just metabolic medicine, but also uh other health goals as well. We're really transparent about the studies that we've used. I really hope you've enjoyed this podcast and you share it with loved ones who you feel could benefit from this information. If there's anything I've missed, let me know on YouTube in the comments. That's where I'm going to be looking at the comments for this a lot more. And if you think that we should do this again through the lens of something slightly different, maybe another condition, maybe uh through supplements or uh some other lifestyle strategies that you think are just as important as the ones that I've mentioned, let me know in the comments as well. I'd love to see those.
