Almost 30 years after earning her bachelor’s degree in Nutrition and Dietetics as well as her master’s degree in Medical Science, Nutritionist Jen Cleveland continues to unlearn a lot of things she was taught about nutrition.
She has spent 30 years in the same big academic children’s healthcare institution. In that time, she has observed what she describes as an alarming increase in the number of children presenting with type-2 diabetes. She has worked with kids with high triglyceride levels, high LDL cholesterol, and a big population of kids with non-alcoholic fatty liver.
Given her years of experience working as a dietitian with children, she opens up in this episode about her opinions on the status of nutrition, various patient experiences, and how food plays a significant role in disease prevention, particularly for the younger population.
Quick Guide:
01:07 Introduction
03:52 Prediabetes and type-2 diabetes cases of children
10:14 The story of why she went into dietetics
13:35 The a-ha moment that changed everything
16:12 Low-carb diet isn’t working
19:34 How to check that your kid isn’t on the road to diabetes
27:54 The right amount of carbohydrates for the young
31:09 What is the diabetes solution?
36:19 The perspective of other dieticians
41:13 Success stories and how her work has changed
53:09 Contacts and closing
Get to know our guest:
Jen Cleveland received her diploma in 1992, the year the famed food pyramid was implemented. She has spent 30 years working with young diabetics and believes that proper diet is a crucial step toward disease prevention.
“But I tried to encourage them and let them know that this can be, because the doctors honestly, they do not go into a room saying you can reverse this. They go into the room saying this is how we are going to treat this and the first thing we're gonna do is metformin and then we may have to add this and then we may have to add this and then I go in and I do my best to go, what I emphasize to the families is whole real foods. Ditch the processed foods. Number one, ditch sugary drinks. That's the absolute number one. Yeah, number one sugary drinks. Number two, whole real foods, meats, vegetables, little bit of fruit, if they are just starting out and move a little bit.” - Jen Cleveland
Connect with her:
LinkedIn: https://www.linkedin.com/in/jennifer-cleveland-mmsc-rd
Chances are, you wouldn't be listening to this podcast if you didn't need to change your life and get healthier.
So take action right now. Book a call with Dr. Ovadia's team.
One small step in the right direction is all it takes to get started.
How to connect with Stay Off My Operating Table:
Twitter:
Learn more:
Theme Song : Rage Against
Written & Performed by Logan Gritton & Colin Gailey
(c) 2016 Mercury Retro Recordings
Almost 30 years after earning her bachelor’s degree in Nutrition and Dietetics as well as her master’s degree in Medical Science, Nutritionist Jen Cleveland continues to unlearn a lot of things she was taught about nutrition.
She has spent 30 years in the same big academic children’s healthcare institution. In that time, she has observed what she describes as an alarming increase in the number of children presenting with type-2 diabetes. She has worked with kids with high triglyceride levels, high LDL cholesterol, and a big population of kids with non-alcoholic fatty liver.
Given her years of experience working as a dietitian with children, she opens up in this episode about her opinions on the status of nutrition, various patient experiences, and how food plays a significant role in disease prevention, particularly for the younger population.
Quick Guide:
01:07 Introduction
03:52 Prediabetes and type-2 diabetes cases of children
10:14 The story of why she went into dietetics
13:35 The a-ha moment that changed everything
16:12 Low-carb diet isn’t working
19:34 How to check that your kid isn’t on the road to diabetes
27:54 The right amount of carbohydrates for the young
31:09 What is the diabetes solution?
36:19 The perspective of other dieticians
41:13 Success stories and how her work has changed
53:09 Contacts and closing
Get to know our guest:
Jen Cleveland received her diploma in 1992, the year the famed food pyramid was implemented. She has spent 30 years working with young diabetics and believes that proper diet is a crucial step toward disease prevention.
“But I tried to encourage them and let them know that this can be, because the doctors honestly, they do not go into a room saying you can reverse this. They go into the room saying this is how we are going to treat this and the first thing we're gonna do is metformin and then we may have to add this and then we may have to add this and then I go in and I do my best to go, what I emphasize to the families is whole real foods. Ditch the processed foods. Number one, ditch sugary drinks. That's the absolute number one. Yeah, number one sugary drinks. Number two, whole real foods, meats, vegetables, little bit of fruit, if they are just starting out and move a little bit.” - Jen Cleveland
Connect with her:
LinkedIn: https://www.linkedin.com/in/jennifer-cleveland-mmsc-rd
Chances are, you wouldn't be listening to this podcast if you didn't need to change your life and get healthier.
So take action right now. Book a call with Dr. Ovadia's team.
One small step in the right direction is all it takes to get started.
How to connect with Stay Off My Operating Table:
Twitter:
Learn more:
Theme Song : Rage Against
Written & Performed by Logan Gritton & Colin Gailey
(c) 2016 Mercury Retro Recordings
S3E26 Jen Cleveland
SUMMARY KEYWORDS
diabetes, insulin, carbohydrate, kids, eat, american diabetes association, dieticians, jen, people, hear, children, grams, food, dietitian, mom, talk, vegetables, type, parents, urine
Announcer 00:10
He was a morbidly obese surgeon destined for an operating table and an early death. Now he's a rebel MD who is Fabulously Fit and fighting to make America healthy again. This is Stay Off My Operating Table with Dr. Philip Ovadia.
Jack Heald 00:37
Welcome back everyone to the Stay Off My Operating Table podcast with Dr. Philip Ovadia. I'm the talking hairdo and there's not much hair actually to talk about, Jack Heald. And we are joined today by I think this is the first registered dietitian we've spoken to, Phil. And that fact alone says something about what dietitians are or are not in our country. Why don't you introduce us to Jen Cleveland?
Dr. Philip Ovadia 01:07
Sure thing, and it's such a pleasure to have Jen here. As you mentioned, she is a registered dietitian. And we're going to talk a bit about what that means and how she has utilized that. And maybe where there are parallels to medical training and how Jen has started to approach things a little bit differently. And that's why I'm excited to have this conversation with her. So, let's start by letting Jen give us, introduce herself to our audience, and give us a little bit of your background, Jen.
Jen Cleveland 01:50
Yes, I'm Jen Cleveland, I am from the Hoosier State, Indiana, went to IU, Indiana University, a bachelor's degree in nutrition and dietetics back in 1992. And as you probably know, that was the year that the infamous food pyramid came into play.
Jack Heald
Oh, I didn’t know that.
Jen Cleveland
So that's when I started. Yes, yes. Yeah, pretty much everything I learned I'm having to relearn and unlearn. And it's quite the process 30 years later, going through a lot. Just trying to unlearn everything I was pretty much ever taught about nutrition. And still and told to teach many times, that part can be a little frustrating. But I also have a master's degree in medical science from Indiana University. And I did some research, interestingly enough, back in 1994 to 96 on the effects of sucrose in the diets of children with type one diabetes. So, my whole thesis in 1992, that I presented at the American Diabetes Association National Conference in Atlanta, was telling people, oh, it's just fine for kids with diabetes to eat sugar. I know. I know. Oh, well, I was just saying it wasn't worse than starch.
Jack Heald
Oh, okay.
Jen Cleveland
On their blood sugars. I wasn’t saying it was good for them. I was just saying it wasn't worse than starch at the time. I was like, well, sucrose is 50% glucose and 50% fructose. And starch is 100% glucose. So, when you give them isocaloric amounts of both, their blood sugars are better with 50% glucose, they're better with sugar. Terrible.
Jack Heald 03:52
So, for our audience who may be brand new to the show and haven't heard us rail on this particular topic for the last year and a half, what would be your report today? If you were giving the same if you had the opportunity to speak to the American Diabetes Association maybe update your recommendations and findings from 1992.
Jen Cleveland 04:21
Yeah, it's a slow process. And it's kind of coming around very, very slowly, not quite as quickly as I'd like it to, especially with this pandemic of children with type two diabetes that we have on our hands, prediabetes. I mean, 30% - 30% of kids have prediabetes 12- to 18-year-olds. Yeah, it's astonishing, and in the age group of 19 to 34, it's like 35% to 40%.
Jack Heald 04:53
I'm having trouble wrapping my head around that number. I had no idea it was that bad.
Jen Cleveland 04:57
It's huge in the last two years. Once COVID hit 2020 to March 28, 2022, the numbers just, it was like 5% more increase.
Dr. Philip Ovadia 05:09
And Jen, do you know roughly what those numbers were in 1992 when you graduated school?
Jen Cleveland 05:17
Less than 5%?
Dr. Philip Ovadia
Yeah.
Jen Cleveland
When I first started practicing, because I've been practicing at the same children's big academic healthcare institution for 30 years, it was rare. I mean, it was like maybe once or twice a year, we would see a kid come in with type two diabetes. And now we have four dedicated clinics every month that are only type two diabetes, and we have a whole youth diabetes prevention clinic. And without getting myself in trouble, what they teach in that clinic is still not quite, I would say this, right.
Jack Heald 06:00
So, we've had a six-to-seven-fold increase in the incidence of prediabetes in 12- to 18-year-olds in 30. years.
Jen Cleveland 06:15
Yes. To me, that's a pretty, pretty darn pandemic, compared to the one we just, it's just as bad in my opinion.
Jack Heald 06:29
Possibly worse.
Jen Cleveland 06:31
Or in fact, worse, because these kids, when kids get type two diabetes, the increase in their beta cell failure, that is so much faster than it is in adults.
Jack Heald 06:46
Okay. You’re already over my head.
Jen Cleveland
Sorry, sorry.
Jack Heald
I represent the average listener. So okay, what did you just say beta cell failure?
Jen Cleveland 06:57
So, beta cells are the cells in your pancreas that make insulin. And because they just diminish so much faster in kids that develop type two diabetes at such a young age much faster, they develop complications much quicker. Kidney disease, all the things that go along with type two diabetes, heart disease, retinopathy, eye diseases, eye damage.
Jack Heald 07:24
So, if I understand what you're saying, the earlier you develop diabetes, the faster the onset of all the other pathologies associated with diabetes.
Jen Cleveland 07:41
Yes, yes.
Jack Heald 07:44
You’ve already blown my mind. We’re five minutes in. And you've already my mind.
Dr. Philip Ovadia 07:49
Specifically, what we're talking about there is children who start with type two diabetes. And again, to step back for a minute, we recognize that type two diabetes is your body is actually making plenty of insulin, but your body cells aren't responding to that insulin. And these kids rapidly accelerate, then develop type one diabetes, which means their pancreas is no longer making insulin. So, it really is a pretty vicious cycle, pretty vicious process. And then, like you said, that accelerates all of the complications. And these are now 30-year-olds that are ending up on my operating table because they have the advanced heart disease of a diabetic that we typically wouldn't see until people are in their 70s, the people who used to develop type two diabetes in their 50s and 60s, and then they get heart disease in their 70s and 80s are now teenagers developing type two diabetes, and then 30-year-olds developing heart disease.
Jen Cleveland 09:08
It happens so fast, and it's just so sad because, as we know, it starts with what they put in their mouth.
Jack Heald 09:19
Well, that was gonna be my follow-up question. Okay, so what has changed in the last 30 years, that we have a 6 to 700% increase in the incidence of this childhood diabetes? What's happened?
Jen Cleveland 09:34
Our food, our food supply, when we look at the food in the grocery stores, I mean, yes, we always had junk foods but in the 50s and 60s when they started bringing all the people who fund the American Diabetes Association, who fund the American Heart Association and who fund all these organizations that are supposed to promote health care are funded by Procter and Gamble's and Kellogg's cereals and Linda sweetener. I mean, there's just there's so much funding that goes on. Half of the continuing education opportunities I get as a dietitian are from, funded by food companies, and they're just promoting things to their own agendas, and not to improve anybody's metabolic health really.
Jack Heald 10:33
I don't even know where to... I want to rip the covers off of this. I want to name names. I want to... Holy smokes.
Dr. Philip Ovadia 10:46
We’ll get into that. But Jen, I want to step back for a minute and just ask you why did you become a dietician? Why did you get into dietetics to start with?
Jen Cleveland 10:59
That is a really good question. So, my grandparents grew up on, I think, I've told you this, but that my grandparents grew up on a farm in northern Indiana, and they were farmers, and always had their own meat, had their own vegetables. We’ll go there in the summertime. And then my mom has always been a health nut, I guess you'd call her health nut, but she's very, very smart. She's always tried to find out, she's wanted to live a long, healthy life and always wanted to do whatever it was that she could do to do that. Well, we will never forget the moment and about the early, probably mid-70s. We were young, or I was not as young as my brothers. But we, my mom, read this book called The Sugar Blues.
Jack Heald
Oh, I remember that book.
Jen Cleveland
And yeah, so she read this book, and she literally ripped every iota of sugar out of our house, probably did a lot of favors that we didn't know at the time. My brothers threw a fit. No more fruity pebbles, no more any kind of sugary cereals, and we were super active back in that day. I mean, we don't, we're not prone anyway to being overweight. I mean, our family is genetically kind of tall and slender. And so, we like we were Ethiopians. We were healthy. We were just normal healthy kids running around. But yeah, so my mom has always had an interest in nutrition and kind of taught me good habits along the way. And so, I was like, well this is interesting. We'd like to help kids with type one diabetes, I don't have anybody personally in my family with diabetes, but there was an opportunity at the hospital to do these research studies and to work with one of them really at that time. He was a very known pediatric endocrinologist in our community. And I was like, well, that's cool. I was only like, in my early 20s, I was like, this is going to be fun. And so, I enjoyed the research and all that, but then when I look back on everything that we did, it was all wrong. It's all wrong. So now, I feel like I'm back in school again because I'm constantly taking nutrition network courses, and learning things that I didn't know before.
Jack Heald 13:35
Was there an aha moment for you that where you said, wait a minute, this is not what...?
Jen Cleveland 13:45
Yeah, so the aha moments are, it was kind of just along the way. We were literally told, we were told by the doctors, so tell the family just have their children eat whatever they want and don't change their diets at all, where we’ll just feed the insulin. We'll just give enough insulin to cover that much carbohydrate. So, we give them insulin to carbohydrate ratio. Say it's one unit for every 15 grams. And so, they're told for every 15 grams of carbohydrate that your child eats, you cover that with a unit of insulin. And for every so many milligram per deciliter high that their blood sugar is over 120, not even 100 or 110, which is a more normal blood sugar, but 120 is the target just to prevent hypoglycemia. And so, then we give them a little extra for that as well. So, it's okay to let them run high and it's okay to let them eat however much carbohydrate, no limit on what kind of carbohydrate, and just cover it with insulin. And so that was my job for years was to teach families carbohydrate-insulin ratios and how to program their insulin pumps, so it delivered enough insulin, and so on.
Jack Heald 15:06
There was no discussion about lifestyle. There was no discussion about nutrition.
Jen Cleveland 15:11
There was a brief, of course, we recommend that most of your child's carbohydrates come from whole grains, fruits, vegetables, whole grains were always very promoted because they're high in fiber.
Dr. Philip Ovadia 15:28
Yeah, yeah. And I've talked a little bit on the show about my brother, my older brother was diagnosed with type one diabetes. And I remember that well, him kind of sitting at the table and calculating his insulin dosage and how much carbohydrates we just need. And, we only had the Cheerios because we couldn't have the sugar cereals. So, we had whole grain cereals, and the Wheaties and all the whole green stuff. And he would sit there and balance his carbohydrate intake with his insulin usage.
Jen Cleveland 16:08
And that had the little heart association implement the top.
Dr. Philip Ovadia 16:12
Yeah, exactly. So yeah, but let's dig into a little bit more like, when did you start to realize that this wasn't working? Or this wasn't the right approach. What made you start to question this? Because, having gone through a similar transformation myself and trying, that's a lot of programming that you had to start to unravel. So, what started that for you?
Jen Cleveland 16:48
So, I mean, personally, I kind of started... I've not ever eaten a super high carb, high carbohydrate diet, even, not since I was like a youngster. I was a competitive swimmer in high school, swam all the way through high school. And so, I ate a ton for that. And then after high school, I was like, well I'm not as active as I used to be. And so, I probably didn't need as many calories, but I just kind of naturally started to eat. I've always loved meat. My mom has a picture of me with a chicken bone in my mouth when I was a year old, and I've just always loved, I've just always liked meat a lot. It's just satisfying, and I don't feel hungry. And I think for years that I did follow kind of that low-fat mantra everybody must eat really high carbohydrate, low-fat diet that was probably up until I would say, my late 30s, early 40s. And then that's about the time when I was like, this stuff isn't working for any of these kids. It's not working for anybody. I was getting consult after consult for hyperlipidemia. But their cholesterol wasn't like cholesterol levels.
Jack Heald
What's hyperlipidemia?
Jen Cleveland
Oh, high cholesterol and triglyceride and LDL levels.
Jack Heald
In kids?
Jen Cleveland
Oh, yeah. I’ve seen kids with triglyceride levels in 2000.
Dr. Philip Ovadia 18:19
Well, yeah, and important to point out you're mostly talking about high triglyceride levels, high LDL cholesterol is becoming more of an issue in kids as well, but the high triglycerides are what you typically see.
Jen Cleveland 18:35
Yeah, we have a very big population of kids with fatty liver as well, non-alcoholic fatty liver.
Jack Heald 18:41
Yeah, that's what you were, the biography you sent us you were talking about non-alcoholic fatty liver disease.
Jen Cleveland 18:51
And they kind of a lot of times go hand in hand with type two diabetes.
Jack Heald 18:57
This is in kids?
Jen Cleveland 19:01
As young as eight, seven- and eight-year-olds.
Jack Heald 19:05
Unbelievable.
Jen Cleveland
I know.
Jack Heald
The question that comes to mind is there are parents listening to this and they're going to be saying, I wonder if that's my kid. Are there... What you do to check your kid? First thing, what's the first thing that parents listening to you do to make sure that their kid is not on this road to diabetes?
Jen Cleveland 19:34
So usually, if they're getting regular, well child checks, they do a urine screen is usually the first thing they'll do and that's how some of our kids are detected. If they do go to their... But during COVID, a lot of kids didn't go to their any doctor's appointments. But they'll do a urine screen, and they can detect glucose in the urine, but that has to be reached the renal threshold blood sugar wise, which is greater than 180 milligrams per deciliter blood sugar, which is pretty darn high before it passes that renal threshold and spilled into the urine.
Jack Heald 20:11
Okay, so what I hear you say is they've got to be pretty far down the road before it even shows up in the urine. Is that right?
Jen Cleveland
Yes.
Jack Heald
What else do parents do?
Jen Cleveland 20:25
The symptoms that they can present with are polyurea, so they're getting up a lot at night to go to the bathroom or they're excessively thirsty. Polydipsia is that and polyphagia which is kind of excessive eating, or the three Polys...
Jack Heald 20:46
I love that you people have all these fancy names for I gotta pee a lot, I'm thirsty all the time. And I eat like I'm starving.
Jen Cleveland 20:55
Yeah, I guess their body’s not able to utilize what they're eating. And so, they just have a voracious appetite. And the type two, a lot of times in kids do they'll have like this darkening ring, you may have seen it on people like a dark ring around their neck, or sometimes in the arm folds of their arms. It's called acanthosis nigricans, in a lot of kids, it's a sign of insulin resistance in type two diabetes. And I've had patients who have come in...
Jack Heald 21:26
For all our listeners, we're talking about a ring around the lower part of the neck...
Jen Cleveland 21:30
Well, it can be all over the body, but sometimes across the neck, sometimes across the knuckles, in the wrist folds. But it's a sign of insulin resistance. And I can walk into the grocery store and see people with it. And like they probably don't even know they have prediabetes or diabetes, one or the other. That it's definitely a sign of insulin resistance.
Jack Heald 21:56
This is one of those times when we need to be able to have a Jamie like Joe Rogan. And Scott says, “Jamie, look that up, show us a photo.” So, we don't have one.
Jen Cleveland 22:04
Oh, yeah.
Dr. Philip Ovadia 22:07
No, it's a problem because kids aren't routinely getting blood work. And so, when we talk about some of the things we talked about in adults and checking insulin levels for early detection, and while those certainly would work in children, if we were to be checking insulin. And we don't routinely do blood work in children. So, it's a challenge to detect this before it gets to that point. And you're right, having glucose in your urine is already fairly far down the track. Before that occurs.
Jen Cleveland 22:55
It used to be age 40, when they would start screening around age 40 for even prediabetes, not even type two. And they have now reduced that to 30. So, they're now routinely screening anyone that's 30 and over.
Jack Heald 23:15
Let's cut to the chase. I know that the way we're going to promote this particular episode, we're going to target at parents of children, parents with children at home. Talk to the parents, you're the dietician, you've got the background and the credentials. Tell them what they got to do now to either get their kids off of this track or better, keep them from ever getting on it. What actions do they have to take starting today?
Jen Cleveland 23:50
Yeah, and that's a great question because a lot of times it's multigenerational, especially with type two diabetes, it's a very multi-generation grandparents have had it, parents have had it and now the kids have it and so it's almost as if they sometimes see this as fatalistic in a way. I don't know. But I tried to encourage them and let them know that this can be, because the doctors honestly, they do not go into a room saying you can reverse this. They go into the room saying this is how we are going to treat this and the first thing we're gonna do is metformin and then we may have to add this and then we may have to add this and then I go in and I do my best to go and anymore, what I emphasize to the families is whole real foods. Ditch the processed foods. Number one, ditch sugary drinks. That's the absolute number one. Yeah, number one sugary drinks. Number two, whole real foods, meats, vegetables, little bit of fruit, if they are just starting out and move a little bit. I mean, sometimes I keep the movement for a little bit later because we're talking about some kids that have body mass index is 45 to 55. So, the movement is...
Jack Heald 25:23
We are talking about kids who are already morbidly obese.
Jen Cleveland 25:27
Very, like 12-year-olds that are 350 Plus.
Jack Heald 25:32
Holy smokes.
Jen Cleveland 25:33
I know, it's really sad. I mean, it does make me sad. And a part of it is there are and I'm not making excuses, but we do have areas of poverty where there are food deserts areas where their access to good food is not the best. A lot of these children, I mean, not in like, I think the end incidence of kids and poverty in certain, in some of these areas has doubled since 1999. And so, for them to find good fresh meat or eggs or things that we kind of maybe take for granted, it's not so easy. And then they'll say that a lot of times they have to go to food pantries to get their food. And the food pantries, what you get at a food pantry is a lot of boxed processed, boxed and processed foods, bagged foods, things that have a long shelf life. And so that's what I have to work with.
Dr. Philip Ovadia 26:37
And we can even extend that these days. Because for a lot of these children, school might be the primary where they get their biggest meal of the day. And the schools are serving largely processed food anymore. They're following the US Dietary Guidelines. And they're serving a lot of processed food and certainly a lot of high carbohydrate food.
Jen Cleveland 27:01
Yes, I had a dad actually come into clinic last week, and he was very upset, his son has type two diabetes. And he's like, I'm trying my best. I'm trying my best. But we rely on school breakfast and school lunch for financial reasons. And I said, oh I understand. So, he pulled up on his phone, the school lunch menu, where the school nurse had written the carbohydrate content of all the items on the menu for that day. And it was over 100 grams for every single meal for the month. That's just for lunch. And the breakfast was another 75 to 100. And it's like, oh. And even our hospitals. I mean, the hospitals don't do much better of the food that we serve in the hospitals.
Dr. Philip Ovadia 27:54
Yeah, what would you say is the reasonable amount of carbohydrates for a child to be consuming in a day?
Jen Cleveland 28:09
That's a trick question. Because as we know...
Dr. Philip Ovadia 28:15
Not even thinking low carb, like just to kind of set the norm so here we are they're serving 100 grams at lunch. And probably close to the same at breakfast. So, 200 grams right there. And again, an average child and nondiabetic average child probably shouldn't be consuming more than 100 grams a day of carbohydrates in one meal.
Jen Cleveland 28:50
Exactly. And if I say that, they look at me like I have five heads.
Dr. Philip Ovadia 28:56
Right? Oh, yeah, we know the challenge.
Jen Cleveland 29:00
Yeah. So, the American Diabetes Association have gotten down to 150 grams per day. As a recommendation.
Jack Heald 29:14
This is for people who already have diabetes.
Jen Cleveland 29:20
Yes. That is the 2021 American Diabetes Association standard of care guidelines
Dr. Philip Ovadia 29:27
Lowered it to that.
Jen Cleveland 29:32
Yeah. Well, it's actually up to 180 for men.
Dr. Philip Ovadia 29:37
Yeah. But those, again, were lower recommendations than they had had in the past.
Jen Cleveland 29:41
That used to be in the form of recommendations to individualize it based on the patient. And so, if a child was typically eating 200 grams per meal or 100 grams per meal, I would be told just cut that in half and I was like, well, that's not enough.
Jack Heald 30:04
I don't have a license that somebody can take away from me because of what I say about issues like this. I'm not afraid of saying this, but it needs to be said, that is absolutely insane that in this day and age, a medical professional would take the approach that it's okay for a child with diabetes to be consuming massive amounts of carbohydrates. And just taking the attitude that, oh, we're gonna put you on drugs for the rest of your life. Eat whatever you want. I'm sorry. At best, that's incompetent. And at worst, it should be legally actionable by any parent who brings a child into hears that. I don't have a license to lose. So, you guys don't have to say anything.
Dr. Philip Ovadia 31:09
I'll second it. And they can come after my license anytime. But so, Jen, I got another question I'm curious about. So, Dr. Richard Bernstein wrote his diabetes solution, which is basically a low-carb approach to type one diabetes. He wrote that in 1997, I believe, is when the first edition came out. When you graduated in 1992, so you were in practice by then. Do you remember when the first time you even heard about that book was and what the discussion was like around that?
Jen Cleveland 31:51
Yes, I do. I'm trying to think about what year that was. It was probably in the early, mid-2000s. Okay, by the time it rolled around, it was not well received. It was not well received. I mean, that they were saying, well, kids need carbohydrates for energy. I mean, it's just now that this year, this, like, well, 2022 that I heard a discussion, a talk by one of our pediatric endocrinologists saying it was a talk on non-alcoholic fatty liver disease, and they were discussing the fact that carbohydrate is not an essential macronutrient and I about fell over. Like so then now every time they bring up when I want to do a lower carbohydrate than what they recommend for certain patients. I will say, but is it carbohydrate not a central macronutrient, especially for these kids? And because it used to be they would always say, well, they need it for energy. These are growing young kids; they need so much amount of carbohydrate for energy. And that's just not true.
Jack Heald 33:10
Yeah, in other words, the kid's body is able to make use of meat in the same way that an adult body can make use of meat.
Jen Cleveland
Yes. Yeah.
Jack Heald
Sounds so complicated.
Dr. Philip Ovadia 33:24
I was just picturing the ironic kind of situation during that lecture of the dieticians and the doctors in the audience throat literally throwing their doughnuts at the speaker who suggests that carbohydrates are not essential, because I'm sure they were being served the grand rounds like they always are.
Jen Cleveland 33:48
It’s usually the Giant Otis Spunkmeyer muffin. Yeah, that's 70 gram, the 70-gram carb one.
Dr. Philip Ovadia 33:56
So, to go back, do you remember learning in school about how diabetes was treated prior to insulin becoming available?
Jen Cleveland 34:11
Oh, yeah. I mean, this is what we're doing now, or what we believe to be true now is how it should be or what’s being done that way, like very low carbohydrate diets, because otherwise, they starve to death. They die before insulin. And so, the only choice was to remove carbohydrates from the diet. And it just makes you wonder what would happen.
Jack Heald 34:41
So, for the folks in the audience who are like not always up on all the medical stuff, what you're saying is prior to the discovery that insulin could be used to help diabetics...
Jen Cleveland 35:01
101 years ago.
Jack Heald 35:04
101 years ago, we still had people who had diabetes, and the standard of care, in other words, what you did if you were a doctor, and somebody came in and had diabetes is you said, quit eating the carbs.
Jen Cleveland
Basically.
Jack Heald
Or you're going to starve to death. Because your body is not...
Jen Cleveland 35:28
Can't use carbohydrates. Because you have that insulin. Yeah.
Jack Heald 35:34
Wow. 101 years ago.
Dr. Philip Ovadia 35:38
101 years ago. Yeah, no, it really is interesting. So, what do you I guess...
Jen Cleveland 35:48
When I first started, it was the exchanges. I don't know if you remember exchanges.
Dr. Philip Ovadia 35:54
The carb equivalent, like this is where...
Jen Cleveland 35:56
We had to tell people like you, one milk exchange and two vegetable exchanges and three bread exchanges and two fruit exchanges for the day, then each exchange was equivalent to 10 to 15 grams of carbohydrate. That was the original.
Dr. Philip Ovadia 36:19
It was a way to make the math look not quite as bad with amount of carbohydrates being promoted. So, what are you seeing now? How many, I guess? Yeah. How many of your colleagues are becoming enlightened? So, I'm fortunate to now know a couple of dieticians RDs or licensed dieticians that are low carb. They realize that that's the way to go. Are you seeing a lot of that among your colleagues?
Jen Cleveland 37:01
Nope. I'm in Indiana. No. I shouldn't say no, there are some. But they definitely, if I'm in the... I don't often eat lunch, I'm kind of, I am little I eat more breakfast and dinner kind of thing. So, I'm usually just so busy working through lunch that I just don't even think about it. But they're always like if I do eat, and it's usually just a bunch of meat of some sort that I like, they're like, oh, you just don't eat any fruit or you don't eat any pasta, or you don’t eat rice, you don't like bread. I've never eaten bread really? Like no. Like, wow. It's like, it's just they think you're weird.
Jack Heald 37:58
Okay, what you're painting for me is a picture that I really wish I was not getting in my head. But you're painting for me a picture of a profession that claims to be able to communicate to people who are sick because of what they, who are sick, for whatever reason. A profession that claims to be able to tell them what they need to eat that is utterly incompetent. That's what I'm hearing. That's the picture I'm hearing. Utter incompetence. If you have a problem with your body, you're sick, and you go to one of these places, they have a dietitian walk in, you could be almost 100% sure that whatever they're telling you is bunk. That's what I'm hearing. Am I wrong?
Jen Cleveland 38:46
No. I sometimes...
Jack Heald 38:50
You're being modest, Jen.
Jen Cleveland 38:53
Well, I sometimes get frustrated because I enjoy being a dietitian. And I think there's a lot that we can offer. I've always felt like food could be the whole Hippocratic message of Let food be thy medicine. I mean, gosh really, it works for a lot of disease prevention, but just getting that message in the right format and so that people can understand it. There's so much confusion out there. I mean, there are so many fad things, but to find something that actually works, and one of the things that the doctors always say with low-carb diets that I hear, not Shinsei doctors, but they come back with is it's just not sustainable. Nobody can eat that low carbohydrates of a diet for that long. And, and I've been doing that as well. I've been doing it for years. I mean, what do you mean?
Jack Heald 39:50
How long does it have to be to be considered sustainable?
Jen Cleveland 39:53
Yeah, like, sustainable. Exactly. And I mean, I mean years and years and I felt good, and my parents have eaten this way for you. years and they are my dad just turned 80 A couple of weeks ago. My mom is 76. And they're the most active, healthy humans around. And I've learned half of what I know in the last 10 years with regards to nutrition from my mom. Of all the, she told me what to watch.
Jack Heald 40:19
She must love that.
Jen Cleveland
That's how I found out about...
Jack Heald
Oh, from your mom?
Jen Cleveland
Yes.
Jack Heald
Well, thanks, Mom.
Jen Cleveland 40:27
I know, I tell her thanks all the time.
Dr. Philip Ovadia 40:29
Well again, it's ironic that you're probably like, oh we learned that I learned this new thing about nutrition and your mom was like, that's what I learned in the 1970s. And unfortunately, you learned the opposite in the 1990s. But again, none of this is new.
Jen Cleveland 40:55
Yeah, the deprogramming and relearning is pretty intense. Yeah, that's a lot.
Dr. Philip Ovadia 41:04
Let's turn the conversation around here. Let's hear some of the success story.
Jack Heald 41:12
I'm getting depressed.
Jen Cleveland 41:13
No, I know. There are successes along the way. And I don't know how much I can say. But there is a movie on Apple TV now called the Diabetes Solution. They actually asked Dr. Bernstein. Have you seen the movie?
Dr. Philip Ovadia 41:31
I actually haven't. I wasn't aware of the movie.
Jen Cleveland 41:34
Yeah. So, well the movie. It was a group of moms of children with type one diabetes, and one of them happened to be, her husband was a physician. And she was just astonished when her child was diagnosed with type one diabetes and was like this is Scott, this is not right. They're telling me that they can have the sugary cereal and orange juice and all these things. And just cover it with insulin. She's like, that's just not right. That's just not right. So, she did further investigation. Anyway, just the film came out on Apple, it's on Apple TV and Prime TV. It's like 399 or something, but it's, it's a really well-done movie. So, I kind of tell people to check that movie out. I am still at the phase where I'm trying to work on getting them to lean down on the carbs.
Dr. Philip Ovadia 42:33
Yep. Yeah. And then there's a massive Facebook group around...
Jen Cleveland
Type one grit.
Dr. Philip Ovadia
Type one grit, which I just actually learned the other day. So, Dr. Bernstein is still active in it. He's, I think, going to turn 90 this year maybe. He's approaching 90 years old and he's still active.
Jen Cleveland 42:59
He's amazing. Yeah, I wish I had taken his advice and along the way, or a lot earlier, but you live in you learn to all
Dr. Philip Ovadia 43:12
So yeah, talk about some of the ways that you're now realizing what you realize and knowing what you know talk about some of the ways that you're incorporating that into your life with working with people.
Jen Cleveland 43:31
So, I very much have to be careful in what I say in this space. Because they’re still telling me 60 gram for boys and 45 for girls type of thing. So, I take the approach of more focusing on processed foods, getting them to eat just whole real foods, the meat, the vegetables because those are naturally low and very low in carbohydrates. Some vegetables, not the corn and the peas and the potatoes. In Indiana, they can still consider potatoes vegetables. And then a little like that they don't want to completely remove fruit.
Jack Heald 44:23
So, what do you do to keep yourself from losing your mind? Inside this type of environment?
Jen Cleveland 44:31
Oh, that is the hard part. I do a lot of yoga. Spend a lot of time with my grandkids. No, I do because I love the kids and I feel like if I can make a difference in one kid's life, then it's worth it in a week. like there's always at least one or two kids I feel like I make a difference in their life in a week and that to me is what it's worth. And I've had very, I've had several great success stories with kids whose parents...
Jack Heald 45:06
Please tell us one, one great success story.
Jen Cleveland 45:10
Well, actually there's a video online about him, but I don't know, well, I guess since he consented for the video, but he just took it to heart and like his mom, single mom.
Jack Heald 45:24
Where did he start? Tell us about who he...
Jen Cleveland 45:27
He was 15 and diagnosed with type two diabetes. And I kind of went through the whole show with him, I was like, we gotta change it change some things in your diet, gotta start moving a little bit more. And he took it to heart. I mean his mom got a bike, a stationary bike in his bedroom. He was on that thing. But he was, it does take some degree of intrinsic motivation to want to be healthier. And sometimes kids feel so bad. They don't know how bad they feel. Their body is so metabolically unhealthy that they don't even know how good they could feel. But he took it to heart, and he was very motivated intrinsically. He wanted to not have to take medicine and he was actually starting out on insulin. Because back in the day, we did. And finally, that was a big success during the last year, we no longer start to type two diabetes patient kids on insulin instead, even if their A1C’s 12%, we start with very, sometimes very low basal insulin, but we tried to get rid of it as soon as possible. But he took everything to heart. He did it. He watched the site. And he's three years later just graduated, and he is in, they call it remission. He's in remission of his type two diabetes. He doesn't take any diabetes medications. And he's, I think he's lost like 80 pounds, 80 or 90 pounds. He's great. I told him you've got to be like a rock star patient for, they featured them at the hospital. And they featured him on the local news and in different things. But he's a great kid.
Jack Heald 47:17
Wow. That is extraordinary. Alright, parents. So, look for the grey rings around your kids’ various places on their bodies. Look at what they're sticking in their mouth, not just at home. But wherever else they're going. Get rid of anything that has more than one ingredient on it is what I guess. Well, what is it you say? Dr. Ovadia? If, like if you can't tell what the ingredients are by looking at it?
Jen Cleveland
Can’t pronounce them?
Dr. Philip Ovadia 47:48
Yeah. If you can't tell what's in your food by just looking at it, then you really shouldn't be eating it. I think that's a great rule to live by.
Jack Heald 48:04
So, there's got to be parents are saying, but my kids are just gonna throw a fit. What do you say to him?
Jen Cleveland 48:12
I said, well, a lot of times, I'll say, but I have other kids and they don't all have diabetes. And I said, well, I'm not telling you to feed your kids anything different than you and feed your other kids. All this, you can feed the whole family this way.
Jack Heald 48:27
Everybody can eat this way.
Jen Cleveland
Yes.
Jen Cleveland 48:31
It's much more supportive for the family that way, if everybody's eating that way, then the child is not singled out. And nor should they be. And they're not. Honestly, they're not the ones buying the food or the I mean, they're children. So, it's not their fault.
Jack Heald 48:50
Wow. Yeah. All right.
Jen Cleveland 48:52
I think we have a lot of work to do. And it's exciting. And I don't want this to be a negative conversation. I want it to be something that people go forward with and just think about what they are feeding their kids.
Jack Heald 49:06
Well, it is gratifying to know that the message that I've been hearing from guest after guest after guest on this show for the last year and a half is essentially the same message over and over again. Eat whole real food. I mean, it's so complicated.
Jen Cleveland 49:31
I know. And people are like, well, what is that? And I'm like, meat before you do anything to it, vegetables, fruit, and a little bit of fruit. It’s not like, it really isn't rocket science. It's just putting it into action. And there's so much addictive qualities to the processed foods. I mean, they just could release all those dopamine receptors and make you feel so good. That's a whole another carbohydrate addiction.
Jack Heald 50:11
Right? Yeah. We had a guest on a while back and I for the life of me can't remember who it was, but she talked about being poor and needing to lose a bunch of weight. And her comment was something along the lines of don't think I was shopping at the fancy dancy grocery stores buying expensive meat, I was going to McDonald's ordering a quarter pounder with nothing on it and throwing away the bread. I was eating McDonald's hamburgers, but all she was eating was the meat. And the lights just kind of went on for me, I realized, oh my gosh, bad meat, low-quality meat. I shouldn't say bad meat. Low-quality meat is better than any kind of processed anything that you're going to eat. So, you can't use, if you eat food at McDonald's, or Wendy's or Burger King or any of those places, you can't say that you can't afford to eat well, because you could just be buying the meat. And by the way, my wife and I go In-n-out once a week, and I now order bear patties. It's fantastic. It's cheaper, I order six bear patties, and I'm getting roughly 10 ounces of I would guess fairly low-quality hamburger for six bucks. It's great, it's fantastic.
Jen Cleveland 51:47
Well, I do that a lot because that is a common thing that I hear it is very expensive to buy meat and to buy fruits, or to buy vegetables, all these things. And so, I'll bring in the, I always every week bring in the grocery ads, and kind of like we'll go through and circle ideas of what they could choose in place of like all the stuff in the middle of the usually the meat and the vegetables are on the front page of the ad. And so, we'll go through that and kind of help them, but it takes a little bit of time to cook meals and people don't necessarily always want to stop to do that. So, the option of what can you do when you're eating out comes up a lot too. And we talk about that, taking the buns off and doing the Unwish from Jimmy John's with just like the gargantuan where you get like five different meats and cheese in a lettuce wrap. So.
Jack Heald 52:47
I didn’t know about that. I've learned today. The Unwich from Jimmy John's
Jen Cleveland 52:49
Oh my gosh it’s so good. It's my to go, like when I’m on the go.
Jack Heald 52:58
I love it. Okay, well, we've got to do sponsored, Phil.
Jack Heald 53:09
I appreciate your time here today. Oh, of course, Phil, how do you wrap this up?
Dr. Philip Ovadia 53:15
Just we didn't really even get to talk about that Jen is one of our coaches over at in the Metabolic Health Coaching Program over at ifixhearts.com. And so, we don't deal with children there. But we'd be happy to deal with their parents. And so, anyone that's looking for help with their metabolic health, Jen is one of our expert coaches, we'd invite you to come to check us out at ifixhearts.com. And then Jen, why don't you let us let the people know where they can connect with you as well?
Jen Cleveland 53:58
And they can connect with me on LinkedIn Jen Cleveland, Twitter. @sadfreeRD. SAD being Standard American Diet, sadfreerds. Yes. And on. I think that the other one’s Instagram is that Jcleaves70.
Jack Heald 54:21
We'll make sure all that stuff shows up in the show notes. Very good. So, if you're too intimidated to talk to Dr. Ovadia at ifixhearts.com, and don't be because he's a great guy. You might have the opportunity to work with Jen Cleveland, who is a registered dietitian who gets it. Thank God there's at least one in America.
Jen Cleveland
There are several.
Jack Heald
All right. Well for Dr. Philip Ovadia and Jen Cleveland, I'm Jack Heald. This is the Stay Off My Operating Table Podcast. I'm gonna invite you to subscribe. We drop a new episode every Tuesday. And we'll talk to y'all next time.
Jack Heald 55:12
America is fat and sick and tired. 88% of Americans are metabolically unhealthy and at risk of a sudden heart attack. Are you one of them? Go to ifixhearts.co and take Dr. Ovadia's metabolic health quiz. Learn specific steps you can take to reclaim your health, reduce your risk of heart attack and stay off Dr. Ovadia's operating table.
Jack Heald 55:40
This has been a production of 38 atoms