Colonoscopy prep; diabetes basics; a quick, healthy recipe: Upstate Medical University's HealthLink on Air for Sunday, Oct. 23, 2022
Colorectal surgeon Kristina Go, MD, discusses preparation for colonoscopy. Family nurse practitioner Dana Lonis and pharmacist Peter Rosher talk about diabetes and its management. Registered dietitian nutritionist Katie Krawczyk shares an easy recipe for healthy mini-quiches.
Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," a colorectal surgeon discusses how to prepare for a colonoscopy.
Kristina Go, MD: ... In order for a patient to have a clean colon, they literally need to flush out any kind of solid and liquid waste, so that we can see the clean inside area. ...
Host Amber Smith: A nurse practitioner and a pharmacist explain why recognizing diabetes early is so important.
Nurse practitioner Dana Lonis: ... If you are overweight with a BMI (body mass index) greater than 25, you should be screened for prediabetes and diabetes yearly. ...
Host Amber Smith: And a registered dietitian nutritionist shares a recipe for quiche that's easy to make and nutritious.
Katie Krawczyk: ... Really, every time you eat, you should have a source of protein, in addition to good variety in your diet and enough calories in general. ...
Host Amber Smith: All that, and a visit from The Healing Muse, coming up after the news.
This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith.
On this week's show, we'll explore what's important to know about a diagnosis of pre-diabetes. Then, a fun and healthy way to prepare protein-packed eggs. But first, we learn how to properly prepare for a colonoscopy.
From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."
Many people who have undergone a colonoscopy say the preparation for the test, which screens for colon cancer, was worse by far than the test itself. But there are new methods available today that may make a dreaded task more bearable. Here to tell us about them is Dr. Kristina Go. She's an assistant professor of surgery at Upstate specializing in colon and rectal surgery.
Welcome back to "HealthLink on Air," Dr. Go.
Kristina Go, MD: Hi. Nice to be here today.
Host Amber Smith: I understand that in order to visualize the colon through the camera that you use, doctors need the colon to be empty and clean, but why is it such an onerous task to clean out the colon?
Kristina Go, MD: When we're doing a colonoscopy, I really want to look at the inner lining of the colon, called the mucosa. And so in order for a patient to have a clean colon, they literally need to flush out any kind of solid and liquid waste, so that we can see the clean inside area.
Host Amber Smith: From the time we ingest food, how long does it take to make its way through the gastrointestinal tract?
Kristina Go, MD: The short answer is that it depends, both on the individual, and sometimes it can even be variable within the same person. So, on average, we say in a non-constipated patient that transit time solely through the colon can take about 30 to 40 hours, and even going to 72 to 100 hours can still be considered normal in a patient, depending on any associated symptoms they might have. Now, when I say that it can be variable in the same patient, that can be based on how much physical activity they've had in the day, what kind of foods they've had during the course of the day, whether it be more processed foods or more fluid and more whole grains. And from patient to patient, it can also be dependent on any kind of medicines or underlying medical conditions they might have.
Host Amber Smith: Do fluids, in general, move more quickly through the system?
Kristina Go, MD: They do. They do.
Host Amber Smith: Well, I'd like to ask you about the colonoscopy before we get into the details of prepping. So, you're looking at the lining, and you're looking for polyps?
Can you explain to us what polyps are and what they look like?
Kristina Go, MD: Sure. When I have a patient in my office asking about colonoscopies or other colorectal cancer screenings, when we talk about polyps, really they're clumps of abnormal cells on that mucosal lining of the colon that I was talking to you about.
So, in a normal colon, the inside lining is nice and smooth and you can see the underlying blood vessels, and it can even look pretty shiny during a colonoscopy.
When I see a polyp, they usually look like little bumps, or they can almost look like little mushrooms whenever we're doing the scope.
So, what I tell patients are polyps are abnormal clumps of cells. They can either have the potential to grow into a cancer, which is why we get very excited about doing colonoscopies, to prevent them from turning into cancer.
But then on the other hand, you have some polyps that never turn into a cancer, and we still won't understand that until we remove it from a patient's colon.
Host Amber Smith: So, every polyp has to come out?
Kristina Go, MD: Generally speaking. I wouldn't say that every polyp has to come out, but experience and expertise can let us know which polyps look more suspicious. That's generally based on what kind of size it is, and what the appearance is.
Host Amber Smith: Are there other things that you might discover during a colonoscopy?
Kristina Go, MD: Yeah. So, I have patients who undergo colonoscopies, not just for colon, and rectal, cancer screening or polyp removal. Sometimes they might have diarrhea that isn't explained for other reasons, and we're trying to find that out. I can also see small outpouchings in the colon called diverticula, which could be a whole other talk in and of itself.
I have patients who have inflammation of the colon that we don't really know why, and they might have an underlying condition called inflammatory bowel disease, either in the form of ulcerative colitis or Crohn's disease.
Host Amber Smith: Now, during this procedure, the patient's anesthetized to some degree, is that right?
Kristina Go, MD: That's right. Generally speaking, most patients either undergo something called moderate sedation, where they get certain types of medications, so they're really just mildly still awake and aware of what's going on. They can also undergo something called monitored anesthesia care, where an anesthesia team is still providing them with a special type of medicine called propofol, but it does require some additional expert care during that time. And depending on the patient and maybe their underlying medical conditions, some patients actually need general anesthesia for their colonoscopy.
Host Amber Smith: Now, what are the current recommendations for who needs colonoscopies and how often?
Kristina Go, MD: That's a really interesting source of conversation right now. Currently in the United States, we have several different medical societies that recommend that an average-risk patient get colon cancer screening starting at the age of 45. Now in the setting of colonoscopies, if no abnormalities are seen, that doesn't need to be repeated for up to 10 years.
And those societies include the U.S. Preventative Services Task Force, the American College of Gastroenterology, as well as the American Society of Colon and Rectal Surgeons.
Host Amber Smith: And what makes somebody average risk, or how would I know whether my risk is average or not?
Kristina Go, MD: When I'm talking to my patients, certain questions I ask include, do you have a family history? So, do any of your biologic relatives have a family history of colon or rectal cancer or any kind of large polyp burden? I also ask the patient if they've had any personal history of polyps from their previous colonoscopies, or if they've had a history of colon or rectal cancer. And then, going back to what we talked about before, if they have a history of inflammatory bowel disease, ulcerative colitis, or Crohn's, that also changes what kind of risk factors I think about.
Host Amber Smith: This is Upstate's "HealthLink on Air," with our guest, Dr. Kristina Go. She's a surgeon at Upstate who specializes in surgery of the colon and rectum. And we've been talking about colonoscopies.
So let's talk about the prepping for the colonoscopy. Do I understand correctly that people used to clean out their colons over several days, using laxatives, such as castor oil or magnesium citrate, before they could have this test?
Kristina Go, MD: That's certainly true. And sometimes that's still true to this day, depending on what kind of prep quality a patient has had in the past. We don't use castor oil as one of the FDA-approved medications. Magnesium citrate is still a laxative that is often used, not necessarily for bowel prep, but for othersources in the colon and rectal world.
Host Amber Smith: Have most patients had to drink a special beverage, that is not known to taste very good, to clean out the colon the day before? Is that typically how it's done?
Kristina Go, MD: The most common bowel prep: You might hear it called GoLytely. It's a polyethylene glycol-based solution, and the most common one is a 4-liter prep that you start drinking usually the day before and often the morning of your colonoscopy.
Host Amber Smith: And then why is drinking a bunch of water along with that part of the prep?
Kristina Go, MD: There's a couple of reasons for that, even if you're taking a lower-volume prep. No. 1, the whole purpose of a bowel prep is to completely clean out your colon. In no euphemistic terms it's really just having a lot of severe diarrhea for the day before, while you're drinking your prep.
So drinking water or fluids keeps you hydrated and can also decrease the symptoms of nausea that can be associated with this type of prep.
Host Amber Smith: The FDA approved a pill called Sutab last year. Is that an option for patients who can't stomach the taste of the GoLytely?
Kristina Go, MD: It is definitely something that is available and that I often prescribe to my patients.
A lot of the times when you are thinking about a bowel prep, or when I'm thinking about bowel prep, I think about a couple of things. No. 1, is it something that a patient can tolerate? No. 2, what is the side-effect profile on these preps? Is it safe for all of my patient population or only certain patient populations?
And then lastly, but I think it's still important, is really the cost of any kind of prep that I'm prescribing to a patient. So Sutab is certainly very effective bowel prep, and that's been shown in certain studies, but it can be cost prohibitive if your insurance doesn't cover it. And so that's also something that we take into account when prescribing these things.
Host Amber Smith: So how does the pill work? Does it do the same thing that the GoLytely does? And is it as effective?
Kristina Go, MD: It's definitely just as effective, and it has a similar what we call mechanism of action as the GoLytely. So both GoLytely and Sutab are what we call osmotic laxatives. So what that really means is that it works by causing water to stay within the colon and be retained in the stool.
And so if you have a lot of fluid in there, you're really giving yourself diarrhea, but for the purposes of cleaning out a colon, it's very effective.
Host Amber Smith: What is your preferred method?
Kristina Go, MD: I generally have patients do a lower-volume source, similar to GoLytely. I use something called MiraLax. It's a flavorless powder, and I ask my patients to dilute it in any kind of Gatorade or clear liquid of their choice, so long as it lacks any red or purple food coloring. And then I ask them to basically drink that for about every 15 minutes until 64 ounces of it is gone.
The other part of that prep is that a patient needs to drink clear liquids, as in nothing that is opaque, nothing with any kind of solid components to it, for the entire day before the day of their colonoscopy.
Host Amber Smith: You mentioned the red and the purple. Why do you have to avoid those before the colonoscopy?
Kristina Go, MD: That can definitely change how the mucosa looks. The inside lining of our colon is a pink color, so that can have the potential of distorting what I see on a colonoscopy.
Host Amber Smith: Other than the bowel prep itself, how do you tell patients to prepare for their exam? Is there any other advice you have?
Kristina Go, MD: Yeah, so in terms of trying to tolerate this amount of liquid that you're having to drink, I give patients some pointers. Some of them work better than others.
So, placing your prep on ice or drinking it through a straw can sometimes decrease how unpalatable the flavor of the prep is.
Sucking on lemon slices or sugar-free menthol candy drops can also decrease that feeling of nausea. And while the instructions on the container of a large-volume prep might say that you need to drink basically a glass every 15 minutes until you're done, that can make patients feel pretty bloated or nauseous. So what I counsel them is, if you're starting to feel a little bit full or unwell, it's certainly OK to space out how quickly you're drinking all of that prep.
Host Amber Smith: Is there anything different that people need to do if they're chronically constipated?
Kristina Go, MD: Sometimes I recommend that they drink clear liquids for more than just the 24 hours. If a patient has told me that they have chronic constipation, or if they've had a poor prep in the past, that might change either the type of prep that I give them, or, unfortunately, I might recommend that they do a two-day instead of a one-day prep, all the better to just get it done and have a good colonoscopy versus being told you have to do it all over again within three to six weeks or so.
Host Amber Smith: Do you have any dietary advice for the week leading up to the colonoscopy? Is there anything that people should eat or should avoid?
Kristina Go, MD: I do tell them, even though it hasn't been really backed up by the literature, that they really should avoid any kind of high-fiber, high-residue diets, so exactly the opposite of advice I tell patients in terms of their colon health I tell them to follow during a colonoscopy prep. So, trying to avoid those great, leafy green vegetables and maybe the Metamucil or other types of fiber supplementation that I generally tell patients to take, I tell them to avoid in the week preceding their colonoscopy.
Host Amber Smith: That's interesting. So after the colonoscopy, you go back to the healthier, high-fiber diet, but to prep for it, that's the opposite.
Kristina Go, MD: Exactly.
Host Amber Smith: Well, before we wrap up, can you tell us about colonoscopy alternatives? Are stool-based tests a reliable way to catch colorectal cancer early?
Kristina Go, MD: Certainly. We have a couple of stool-based studies, and what I tell patients when they're exploring non-colonoscopic avenues for colorectal cancer screening is, well, they're certainly an alternative, but if any of these are positive, you still need to get a colonoscopy. So let me preface by saying that in terms of the stool-based tests out there, several fall in the category of just looking for blood in your GI (gastrointestinal) tract.
And so if they're not particularly specific, they might let us know that you have an underlying colon cancer. One of the newer tests looks at the DNA in the stools, called Cologuard. You might have heard of it on commercials. And that actually has a pretty good accuracy in letting us know if there's any underlying colon cancer.
However, it's not as good at allowing us to know whether or not you have polyps in your colon. And again, if any of these are positive, you still need to follow up with a colonoscopy.
Host Amber Smith: What about virtual colonoscopies? Would that be an option for everybody?
Kristina Go, MD: It is an option. Sometimes virtual colonoscopies are also called CT colongraphies, so if you hear that term, it's, basically the same thing. What I tell patients who are considering a virtual colonoscopy, I have prescribed them to some of my patients sometimes if they have a difficult colon to navigate, as an example, but remember in a virtual colonoscopy that you still need to drink an adequate bowel prep to clean out your colon.
And then what happens is that whoever is doing the CT scan has to basically place a tube up your bottom and puff some air into it to basically inflate your entire colon. And the patient is asked to move in several positions while a CAT scan is occurring, so it's not as pain free or as lacking in being inconvenient or uncomfortable as patients might think. The other part, again, is the same as the stool-based studies, is if we see something concerning, you're still going to need a colonoscopy to be scheduled.
Host Amber Smith: Well, Dr. Go, this has been very informative, and I appreciate you making time for this interview.
Kristina Go, MD: Well, thank you very much. It's been a great chat.
Host Amber Smith: My guest has been Dr. Kristina Go. She's an assistant professor of surgery at Upstate specializing in colon and rectal surgery. This is your host, Amber Smith, for Upstate's "HealthLink on Air."
Could you have pre-diabetes? Next, on Upstate's "HealthLink on Air."
From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." Many of the people who have diabetes are undiagnosed and untreated. This is a disease that can have an impact on all sorts of other conditions, so being aware that you have developed diabetes or that you're at risk is important. Here to explain why is Upstate family nurse practitioner
Dana Lonis and Peter Rosher, who's a pharmacist specializing in endocrinology. Thank you for being here, both of you.
Nurse practitioner Dana Lonis: Our pleasure.
Pharmacist Peter Rosher: Thank you.
Host Amber Smith: I've heard that up to one in three adults has prediabetes. Can you tell us what that is? Ms. Lonis?
Nurse practitioner Dana Lonis: Sure. So, prediabetes is a serious health condition where the blood sugar level is higher than normal, but not high enough to be diagnosed with the disease. A normal -- we use an A1C (hemoglobin) level -- is below 5.7%. A level between 5.7% and 6.4% indicates prediabetes. And if you're higher than that, then you would be diagnosed as a person living with diabetes.
Host Amber Smith: So if someone's provider tells them they have pre-diabetes, that doesn't necessarily mean they will develop diabetes. They can take action to turn things around, it sounds like.
Nurse practitioner Dana Lonis: Yes, they can. The link for that person being likely to develop diabetes is there, however. So it's definitely a precursor to type 2 diabetes, and we want to make sure that people take that very seriously. Like I said, it is a serious health condition where your blood sugar level is higher than normal. It hasn't gotten to the point where we're going to diagnose you with diabetes, but it's telling us we have to make changes.
Host Amber Smith: So how do people usually learn that they have prediabetes? Are there symptoms that bring them to a doctor's or a nurse practitioner's office?
Nurse practitioner Dana Lonis: There are definitely symptoms associated with type 2 diabetes. A lot of times in the pre-diabetes phase, folks will not have symptoms, so these numbers will be picked up on screenings at your primary care physician. A lot of times people do not know that their numbers are abnormal because they're not high enough to create symptoms at that point.
Host Amber Smith: Now, is this a concern for adults, or would children, perhaps, be diagnosed with pre-diabetes as well?
Nurse practitioner Dana Lonis: In the past, type 2 diabetes was also known as adult onset diabetes, because most people developed it later in life. But increasingly, certain lifestyle choices and habits have put children at risk for prediabetes and type 2 diabetes. Both the CDC (Centers for Disease Control and Prevention) and the American Diabetes Association have identified what these risk factors are. They mostly include being overweight and not being physically active.
Host Amber Smith: So at the point of pre-diabetes, Mr. Rosher, are there any medications that may be prescribed for someone at this point?
Pharmacist Peter Rosher: Yes, there are. One would be metformin, depending on the risk, but I think the biggest factor if you're pre-diabetic would be lifestyle changes, things like exercise and diet education would help with trying to prevent the onset of diabetes and reverse prediabetes.
Host Amber Smith: Now, you used the word metformin, and I've heard that before. It's of common medication, but what is it and what does it do?
Pharmacist Peter Rosher: It helps with the sensitivity of insulin that your body already makes. It's pretty benign. The biggest side effect of it may be some GI (gastrointestinal) irritation, some nausea, vomiting, increased bowel movements. But it is generally well tolerated, has been around for many years, and I think that, if it's needed, it is a great medication. And it's relatively inexpensive.
Host Amber Smith: Well, Ms. Lonis, what are the most common signs and symptoms that prediabetes has evolved into Type 2 diabetes? What do you monitor to tell when that has happened with somebody?
Nurse practitioner Dana Lonis: So if you're looking for the symptoms for when a person's actually coming into the disease, you're going to look at what we call the three P's -- increased thirst, increased or frequent urination and increased hunger. Other signs and symptoms could be fatigue, blurred vision, numbness or tingling in your feet or hands, frequent infections, slow healing ulcers or sores, and, occasionally, unintended weight loss. The three P's that we speak of are more medical terminology, which is polyuria, polydipsia and polyphagia, which are the three things that I just described.
The other thing that primary care providers want to keep an eye out for is any darkening of the skin, in skin folds or in the underarms. This is often due to a condition called acanthosis nigricans, and it causes your skin to be thick and dark in the folds in the body. Carrying extra weight makes your body more resistant to the effects of insulin. High levels of insulin in your blood can lead to increased production of skin pigment cells. So if you're seeing that in yourself or in a patient, you would want to report that to your primary care so they can then check an A1C to make sure that you aren't a person who is in the pre or diabetes phase.
Host Amber Smith: You listed a lot of signs and symptoms. Do most people have more than one of those?
Nurse practitioner Dana Lonis: Most people, if they're living with pre-diabetes, probably have no symptoms at all, other than if you are overweight with a BMI (body mass index) greater than 25, you should be screened for prediabetes and diabetes yearly. But those other symptoms, yes, you will oftentimes have those together. The thirst, the frequent urination, the hunger, fatigue, blurred vision -- those things a lot of times will be together.
Host Amber Smith: You said the A1C. Is that a blood test?
Nurse practitioner Dana Lonis: Yes, ma'am. It's a blood test. It's a blood test that tells us essentially how much sugar is attached to hemoglobin A in your blood. And it gives us a percentage, which we then use to categorize what your blood sugar's been doing over a three-month period.
Host Amber Smith: So I know diabetes seems to be all about blood sugar ...
Nurse practitioner Dana Lonis: Uh-huh.
Host Amber Smith: ... but it's the pancreas that makes the insulin. So how would somebody know that their pancreas was working effectively, or if it wasn't?
Nurse practitioner Dana Lonis: Well, a screening at your primary care is extremely important, which will show us blood levels of glucose. But if you're looking to know, after you've been diagnosed, what blood tests can be done to see if your pancreas is still making insulin, we have a blood test called the C-peptide. And it's measured to tell the difference between insulin that the body produces and insulin that's injected into the body. We use that, oftentimes, in the hospital environment, especially, to try to delineate between type 1 diabetes and type 2 diabetes. But your C-peptide level will be able to generally tell us if your body is still producing insulin or if your pancreas is still producing insulin.
Host Amber Smith: What effect does diabetes have on the heart and blood vessels?
Nurse practitioner Dana Lonis: Well, high blood sugar comes, oftentimes, with other things that it's associated with, such as high triglycerides, high blood pressure, high cholesterol, overall. All of these things can damage your blood vessels and nerves. They can damage the small blood vessels that nourish your nerves with oxygen and nutrients, and they can also promote atherosclerotic disease in your larger blood vessels.
Host Amber Smith: And what does diabetes do to the kidneys?
Nurse practitioner Dana Lonis: Well, the blood vessels inside your kidneys, there are millions of tiny blood vessels. So over time, high blood sugar can cause those vessels to become narrowed or even clogged. Of course, if your kidneys aren't getting enough blood, the kidney then becomes damaged, and we can see that by the buildup of something called albumin, which is a protein that passes through those tiny little filters in your kidney and ends up in your urine. So we oftentimes will, in those screening phases, we'll check your urine for any type of protein or albumin.
Host Amber Smith: .This is Upstate's "HealthLink on Air" with our guest, Dana Lonis, who's a family nurse practitioner at Upstate, and Peter Rosher, who's a pharmacist specializing in endocrinology. Our subject today is management of diabetes.
Mr. Rosher, I'd like to talk now about how diabetes type 2 is treated. What medications are typically used, and what do they do? You already told us about metformin, but are there some other common ones?
Pharmacist Peter Rosher: Yes. First of all, they would probably start with some drugs called (sodium-glucose cotransporter-2) SGLT2 inhibitors and (glucagon-like peptide 1) GLP-1 agonists. And they are the forefront of diabetes therapy right now. But the downside is they're a lot more expensive. They will also use sulfonylureas, and they are cheaper and older, but still very good. The downside with those is that you might become hypoglycemic (have a low blood sugar level). So, every plan that is developed for patients has to be patient-specific of what they can afford and what side effects they can tolerate. So each plan is individualized per patient.
Host Amber Smith: If someone starts taking an insulin for diabetes, is this a lifelong medication that they'll always be taking an insulin?
Pharmacist Peter Rosher: Great question. Not always. If it's type 2 diabetes, then you're able to make lifestyle modifications through diet and exercise, you can likely come off insulin, with a reduction in weight. If you are a patient with type 1 diabetes, then you produce no insulin, and you would need to be on some form of insulin.
Host Amber Smith: So, have you ever seen a patient get their diabetes under control and be able to come off the medications that they've been taking?
Pharmacist Peter Rosher: Yes. Some people are very determined and make huge lifestyle modifications and are able to reverse their diagnosis of diabetes and just treat it with diet and exercise.
Host Amber Smith: I've heard about insulin pumps, and I'm wondering what can you tell us about how well those work for people and if they're being used across the board?
Pharmacist Peter Rosher: They are one of the great modern medicine advancements that we've had in the last 20 years, and you're able to basically mimic a pancreas, not completely yet, but 90% of the way. It tackles your hepatic blood glucose production by giving insulin throughout the day. And then if you're eating, it can administer, extra bolus doses to attack the carbs that you're eating in your meals. And then in combination with continuous glucose monitors that monitor your blood glucose continuously, there can become some systems that are closed-loop and can even adjust the insulin pump based on your current blood sugar.
Host Amber Smith: Are most people with diabetes candidates for using a pump?
Pharmacist Peter Rosher: There's a lot involved with it. It is intensive therapy. You have to be cognitively evaluated to be able to manage it. Some people find it easy, and other people find it more difficult, so it's, again, patient-specific.
Host Amber Smith: Ms. Lonis, what concerns do your newly diagnosed patients have?
Nurse practitioner Dana Lonis: Well, it's overwhelming. And people are scared and nervous about what the next steps are. So reassuring them that there are many proven ways to tackle this disease, and that there is a community that they can fall back on, you won't have to maneuver this disease by yourself. You have this support of countless others who have felt the same shock you're feeling. And that there are, generally speaking, a regimen for anyone. So, like Pete was describing, some people will want to use the advanced technologies of a pump. Some folks would want to do more traditional types of diabetes regimen. No matter what your lifestyle preference is, we can generally find a regimen that will work for you.
Host Amber Smith: Let's talk about complications that can develop from diabetes that is not properly managed. What types of issues are the most common that you try to warn your patients about?
Nurse practitioner Dana Lonis: Well, the most common things are going to be macro- or microvascular damage. And those things can lead to very serious complications, as we've already discussed. We can have kidneys that don't function properly. We can certainly have eye damage, nerve damage, liver disease, heart disease, stroke. Oftentimes we call the ABC's of diabetes -- the A1C is the A, the B is blood pressure, and the C is cholesterol -- so the high blood pressure and the cholesterol elevation are also, oftentimes, diagnosed at the same time diabetes is diagnosed. Those are very serious complications, if you don't manage your diabetes properly, that you will be faced with.
Host Amber Smith: I'd like to ask about risk factors for diabetes. Does this disease run in families?
Nurse practitioner Dana Lonis: It does run in families. And there are risk factors. Mostly, two that I already described, which is a sedentary lifestyle and being overweight. Also, having high blood pressure, high cholesterol. If you use alcohol, heavy use of alcohol can also be associated, and some adults who haven't gotten the proper sleep have also shown to be more likely to develop diabetes. So those are certainly some risk factors.
And as far as running in families, it has been shown, especially with a person living with type 2 diabetes, that that can run in families. What hasn't been shown is exactly what the link is and whether or not that is just related to the fact that most families eat the same or maybe don't exercise enough together. We aren't exactly sure of that link. I hope that answers your question.
Host Amber Smith: Well, what is your best advice for how to prevent diabetes? I know you're going to say to be active and ...
Nurse practitioner Dana Lonis: Uh-huh.
Host Amber Smith: ... maintain a healthy weight. Are there particular foods to avoid or particular foods to eat, or anything other that someone can do to take action to hopefully prevent diabetes?
Nurse practitioner Dana Lonis: Certainly, as you describe, having an active lifestyle is one of the best things you can do. If you're in the pre-diabetes phase and you're overweight, obviously losing weight is very helpful. Choosing drinks that do not have sugar. if you're going to eat high-carbohydrate foods, maybe higher-fiber carbohydrates. Cutting down on red or processed meat. Eating plenty of fruits and vegetables. Be sensible with alcohol. And maintain a healthy weight, a BMI less than 25, maybe greater than 18.5.
Host Amber Smith: Well, that's helpful advice. I want to thank both of you for making time for this interview.
Nurse practitioner Dana Lonis: My pleasure.
Pharmacist Peter Rosher: Thank you. My pleasure.
Host Amber Smith: My guests have been Dana Lonis -- she's a family nurse practitioner at Upstate -- and Peter Rosher. He's a pharmacist specializing in endocrinology. I'm Amber Smith for Upstate's "HealthLink on Air."
Next on Upstate's "HealthLink on Air" -- step-by-step instructions for making mini-quiches.
From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." Nutrition is important all the time, but it can be especially challenging for someone who is in cancer treatment. Today, I'm talking with Katie Krawczyk. She's the Upstate Cancer Center's registered dietician nutritionist, and she agreed to share a quiche recipe that's easy to prepare and very versatile. Welcome back to "HealthLink on Air," Ms. Krawczyk.
Katie Krawczyk: Thanks for having me, Amber.
Host Amber Smith: Now, please tell me why you like to share this particular recipe with patients.
Katie Krawczyk: I love to share this recipe for a little mini-quiche, or an egg muffin, whatever you want to call it, because it's so versatile. And, it gives patients a little bit more of an appetite when I say, "OK, let's incorporate some protein foods into your diet," and we talk about eggs, and oftentimes patients will say, "Well, I'm sick of scrambled eggs in the morning." So this recipe is very easy and allows a patient to really adjust it to the flavors that they like.
Host Amber Smith: Well, without the traditional pie crust of a quiche, does that help reduce the calories?
Katie Krawczyk: Without that base, there will be a little bit less calories, but I think that it makes this recipe very easy to prepare without that kind of pie crust.
Host Amber Smith: Now, obviously this recipe has eggs, so I wanted to ask you about the nutritional value of the egg, because I've always heard it's a "complete" source of protein, but what does that mean, complete?
Katie Krawczyk: Complete protein is when it contains the nine essential amino acids that our body cannot produce on its own. So amino acids are the smaller component to a protein. Most sources of complete protein come from animal products.
Host Amber Smith: Is protein extra important during cancer treatment?
Katie Krawczyk: Protein is very crucial during cancer treatment. You want to make sure that really, every time you eat, you should have a source of protein, in addition to good variety in your diet and enough calories in general.
Host Amber Smith: Well, let me ask you to sort of help us compile a shopping list. I know a dozen eggs is at the top of that list. Would an egg substitute work?
Katie Krawczyk: A substitute would work perfect in this recipe as well. So you can use either your regular eggs that we're going to crack, or you can use the liquid eggs.
Host Amber Smith: And then what else do we need?
Katie Krawczyk: With this recipe, we'll also have 1/2 a cup of heavy cream, 1/4 cup of milk.
Host Amber Smith: Let me ask you on the milk, if you don't mind, does it need to be cow's milk or can you use a milk substitute?
Katie Krawczyk: Use any milk substitute that you're used to having in your home, whether that be almond milk or soy milk or any other lactose-free milk, as long as it's unflavored.
Host Amber Smith: Now, if someone has lactose intolerance making this recipe, can they omit the heavy cream?
Katie Krawczyk: Yes, you can take that heavy cream out and then just increase that 1/4 cup milk to 1/2 a cup of milk, or that lactose-free milk that you might be using.
We'll also add some fresh parsley and basil, 2 tablespoons each, but you can also use dried spices here, whether that be oregano or an Italian blend, or garlic powder also works well. And when using the dried spice, we can reduce that amount from the 2 tablespoons with the fresh ingredients, fresh herbs, to about 1 teaspoon.
You can also add 1/4 teaspoon of salt and pepper, and 1 cup of cheese.
Host Amber Smith: Now on the cheese, what flavor cheese do you recommend?
Katie Krawczyk: Again, this recipe is very versatile. So whatever cheese that you like, whether that be cheddar or mozzarella or Gouda -- those all work really well here.
Host Amber Smith: Now, does it matter if you're using no-fat cheese or low-fat cheese or an alternative to cheese made with cow's milk?
Katie Krawczyk: That depends on, kind of, patient to patient. If you are a patient who is struggling to maintain weight, go with that full fat. If you are a patient who would like to watch the waistline, then choose the lower fat. So either way, this will cook up really nicely.
Host Amber Smith: Now, what about the vegetables?
Katie Krawczyk: For vegetables, again, this is really versatile. You can even do a variety within these kind of muffin tins that we're going to be creating. You can have different flavors within each one. So some good choices include broccoli, spinach, red bell pepper, onion. And if you're looking for a little bit more flavor, you can even add a jalapeño pepper.
Host Amber Smith: So it sounds like you can look at what you have in your refrigerator and see if that would work. Or go to the store or the market and pick whatever catches your eye.
Katie Krawczyk: Absolutely. And these will be really colorful too, to catch your eye.
Host Amber Smith: Could someone add meat if they wanted to? I'm thinking chopped up bacon or ham or ground beef, for instance?
Katie Krawczyk: Absolutely. A good combination might be bacon, cheddar and mushroom, for example. Or, yes, you can use sausage or ham. And then other ideas for vegetables: You could add zucchini right now is in season, tomato, potatoes, white or purple onion.
Host Amber Smith: Now this recipe has 12 eggs, and it's meant to fill a 12-section muffin tin. Could you double the recipe if you wanted to make, like, 24 of these mini-quiches at once?
Katie Krawczyk: Absolutely. And I would recommend that because these quiches can be a grab-and-go snack or meal. So if you want to make extra, they freeze really well. And then you can just take them out of the freezer to thaw and then microwave for about 30 seconds when you want to enjoy them.
Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, amber Smith. I'm talking with Katie Krawczyk. She's a registered dietician nutritionist who works at the Upstate Cancer Center, and she's sharing with us a quiche recipe that she likes to share with her patients. Listeners can find this recipe connected to this interview on our website at upstate.edu/informed.
So, now let's talk about the preparation. What kind of pan do you recommend, and do you need to spray it ahead of time?
Katie Krawczyk: To bake this, we're going to use a muffin or cupcake pan, and you do want to spray it with a nonstick spray, or you can utilize butter or coconut oil for each individual little muffin space.
You'll also need a bowl to whisk the eggs and add in all the vegetables and cheese. I like to use my large Pyrex measuring cup because it has a spout that's easy to pour the mixture into the muffin tins. You'll also need a knife and cutting board to chop your vegetables into, kind of dice them into a little bit smaller than your bite size to incorporate into the eggs nicely.
Host Amber Smith: I've heard some people like to saute their onions before they use them in a recipe like this. Do you recommend that?
Katie Krawczyk: You can sauté all your vegetables, including onions, if you're utilizing them. You do not have to, but it will just kind of take away that little bite for onions and make the vegetables a little bit more tender. And then at that time, when you're sautéing, if you want to add your salt and pepper or other dried spices, you can do so, but it is not required. You can just put the broccoli, the peppers and onions incorporated into the eggs without sautéing.
Host Amber Smith: Let me ask you on all the broccoli, spinach, red pepper, whatever you're using: Do the chunks, when you cut them, are you looking for them to be about equal in size?
Katie Krawczyk: Yes. That will just better help incorporate so that you get that flavor of all of your ingredients within one bite.
Host Amber Smith: Also, should the oven be preheating while we're doing all of this? I forgot to ask at the beginning.
Katie Krawczyk: Yes. We're going to cook these at 375, so you can preheat your oven right away, because this is such a quick recipe. So we're just whisking the eggs with the vegetables in there and pouring them into the muffin tins, so we can preheat your oven right away, unless you're going to be sautéing. Even that won't take too long. So your first step can be to turn on the oven to get that heated up.
Host Amber Smith: Now, the cheese is the last thing that you would stir into this, is that right?
Yep. I should ask you, we're talking about shredded cheese, right?
Katie Krawczyk: Yes. You do want your cheese to be shredded, whether you're purchasing that pre-shredded, or shredding it yourself.
Host Amber Smith: All right. So once that is stirred in, I know you work with a batter bowl so that you can easily pour it. if someone doesn't have that, would, like, a ladle work?
Katie Krawczyk: Absolutely -- a ladle or an ice cream scooper.
Host Amber Smith: And how high up should you fill each of the sections?
Katie Krawczyk: Fill each muffin tin to about three-quarters of the way up, or there's a quarter left to that top before overflowing.
Host Amber Smith: All right. And I think you said 375 (degrees). How long do they cook, and how do you know when they're done?
Katie Krawczyk: They're going to bake for 20 to 25 minutes or until that egg is fully set, so it doesn't jiggle when you move it, and the cheese has just started to turn golden on top.
Host Amber Smith: And then you need to let them cool a little before you can get them out of the pan?
Katie Krawczyk: Yep. Once they're done cooking, take them out of the oven, leave them put for about five to 10 minutes, and then they should come out of the tins really easily, if they use a butter knife around them to help just kind of pull them from the sides. And then you can eat them warm or let them cool completely and store them in a container in the refrigerator. Or, again, you can also freeze these.
Host Amber Smith: How long do they last in the refrigerator? If I made them on a Monday morning, can I eat them all week?
Katie Krawczyk: Yep. For one week.
Host Amber Smith: Many people think of eggs for breakfast. Do you think these mini-quiches could make for satisfying lunches or dinners?
Katie Krawczyk: Absolutely. If you are thinking -- again, this is a prep-ahead meal -- if you say, "Oh, OK, yeah, I've got these egg muffins in my freezer." Take them out and reheat them in the microwave and have them as your dinner, maybe alongside of some toast. Or have a full breakfast for dinner, like you have pancakes there.
Host Amber Smith: I really appreciate you sharing this recipe with us.
Katie Krawczyk: Thank you for having me.
Host Amber Smith: My guest has been registered dietician nutritionist Katie Krawczyk from the Upstate Cancer Center. I'm Amber Smith for Upstate's "HealthLink on Air."
And now, Deirdre Neilen, editor of Upstate's literary and visual arts journal, The Healing Muse, with this week's selection.
Deirdre Neilen, PhD: Two of our poets provided us a sense of how appearances are only a small part of any story. It takes a perceptive observer to see within.
Erin McConnell is a pediatric physician from Ohio who is also working on a master's degree in medical humanities. Look at how the patient she describes has tried so hard to be good.
This is "The Easy Patient":
You aim to be the easy patient:
seeing enough specialists
to not be a burden or
cause cognitive strain
Just a few refill requests
no additional concerns
arrival on time
even disposing of your own
No need for receipt
no follow-up scheduled
making as small a
carbon chain footprint as possible.
Mick Cochrane from Buffalo asks us to think about how the airlines reinforce our sense of worthiness with their zone hierarchies. But we don't know the real story.
Here is "In Zone Three":
no one thanks us for our service
we have accumulated no
points no perks we have no
right to upgrade no hope
of extra leg space or complimentary
anything it doesn't matter what indignity
our poorly packed luggage suffers to make
it fit we are nobodies red-eyed
sleepless lumps of coffee fear
we wear cargo shorts and Crocs
we are the army of the un-
fashionable we are a-stylish we
take no selfies because
we don't want to know we are
flustered by TSA and pet
the wrong dogs we belong
on a bus but we are here please
forgive us our sorry state
our heartache is too sudden
so this one time we must
find a way to fly
Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York. Next week on "HealthLink on Air," important information about Covid and flu. If you missed any of today's show, or for more information on a variety of health, science and medical topics, visit our website at healthlinkonair.org. Upstate's "HealthLink on Air" is produced by Jim Howe, with sound engineering by Bill Broeckel. This is your host, Amber Smith, thanking you for listening.