Podcast transcript

INTRO
Welcome to Docs in a Pod, presented by WellMed. Over the next half hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-hosts Dr. Tamika Perry and award winning veteran broadcaster Ron Aaron will share information to improve your health and well-being. And now here are Ron Aaron and Dr. Tamika Perry.

RON AARON
Thank you so much for joining us today on the award winning Docs in a Pod. I'm Ron Aaron, and we come to you every week with a look at a variety of health and wellness issues that affect people of every age, especially those who are seniors, 60 and over. Our co-host, Dr. Tamika Perry is with us as well. Dr. Perry is an associate medical director at WellMed. She oversees several large clinics in the Optum Care in North Texas region, the southern sector. She earned her undergraduate degree from Prairie View A&M. She then went on to graduate from Philadelphia College of Osteopathic Medicine, where she was National Health Service Corps scholar. Dr. Perry completed her family medicine residency at Methodist Charlton Medical Center, where she served as chief resident. She's board certified by the American Osteopathic Board of Family Physicians. Pertinent to the show we're doing today, Dr. Perry is a diplomat of the American Board of Obesity Medicine. Dr. Perry, what got you interested in obesity medicine?

DR. TAMIKA PERRY
Obesity is a chronic disease that affects almost every population, especially the American population. It is linked to so many other health problems. I was like, if I could maybe tackle one at the root, I would affect a whole bunch of others. And honestly, that's what got me into it. And I like food. I like food a lot.

RON AARON
Food is tempting. Well, let's welcome our special guest, Dr. Kathleen Burger. Dr. Berger is a skilled and compassionate general practitioner at WellMed and Fannin in Houston. She provides high quality care for her patients. With a doctorate in medicine from the prestigious University of Guadalajara in Mexico, Dr. Berger brings extensive international training and expertise to her practice. She honed her medical skills during a surgical residency at Bronx Lebanon Hospital Center and Lincoln Hospital, both located in the Bronx in New York. Following her residency, Dr. Berger completed a surgical fellowship in Queens Hospital in Queens, New York. But she is not a surgeon these days. She is a PCP, a primary care physician. Dr. Berger, we're delighted to have you back with us.

DR. KATHLEEN BERGER
Thank you, Ron and Dr. Perry. As we were talking about, I love coming on the show. So, thank you so much.

RON AARON
What prompted you to go from surgery into general practice?

DR. KATHLEEN BERGER
Mainly work-life balance. Being able to spend more time with my family. Being a surgeon is very rigorous, and I respect that specialty tremendously. I think you need to really dedicate a greater piece of yourself than I was able to give. So, that's the main reason. But it's a wonderful specialty, and I enjoyed every moment of it.

RON AARON
One of the things that we have you talking about today is the impact of sugar on your body. We all know, at least intellectually, sugar is bad.

DR. KATHLEEN BERGER
Yes. Like any substance in excess or if we don't have enough of it when it comes to medicine is bad. So, we do need glucose for our cellular processes for our everyday functioning. But in excess. Or if we don't have enough of it, then it's damaging to the body. All organ systems, essentially.

RON AARON
Yet we're inundated daily with tempting sugar laced products from sodas to cereals to candy. Part of the problem, of course, is that sugar tastes really good.

DR. KATHLEEN BERGER
Yes, it does. And it's hard to stay away from it. It can be addictive even. Sugar comes in carbohydrates in our breads and our pastas. So, even outside of just sweets, we can eat excess carbohydrates in the form of bread, toast, cookies, crackers, tortillas, and then we develop that excess sugar without ever eating any sweets. A lot of our patients don't understand that, or we have to educate them on that as well. It's not just the sweets.

RON AARON
Sugar is everywhere.

DR. KATHLEEN BERGER
Pretty much. Yes.

RON AARON
Tell us, what does it do to our body when we use it in excess? Of course, we immediately think of diabetes, but what's the impact of sugar?

DR. KATHLEEN BERGER
I thought maybe to discuss it by the different organ systems. Too much glucose or sugar in our body damages every organ system from the brain, the heart, primarily the cardiovascular system, our kidneys and our eye. Those are the main complications in those organs that we see in primary care. For example, in the brain, it can increase risk of dementia. I see mainly older patients. Dr. Perry, do you mainly see geriatric patients or all ages?

DR. TAMIKA PERRY
I do see geriatric patients. The studies that you and I have read that if you have a higher processed sugar, higher fat diet, your incidence of dementia is tremendously increased. I think it's important to note that there are certain foods that are sold here in United States that are banned in other places. Like foods made with high fructose corn syrup, youÕre not going to Europe, youÕre not going to get them in parts of Asia. I travel a lot and I like snacks. I just don't throw that in there.

RON AARON
Snacks are good.

DR. TAMIKA PERRY
Yes. Snacks are great. But when I go to these other countries and have American snacks, like even a Coke or Pringles or something of the sort, it doesn't taste the same. You know why? Because it doesn't have all the stuff in it that we're allowed to put in it here.

DR. KATHLEEN BERGER
Yes.

RON AARON
Interesting. So, the high-fructose sugar is not there?

DR. TAMIKA PERRY
No. A lot of the dyes, the high-fructose sugars, the preservatives, none of that stuff is there. Distinctly, if you're used to eating a certain snack here that isn't good for you, when you go to a different country and you taste it, it does not taste the same. It probably tastes how itÕs supposed to taste. But we put a lot of stuff in our food, a lot of sugar in our food, put a lot of fats, we put a lot of coloring, we put a lot of stuff in our food to make it look more palatable. Make it look better, smell better, taste better. But is it better for us? Not necessarily.

RON AARON
Let's let folks know who may have just joined us, you're listening to the award winning Docs in a Pod. Our podcast is available wherever you get your podcasts. I'm Ron and along with our co-host, Dr. Tamika Perry, and we're talking with Dr. Kathleen Berger about foods and sugars and what they do to us. Talking about carbohydrates and all the other ways in which sugar enters our body. Dr. Berger, you were talking about the impact it can have on our various organs.

DR. KATHLEEN BERGER
Yeah. So, the way it can increase risk of dementia is by several mechanisms. In diabetes, which is the disease that we call when too much sugar develops over time in the body, insulin resistance occurs, which is the cellsÕ ability to bring sugar into the cell. So, the cell can use that sugar to do the things it needs to do. When we have that insulin resistance, the brain cells in this case don't have enough sugar. This leads to decline or poor functioning of those brain cells, which leads to the cognitive dysfunction. The cognitive decline in the patients. Insulin resistance also increases inflammation. Those inflammatory markers that are the hallmarks of inflammation, which damage the cells further. Inflammation is implicated in cancer as well and chronic pain. So, inflammation chronically is a bad thing. Acutely, we need it. Chronically, it's not good for the body. There is something called advanced glycation end products, which is when the sugar starts binding to proteins and fats in our bloodstream. And those substances damage blood vessels. They can increase plaque formation in the blood vessels and all over the body. If we have plaque formation in the blood vessels, we have decreased blood flow to that organ. In the case of the brain, decreased blood flow, those cells aren't getting their nutrients, increased cognitive decline. Oxidative stress. Too much sugar causes us to release reactive oxygen species. Those are damaging substances that we need to clear. If we produce too many reactive oxygen species, we don't have enough antioxidants. If we produce more reactive oxidative species, then we can clear that up and damage the cells further. These advanced glycation end products also change the structure of the tau protein. Tau protein is one of the hallmarks of dementia. That's why, as Dr. Perry was saying, there's a much higher risk of dementia in patients with diabetes because it kind of accelerates the whole process or the whole pathology of what dementia is compared to someone that doesn't have diabetes.

DR. TAMIKA PERRY
What I propose that some of the listeners may be thinking, well, I read that the brain is, let's call it a glucose obligate, like it needs that energy source in order for it to function. That's absolutely right. But, Dr. Berger, a lot of what she's talking about is sucrose and sucrose is what we call a disaccharide. So, it's made of glucose and fructose put together. Correct me if IÕm wrong, Dr. Berger, because biochemistry was not my strong suit from what I remember.

DR. KATHLEEN BERGER
It's not mine either.

DR. TAMIKA PERRY
It is those two put together. You take a fructose and glucose and put it together. So, your brain needs glucose not sucrose, the disaccharide, it needs to monosaccharide. You can get that source from a lot. It doesnÕt have to be candy or it doesnÕt have to be cake. Your brain is okay with an orange. Some whole wheat. Some vegetables. It doesn't have to be Pringles and Coke.

DR. KATHLEEN BERGER
Yes, exactly.

RON AARON
Or a bag of chips and a soda.

DR. TAMIKA PERRY
Which is the American choice. A bag of chips and a soda.

RON AARON
Exactly.

DR. TAMIKA PERRY
But honestly, it's okay to have an orange. When people say, I always keep a peppermint in my purse because my sugar gets low. Yeah, that peppermint is definitely going to increase your blood sugar, but it's okay to have a tangerine in there too.

RON AARON
Or a clementine.

DR. TAMIKA PERRY
Or a clementine, yes.

RON AARON
I like clementines. Dr. Berger, this gets back to what over time on Docs in a Pod we talk about over and over and over again is the kinds of foods we should be eating and the kind of choices that we make. Most of us don't really have the guidance we need.

DR. KATHLEEN BERGER
Right. We try to, as primary care doctors, educate or inform the patients of what's going to help them either improve their diabetes if they already have it or prevent them from developing it. If they have prediabetes or have morbid obesity, which also increases the risk of diabetes. So, diet and exercise, if we all were to enforce those two aspects of our health, there would be a lot less chronic illness in this case, diabetes. And as Dr. Perry mentioned, morbid obesity. So yes, education is a big part of being a PCP in family medicine or internal medicine or GP. A lot of the patients do listen, and they do improve their glycemic control or their sugars come down when they are pre-diabetic.

DR. TAMIKA PERRY
I will continue to say this on almost every show that you will allow me that if people ate right, exercised, had protected sex, didn't smoke or drink, Dr. Berger and I would need second jobs. Because a lot of what happens, especially in the PCP office, and I'm not saying you're intentionally doing anything bad to yourself or intentionally doing anything bad to myself, but this is the situation that we're in. So, we need to be really mindful of what we put into our mouths, how much physical activity that we do on a daily basis avoid. No smoking. Little to no alcohol. This is important. Our body was meant to operate in a certain environment, and we got to make it conducive.

RON AARON
Hold that thought. We'll get back to it in a moment. Thank you to Dr. Kathleen Berger for joining us today. Delighted to have her with us. Our co-host is Dr. Tamika Perry. I'm Ron Aaron. You're listening to the award-winning Docs in a Pod.

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RON AARON
We're so pleased you're joining us today and sticking with us on the award winning Docs in a Pod. Our podcast is available wherever you get your podcasts. We're also on the radio in several cities in Texas and Florida as well. I'm Ron Aaron and our co-host today, Dr. Tamika Perry is with us and our special guest, Dr. Kathleen Berger. You find her in Houston at WellMed at Fannin. We're talking about diet, exercise and the impact of sugar on our body. I want to come back to something you said a little earlier. Dr. Berger, for folks who may have just joined us and didn't get it. Sugar is not just what you find in candy and cake and sweets.

DR. KATHLEEN BERGER
Yes. Correct. In our in our breads, our pastas, rice, tortillas, even in some vegetables, protein. I mean, sugar is pretty much in almost every food, it's just the amount that you're going to find in each food vary.

RON AARON
Now, I know people who are marathon runners very often we'll talk about carbo loading before the race. The night before, they'll load up on pasta and all kinds of stuff in order to fill that reserve, I guess, of sugar in their body.

DR. TAMIKA PERRY
Here's the thing, Ron. Because I always give that example to my patients to like, who eats spaghetti with garlic bread and then goes runs 26 miles the next day?

RON AARON
Marathoners.

DR. TAMIKA PERRY
Yeah, but the regular Joe Blow doesnÕt. That pasta low goes to the store to something called glycogen. it is stored right around your midsection for later usage. Who does this? Who uses it later?

DR. KATHLEEN BERGER
In that case, that makes sense in marathon runners. But as Dr. Perry stated, if we have more calorie or carbon intake than what we're going to use, it is going to accumulate as fat. It's not going to get utilized.

RON AARON
In the middle of your body?

DR. TAMIKA PERRY
In the middle of your body.

DR. KATHLEEN BERGER
Yes, which further increases insulin resistance, which leads to diabetes. That fat in the abdominal area specifically.

DR. TAMIKA PERRY
Yeah. YouÕre going to look like Homer Simpson.

DR. KATHLEEN BERGER
Homer SimpsonÕs body habitus. I got to remember that. The high sugar damages our arteries. I mentioned that I'm discussing dementia. When we damage our arteries, that is going to affect any organ that requires arterial blood flow, which is pretty much every organ. So, if we damage the arteries in our heart, that increases risk of heart attack. High sugar, again, increases inflammation and plaque formation. That's how that blockage and the damage to the artery occurs. If we have blockages in our legs, that's how patients with diabetes develop some of the ulcers that they develop due to lack of blood flow. High sugar tracks bacteria, which increases risk of infection. When we have decreased blood flow, now you've compounded your risk of either losing a limb or requiring an operation due to infection or decreased blood flow.

RON AARON
Or death.

DR. TAMIKA PERRY
Yup, or death.

DR. KATHLEEN BERGER
Yes. And the kidneys, the damage to those arteries decreases the filtration ability of the kidney. But basically, our kidneys are to filtrate substances is that we need, reabsorb or discard what we don't need. If we damage the arteries to the kidneys, that can lead to diabetic nephropathy, which is when we start leaking protein in the urine due to the damaging of that filtration function of the kidney. Then that can ultimately, if it's not corrected, lead to kidney failure. Then we talk about end stage kidney disease, dialysis or requiring transplant. In the eye, we can develop diabetic retinopathy from high glucose levels due to damage of the blood vessels due to damage to our lens, which increases risk of cataracts, which can cause blindness. Damage to the small arterials in our eyes causes the arteries to be leaky. That leakage of fluid from the arterials into the eye increases pressure in the eye, which can damage the optic nerve, which is what glaucoma is. If that's not corrected, it can lead to blindness. Prior to blindness, patients will start complaining of blurry vision. This is why we encourage them to have once-a-year eye exams for patients with diabetes. If they have no signs of eye retinopathy, then the ophthalmologist will say you can do it every two years. That's the long and the short of most of what we commonly see in in primary care.

RON AARON
Now, if we made you leader for the day for the universe, are there foods as they do in other countries that you would not permit sales of in this country? I'm thinking, for example, of all the people, looking at Dr. Perry, who sucked down sodas every day.

DR. TAMIKA PERRY
Not every day, Ron. Maybe every other day.

DR. KATHLEEN BERGER
Well, Dr. Perry mentioned at the beginning several substances. The food dye, the high fructose corn sirup, the preserves. Anything that's not naturally grown, for the most part, probably isn't good for us in high amounts without generalizing. Because even water in excess is not good for you.

DR. TAMIKA PERRY
Right. You can become water toxic. Absolutely. I totally agree with Dr. Berger. If it didn't grow out of the ground or if you have to drive around the building and somebody hands you it out of a window in a paper sack, it's probably not for you. Just think about that. Is it something that naturally grows? How many preservatives went into it? How much sugar was added to it? Because a lot of times patients will be like, itÕs juice. It comes from an apple. They'll add sucrose to it to make it more palatable to make you really like that brand of apple juice. So, one of the important things to know is, well, how do I know what is too much and what is too little carbohydrates? Well, just basic label reading. If you just turn over the back of any product, look at the serving size to begin with because you could have a product that's a regular sized package. That package of potato chips really has four servings in there. So, you really have to look at serving size. And then you're going to take the total number of carbohydrates, divide it by four, and that's approximately how many teaspoons of equivalent or sugar is in that product. So, just be mindful of that. Some of the stuff that you're eating you might not think is that much sugar in it until you actually look at it, and you're like, I've eaten ten teaspoons of sugar.

RON AARON
It's interesting, Dr. Perry, that by increasing the number of servings in a package, you lower the calories per serving. But the fact is, take that package of chips, you're going to eat the whole package.

DR. TAMIKA PERRY
You're going to eat the whole package. That's not four servings. ThatÕs four servings for some toddlers or something. That's not four servings for an adult. Just keep that in mind. If you look at a regular soda pop, and I say soda pop because IÕm truly from the south. So, if you look at a regular pop, a regular can on average has about ten teaspoons of sugar in it. Now, IÕm not talking about diet sodas, regular sodas. There are some fruit flavored sodas that are really high, and they have about 12 teaspoons of sugar in them.

RON AARON
12 teaspoons? How many should you have in a day?

DR. TAMIKA PERRY
A lot less than that.

RON AARON
I would think.

DR. TAMIKA PERRY
Yeah. I tell patients, you have a couple of options. You can either drink that Coke or you can put 10 teaspoons of sugar on your tongue because you're basically doing the same thing.

RON AARON
Interesting.

DR. TAMIKA PERRY
Yeah. Your waistline does not appreciate that. Your heart does not appreciate it. Your kidneys do not appreciate it.

RON AARON
Dr. Berger, when you talk with your patients and go over nutritional choices, are they receptive?

DR. KATHLEEN BERGER
For the most part they're receptive. I'd say maybe 30% to 40% try to try to make changes in their diet. They tell me they do. In most times, I can see a difference either in their blood pressure, their weight, or their glucose levels. So, I just literally tell them it's a mindset change more so than just being so strict on yourself with cutting out a particular food. I tell them, just cut what you normally eat in half, or pick one food that you happen to enjoy, or that you feel like you're eating in excess. Like if it's tortillas. Or I'll ask them, are you eating a lot of this, that or the other? And I'll say, well, now just try to cut it in half.

DR. TAMIKA PERRY
Right.

DR. KATHLEEN BERGER
Or instead of having it every day, try doing it every other day. That will get their mind used to the change, which will make it easier for them to further change. So, I try to tell them, you just have to make the changes that you can make over time so those changes last and you can maintain those changes. Because even if we're on medications for diabetes, if we don't change our diet, those medications may not work. Especially with the advent of the new GLP-one inhibitors and Mounjaro, if those patients are to stop those medications after they've started, we're seeing a lot of rebound weight gain in studies that are coming out. Because if the patient continues their regular eating habits even after they've lost the weight, then the change cannot remain. It won't remain most likely.

DR. TAMIKA PERRY
That goes with a lot of weight loss medicines. The weight comes back. When I used to have a dedicated weight loss clinic, we always stress lifestyle changes. This is a time, like my mother always says, get your mind right. So, while you're on the medicines, this is the time to get your mind right. Meaning that you have to change your habits because patients will say, when you come off Phentermine, that makes you gain a lot of weight. No, honey, Snickers make you gain weight. You have to say, I'm not going to eat that anymore. And please, Snickers people don't come after me. I mean, really, you have to change your mindset.

RON AARON
Or Milk Duds or Milky Way. It doesn't matter.

DR. TAMIKA PERRY
All of it.

RON AARON
I got to stop you both right here. Flat out of time. Thank you so much to our special guest, Dr. Kathleen Berger, and to our co-host, Dr. Tamika Perry. I'm Ron Aaron. Thanks for joining us today on the award Docs in a Pod.

OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherese Pendleton. Thank you for listening to Docs in a Pod presented by WellMed. Be sure and listen next week to Docs in a Pod presented by WellMed.

DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.

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