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Melissa Dobbins is an RDN, CDE and award-winning food & nutrition expert. We’re talking with her about food and fads, nutrition and practical and easy changes we can all make. Melissa also hosts the podcast Sound Bites and features Stacey in her latest episode.
In our Community Connection, a family devastated by their toddler’s diagnosis becomes inspired by her. We’ll talk to Team Olivia, nine people running the NYC Marathon! Isabel & Mike Klingshirn share their daughter’s diagnosis story and Olivia’s aunt, Abby Wallisch talks about putting the team together.
Stacey also confirms that Ross Baker finished his incredible goal of running a marathon in every state and DC. He says “51 and done!” Ross was diagnosed with type 1 as a young adult – you can hear his story in this previous episode.
In our Shoptalk segment, learn about the DRI Foundation, part of the Diabetes Research Institute as Stacey talks to senior vice president Lori Weintraub.
3:00 Stacey reads a “not so hot” Apple Podcast Review
9:30 Stacey talks about the Diabetes Empowerment Summit (more info and signup at link)
12:00 Interview with Melissa Dobbins, Guilt Free RD
39:00 Community Connection: Team Olivia & the NYC Marathon
58:00 Shoptalk with Diabetes Research Institute Foundation
1:06:00 Stacey talks about podcast reviews & subscribing
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Stacey: Melissa thanks for joining me. I think this is going to be a lot of fun. I’m glad to talk to you.
Melissa: Oh Stacey, thank you so much for having me on your show. I can’t wait.
When we talk about food and nutrition there are so many different topics and directions we could go but let’s just start with you. Why was this interesting enough to you to make it your career?
I remember being in high school and watching infomercials with people selling pills and powders and books and products and wondering what it was all about.
I grew up studying ballet. I am from a very artistic family. My father was an actor, director and playwright. My mom is the visual artist, graphic artist. My brothers were musicians. And so I was a ballerina and I wasn’t even going to go to college. I went to a performing arts high school where I saw all kinds of crazy nutrition diet stuff. I remember thinking to myself, there should be somebody here to talk to us about food; there should be somebody here to talk to us about the emotional stuff that goes along with food. I didn’t know what a dietitian or a counselor was.
I like to say I survived that performing arts high school. I went back to regular high school for my senior year and had an excellent chemistry teacher. I’ll never forget, Mr. Rudolph. He kind of looked like Kris Kringle, which was kind of funny is it was Mr. Rudolph. He was just the best teacher and he made me love chemistry.
I had moved around a lot growing up. I had gone to three different high schools and all of a sudden it was like bam. I’m going to college. I was never going to go to college and everything kind of happened really fast. So I said “Well, I’m good at science and I have to make a decision.” So I went into college as a pharmacy major because that’s what all my chemistry classmates were doing. I barely survived, about three semesters of organic chemistry and biochemistry before I realized this is going to be the death of me.
I went to my college counselor and I said, ‘Okay, I’m good at science, but I want to work with people. I don’t want to be in a lab somewhere. This is just really abstract. I just don’t get it.’ And he said, ‘Well, you should look into dietetics.’ And I said isn’t that a book by L Ron Hubbard? I’m serious. I thought I’m like dietetics, right? So for those who don’t know that’s “Dianetics” and so he’s like no, no, no, check this out. I enrolled in a few classes and then I made the mistake of volunteering at the local hospital where they put me on the tray line. And I thought gosh, you have to have a college degree to plate up food. I’m so confused, you know. Long story short, as soon as I took some nutrition classes and most of all saw the campus dietitian in action. She was helping a group of sorority girls talk about like body image. I was like, that’s what I want to do. I want to help people sift through all this nonsense and craziness and you know, take care of themselves in a way that’s healthy.
I’m fascinated by the ballerina experience and I want to go back to that because you must have seen many difficult eating situations firsthand. But do you have a personal connection to type 1 diabetes? Or any diabetes?
My grandfather was diagnosed with type 2 when he was 80. Which was probably right around the time that I got out of grad school and started working as a clinical dietitian. I worked as a clinical dietitian for a couple of years and then had my dream job as an outpatient dietitian. A short time into that job, I covered for a colleague in our Joslin Center for diabetes. That’s when I realized I love working with people with diabetes. I was getting kind of burnt out on eating disorders and weight loss and I just was like wow, this is so interesting and I can really help people. I can really empower them. It was so rewarding and that’s when I became a Certified Diabetes Educator, back in 1997. I’m happy to say I have maintained that credential for 20 years, which is not easy.
Aside from my grandfather who got diagnosed with type 2 at the age of 80, my father who since passed away, was diagnosed with type 2 in his early to mid 60’s. But my niece was diagnosed with type 1 when she was 14. Now my father and my niece didn’t happen until I had been a CDE for over 15 years. So yeah, it was it really wasn’t because of any direct personal experience. It was really that that work experience and just seeing what a huge difference I could help, I could make in people’s lives that they could have a more fulfilling positive life, quality of life.
Did your niece’s experience change your perspective on working with people with type 1 at all?
Not really. Most of my work with diabetes is type 2. I have done a little bit with type 1 but as you know, the majority of people with diabetes have type 2. So I was in, even though I worked initially at the Joslin Center for Diabetes, I was really based in a more general setting. If somebody had type 1 they were going to go to our Joslin Center, they were going to go see a specialist. I was seeing more of the typical type 2s until about 2011 when I worked in a high-risk OB clinic and a lot of that was gestational diabetes. There were some type 1s on pumps who got pregnant and some multiples and things like that, but the majority of my experience has been type 2. So when my niece was diagnosed with type 1, I was just at a loss. I was like, I don’t even know where to begin to help you. I did an interview on my podcast with my niece and my sister-in-law to delve into their story and kind of how that all unraveled. Well, not unraveled, I mean unfolded.
There’s a lot of unraveling.
Yes! It was a really hard interview for me to do because it, it was a very emotional situation and I felt helpless. Even as a CDE, I felt helpless and I remember calling a friend of mine whose son had been diagnosed around the age of nine or ten. I said to her, ‘What do I do? How do I support my niece and my sister-in-law and my brother and my other niece?’ I was thinking about sending a care package. And she said, ‘Great, idea, make sure it has nothing to do with diabetes.’
That was the best advice I ever got because I realized, I just need to show her my love, my support, and that there’s more to her than this. My daughter and I went to Walgreens and we got magazines and nail polish and blankets and fuzzy slippers and things like that.
That is such a great bit of advice. Because you know, you want to be reminded that life goes, on it’s going to be okay and that you as the aunt, you’re still seeing them as people, not the diabetes people.
In 20 years as a CDE, is there any advice that you give people that has changed significantly since you started?
Yes, a couple of things. The biggest thing I’ve seen in my 25-year career is the emergence or the detection of vitamin D deficiency and the changes in the recommended daily amounts. The recommendations are higher than they used to be but they probably still need to be higher. A large portion of the American population is Vitamin D deficient. The only way you know for sure is to go to your doctor and have your levels checked. I’m in Chicago, I don’t get a lot of vitamin D from the sun and that’s our primary source. So especially if you’re in a Northern part of the US, we’re not getting enough vitamin D from the sun. Also because we use sunscreen, we cover our bodies, so that we don’t get skin cancer or things like that.
The other problem is because the primary sources the sun, it’s really not found much naturally in foods. And then you know, some foods are fortified like cow’s milk vitamin D is added to that. But it’s almost impossible to get the amount that we need from food alone. So, if you do have a deficiency, you do need to supplement and in my field we try to say food first; try to have a balanced diet. But no one has the perfect diet – I’m a dietician and I don’t – so if there are some deficiencies here and you might need supplementation. Case in point, about 15 years ago, I was diagnosed with a B12 deficiency and I’m not a vegan or vegetarian and B12 comes from animal foods. It’s important to work with your health care provider and see what your levels are
Is Vitamin D deficiency particularly troublesome in people with diabetes?
There is research looking into the connection. In fact, I just did an interview for Everyday Health on calcium and diabetes and when I was looking into the research on that, it’s not just calcium, it’s calcium and vitamin D together, decreasing the risk for developing type 2. Now type 1, as you know, it’s a completely different disease. So there is some research looking into the connection between vitamin D deficiency and the incidence of type 1 diabetes. But vitamin D deficiency is hard to detect and the symptoms are kind of vague. It may be closely related to cancer and MS and other diseases, so it’s really important that people know if they’re vitamin D deficient or not. And the one thing that’s really important is if you do go to your doctor to get your levels checked, and you are deficient, you need a prescription level dose to get you back up into the normal range, and then you need to go on a maintenance dose. People say, “Oh, well, I’m deficient, I’m just going to take an over-the-counter supplement.” That might not be enough to get you back up. So that’s something people can talk to their doctor about.
What else has changed?
I first became a dietitian back in 1993, when I started my hospital job. Shortly after I started is when carbohydrate counting came about. So I was learning how to do, you know, it’s clinical so mostly tube feedings or the ADA diet the American Diabetes Association diet. I remember clearly when that changed, another dietitian trying to explain to me that a carbohydrate is a carbohydrate and I was just like what? Wait, there’s sugar and there’s simple carbs and complex carbs. What do you mean a carb is a carb? But once I kind of wrapped my brain around it, I realized this is good. Previously, the exchange diet, which most people are probably familiar with, gives you a certain number of roots, a certain number of vegetables, certain number of grains, certain number or certain amount of protein. But nobody eats this way every day. Even as a dietitian, it’s challenging. But carbohydrate counting gives people a flexibility on how they want to spend their carbohydrate allotment per meal and per snack. And I just feel like it was a complete game changer.
We came into diabetes in 2006 when it was still kind of mixed. I knew, I knew people who were still doing a little bit of exchange. I knew people using older insulins who really had toe “eat to the insulin” with set meal times and amounts. Whereas we jumped right into carb counting and I can’t imagine doing it any other way for a two-year-old. It was so much easier than I think it could have been. Although in the beginning we counted every single carb. We measured ketchup and counted out peas. Until I went back to my doctor month later. He laughed and say, Stacey, you’re doing great, but simmer down.
Well, of course. It’s scary!
What about the lower carb trend? What you think of super low carb? I think there are a few different ways to look at this. We in America all probably eat too many carbs to begin with. But I’m talking about a low-carb high-fat plan where people are trying to get in fewer than 30 carbs a day. Where do you come down on that as a dietitian?
First of all, I completely agree, as a nation, most of us are eating way too many carbs; whether you think they’re good carbs bad carbs, whatever, we eat way too many carbs. What I recommend for people with diabetes is what I recommend for everybody: just have a little bit more balance in the diet. Maybe you need a little bit more protein. Maybe you don’t, but when it comes to specific diets or types of diets, like low carb, paleo, vegetarian, that sort of thing. The first thing I would ask an individual is what’s your preference? If you really like a vegetarian lifestyle diet, I need you to know that you’re probably going to have more carbohydrate in your diet then somebody else so it might be a little bit more challenging for you to control your blood sugars. If you tend to like more of a Paleo, that’s different too. Of course, I’m talking the extremes.
With a Paleo diet you will have fewer carbs and it might be easier for you to control your blood sugars. So, I like to start with you know, what what’s your tendency? What’s your preference? Where are you at? Because if you’re trying to do something that is completely different than what you tend to like, it’s going to be hard to to sustain. At the end of the day, research shows kind of all diets work and no diets work. In other words, the only diet that works is one that you can live with. That’s why it’s so individualized.
I encourage people to kind of experiment a little bit; maybe try to cut down on some of your carbs. Try moving towards that and see if that works for you. As a starting point, think about half of your calories from carbohydrates and spread them throughout the day. See what that looks like. If it’s too much carb for you, go ahead and cut back. My concern with the really low carb like 30 grams a day is, not only do I see anything extreme as almost impossible to stick with, our brains need glucose and our bodies need carbs for energy. So if we don’t give our body that then it has to break it down from our protein and fat stores. I don’t know that there’s a lot of research that shows this is not the healthiest way to provide energy for your body. But if you eat this way and you like it and you feel good, who am I to judge? Everybody is the master of their own body and their own preferences.
I will say to make sure you’re not fooling yourself into thinking that this is what you have to do in order to be healthy. There’s a lot of different ways to eat and be healthy.
What I hear a lot with those really strict carb diets is that you’re going to reverse diabetes or cure diabetes. That’s when I just like lose my you-know-what. Because I don’t want to give people false hope. With diabetes, yes, you need to do the best you can with diet and exercise and taking the medications that you’re prescribed in the proper amounts and as prescribed. But this whole concept of well if I just do this, I can get off insulin or get off these pills – I just like to take a step back.
Let’s say, you have high blood pressure, and it wasn’t a salt related high blood pressure, it’s genetic, it runs in your family. You have high blood pressure. Would you be saying, ‘If I just do XYZ and I’ll get off the blood pressure medication or other medication?” We don’t see that. Sure, people are concerned about side effects. Absolutely. We don’t just want to load up on a bunch of pills, of course not, but we see this reluctance especially in diabetes. There are medications for a reason. There are different kinds of medications that work in different ways. And that’s a tool in the toolbox that I want people to feel good about using and not feel as though the whole goal is to get off of that medication.
Exactly. You don’t fail if you need it. If you’re trying and you’ve changed your lifestyle and you realize that nobody’s perfect. There is this shame, I think, that’s in diabetes. That’s not around high cholesterol. That’s not around high blood pressure. It’s amazing to me.
Melissa, one of the things I really enjoyed seeing was that you were talking at some of these conferences that we all go to, to health care providers about social media. How difficult is it to get some of these doctors, health care providers to be okay with even little logging on to Twitter? It must be such an interesting discussion.
Oh, it is and it’s something that I’m very passionate about. Several years ago. I was asked by Today’s Dietitian magazine to write a 4,000-word article on diabetes and social media. I was thrilled and I cranked out a draft and you’ll understand, there’s a difference between social media and mobile health. Social media we’re talking like Twitter, Instagram, Facebook. Mobile health means things like software and apps and things that have data you can share with your healthcare provider.
So I wrote my outline and that was approved and I clarified that I can talk about social media and that mobile health is not my arena. But later, my draft was rejected because they decided they wanted to go more in the mobile health range. But the beauty of this, and this is really how I live my life, things happen for a reason. One thing leads to another we may not see what it is at the time but be open to the journey, right?
So I was like, wow, you know that was a lot of work, but when I was writing that 4,000 word article, I interviewed people like Hope Warshaw, Joe Weisenberger, Toby Smith’s son, other colleagues of mine, Manny Hernandez, who have diabetes or are diabetes educators who work in that space. Doing that told certain people in that arena that I’m really passionate about this topic and that led me to speak at AADE in New Orleans, which was three years ago.
I did a presentation on social media and diabetes and then I did a workshop with Hope Warshaw who’s written many, many books about diabetes. She’s the RD CDE guru and we had over a hundred people in the room, and we had tables of 10, and we had a leader at each table, to kind of help people log into Twitter and learn why they should do this. To learn the importance of meeting people with diabetes where they’re at. We need to make sure that to be plugged in and in that space. And it was so well received that right after that session, they said let’s do this again next year in San Diego. So I did it again in San Diego and that’s when I realized we needed a different way. With a table of 10 there’s still 10 different experiences. One person doesn’t want to do Twitter. They want to do Pinterest. Or someone’s been on Twitter, but they forgot their login. Or someone’s got an Apple. Somebody’s got Android. I said we need a booth at the expo hall with a techie guy and a CDE and we need to walk people through this one-by-one.
Because diabetes educators oh my God, they are the salt of the earth. They will do whatever they can to help their patients and clients, but a lot of them don’t get the social media thing. Who does, until you dive in and do it? You learn by doing. And that flies a little bit in the face of science health educators, because we are not trained that you learn by doing. We are trained here’s the science. Here’s how you do it. You practice, practice, practice, and then they release you to into the wild. It’s just a whole different mindset. It’s not as rewarding as working with somebody with diabetes, but it’s almost as rewarding to work with a diabetes educator and say, okay, let’s think about this differently. Here’s how we can approach this; it doesn’t have to be a time suck. You can make it work for you. Where are your patients? What are your passions? And just see them go, ‘Oh, wow. I’m so excited. Now. I know how to help my patients.’
That’s fantastic. Melissa, before I let you go, one more question for you. Did I read that you are taking ballet again?
Yes, after a 25-year hiatus, a couple of years ago. I went back to ballet. It started off as a midlife experiment of running, which I hate and that led to a triathlon which is a really strange way that that that came about. I’m the last person you would think to do something like that. And when I did that which I will say two things. Doing a triathlon is a little crazy, but also well, I did a sprint triathlon. So it’s a very short one. But it’s still like a 5K run and a 20K bike I think, and at least 15 minutes of swimming. I mean, it’s a little crazy. But at the same time, having done it, I firmly believe anybody can do one if you train for it.
And as a side note, I heard Jay Hewitt speak several years ago; he’s a triathlete, and he has type 1 diabetes. He was so inspirational and I just sat in the audience going, ‘Oh my God, I’m so lame.’ This guy is ripping off his wet suit and making sure his insulin pump doesn’t come out and you know, he’s crashing, like literally not crashing his bike but crashing his blood sugars and has it go to the medical. And he finishes and it’s so inspiring. He planted a seed. It was years before I acted on it. But that seed was growing in me for a long time going, ‘this guy’s amazing. I need to, I need to run because I can.’ After I did this triathlon I though, “Oh my God if I can do that, I can go back to ballet.” And so I did and I have been loving it. So amazing.
I love it,. Melissa, thank you for joining me.
Oh, my pleasure. It’s been so great talking with you.