Food Rx: An Endocrinologist Shares What She Eats in a Day to Help Prevent Type 2 Diabetes
A Stanford University doctor who specializes in treating people with type 2 diabetes and obesity talks about eating vegetables sneakily, portioning rice, and cutting out added sugar and salt.
Sun Kim, MD, associate professor of medicine in the division of endocrinology at Stanford University Medical Center in California, playfully admits that she is obsessed with different types of lettuce and kale.
She mounds them on her morning avocado toast, packs them in her lunch, and throws them into anything her family eats for dinner.
Sneaking in vegetables is a habit she encourages for her patients with prediabetes, type 2 diabetes, and obesity. (Although she confides that she rarely brings up her personal habits with patients.) Dr. Kim has dual roles at Stanford, treating patients and leading clinical research in diabetes and nutrition, which she began under the mentorship of Gerald Reaven, MD, a Stanford endocrinologist who pioneered the concept of insulin resistance. Kim is also a mom of two and has a husband who practices nephrology in the Bay Area.
“I’ve always been interested in what makes people tick and what influences behavior,” says Kim, who originally debated becoming a psychologist or psychiatrist before instead choosing endocrinology more than 15 years ago.
Behavior is a cornerstone of Kim’s approach with her patients, who are trying to lose weight and eat healthfully. “No one is perfect. I strive for the best, but I’m human, too,” says Kim, who does not have type 2 diabetes but focuses on a healthy lifestyle with nutritious foods and regular exercise. “Weight gain is a common issue we’re all facing,” she adds.
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Diet and Type 2 Diabetes Prevention
Being overweight, along with other factors, increases your risk for developing type 2 diabetes, according to the Centers for Disease Control and Prevention.
Eating fewer calories and exercising can help people at risk for diabetes lose weight and prevent the disease, according to the Diabetes Prevention Plan study, which was published in The New England Journal of Medicine.
“Evidence suggests that the overall quality of food, with an emphasis on whole grains, legumes, nuts, fruits, and vegetables and minimal refined and processed foods, is also associated with a lower risk for type 2 diabetes,” according to the American Diabetes Association’s (ADA) 2021 "Standards of Medical Care in Diabetes." A variety of eating patterns or diets may be appropriate for people at risk for developing diabetes, says the ADA in the same standards.
A Mediterranean-style diet — high in vegetables, fruits, nuts, olive oil, and whole grains — reduced the incidence of type 2 diabetes in a group of people who did not have diabetes but who had cardiovascular disease, according to one study.
The DASH (Dietary Approaches to Stop Hypertension) diet is also associated with a lower risk of developing type 2 diabetes, according to a report published in April 2019 in Diabetes Care. DASH emphasizes vegetables, fruits, and low-fat dairy, and often reduced salt. Kim says that DASH showed the importance of cutting out salt to reduce blood pressure, a risk factor for cardiovascular disease and type 2 diabetes.
Avoiding soda is also ideal because sugar-sweetened beverages are associated with an increased risk for type 2 diabetes, according to another study.
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Diet and Type 2 Diabetes Management
“What should I eat?” is the No. 1 question Kim hears from her patients.
Instead of one particular diet, Kim recommends a lifestyle approach. “It comes down to trying to eat at home, not eating processed foods, and trying to eat more vegetables and fruit. That is the heart of the foods you want to eat,” she says.
Evidence suggests that there is not an ideal percentage of calories from carbohydrates, protein, and fats for people with diabetes, according to the ADA standards. The ADA does not recommend one particular eating pattern for managing type 2 diabetes.
“There are different philosophies about diets, but I think most people would agree that added sugar is not necessary,” says Kim. She says that these sugars, found in baked goods, soda, and processed foods, can be hard to cut out of your diet. “Added sugars can be really hard to cut out because foods with added sugars are quite palatable for most people. They are also in a lot of foods (even foods people assume are healthy, like yogurt with added fruit or cereal bars, and many people are not looking for added sugar,” she says.
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Popular Diets and Type 2 Diabetes: What’s With Keto?
The ketogenic (keto) diet, which is very low in carbohydrates and high in fat, is popular these days. But how does it work for people with type 2 diabetes?
“It is absolutely true that the lower your carbs, the better your glucose,” says Kim. “But is keto a healthful diet and is it something you can maintain?” Kim is investigating a keto diet versus a Mediterranean diet in people with diabetes and prediabetes.
The Mediterranean diet can reduce A1C in people with type 2 diabetes, according to a study published in May 2020 in Diabetes Spectrum, as well as other studies.
RELATED: Is the Mediterranean Diet Best for Diabetes?
Q&A with Dr. Kim: What Does She Eat to Stay Healthy?
We asked Kim about how her work has changed the way she eats. (Responses have been edited for concision and clarity.) Here’s what she said:
Everyday Health: What does a typical day of eating look like for you?
SK: In the morning, we as a family eat breakfast. My breakfast and lunch are usually whole-wheat bread and lettuce or kale. Sometimes tomato and egg or avocado. I like avocados because it is a good fat with lots of monounsaturated fat, and I can encourage patients with diabetes to eat it, as it will have less impact on glucose.
For lunch, I try to include two vegetables and two fruits that can fit in a 12-ounce container. I pick items that are easy to prepare in the morning; thus, I choose carrots and cucumbers. Plus, the carrots are to die for! I sometimes try to mix it up with tomatoes or broccoli or radishes.
I’m lucky that my husband cooks dinner, so he gets a lot of credit. It helps. And I appreciate it because eating out lends itself to eating more. So [cooking at home] has helped our family. You always eat less when you eat at home. He often makes salmon or baked chicken with roasted cauliflower or broccoli. He also likes to make Korean food.
EH: Why is this a strategy you follow?
SK: If I didn’t pack food and I went to the hospital cafeteria, I would gravitate toward things with higher calories [like the Vietnamese sandwiches banh mi].
EH: What’s your favorite healthy snack?
SK: I just love the orange carrots from the farmers market. We’ll have a potluck at work, and I often bring them raw. No dip. People are always skeptical, but then they say they’re really great. I’m not saying this would replace anyone’s amazing home-baked anything. But I think it’s nice to have as an option.
I think it’s good to aim to eat three different vegetables, not potatoes in the count, and two fruits per day. A study published in March 2021 in Circulation agrees with me — it showed that eating more fruits and vegetables was associated with lower mortality.
RELATED: 20 Easy and Quick Snacks for People With Type 2 Diabetes
EH: How about your go-to quick breakfast?
SK: Avocado toast with extra lettuce on top. As mentioned, avocados are a source of good monounsaturated fat. Same with nuts. Fats do have a lot of calories, so eat them in moderation.
EH: When you’re feeling run down, which foods do you rely on to boost your energy?
SK: I’m really intrigued by that question. I personally try not to use food for anything energy- or emotion-related. If I were tired, I would rather take a power nap.
For my patients, a top complaint is fatigue. So could food help you? It’s hard with just one nutrient or food. Everything is symbiotic. But I wish there was one food!
EH: Is there an eating strategy that you try to avoid or embrace?
SK: A study [published in November 2016 in Cell Metabolism] that had an impact on me found that a lot of people just kind of graze-ate from morning until night. And the only time they didn’t eat was when they were sleeping. Shortening the amount of time spent eating throughout the day helped people [in the study] feel better. They got better sleep because they didn’t eat so close to bedtime. They felt more energetic. It makes me think, could timing help someone’s energy?
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EH: How do you treat yourself?
SK: I try to figure out how to work in exercise. Especially for dual-working families caring for kids and a household, exercise sometimes goes to the bottom of the list. It has to be a habit. For example, I do barre on Saturday and Zumba on Sunday. You have to be a little selfish about your time.
EH: What’s one healthy food you wish you ate more of?
SK: I wish I could experiment more with vegetables at dinner. I think that’s why I started supplementing with raw vegetables.
EH: Are there any foods you rarely eat?
SK: I’m of Asian background so rice is a big thing. It’s hard for me to eat a lot of rice because I’m always telling patients that it raises glucose. So I always try to just have a little and supplement with nonstarchy vegetables like lettuce or broccoli and cauliflower.
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EH: What’s your strategy when eating out?
SK: Restaurant food is really tasty, so you always want to eat more. We try to limit eating out, but obviously, my husband and I both work so it’s not always possible. During the pandemic, we try to limit takeout to once a week.
EH: Wine with dinner: Yes or no?
SK: Do I love a really good glass of wine? Absolutely. But it’s a hard one. It’s expensive, and it’s not a habit you can sustain on a daily basis. For people who are struggling with weight, it’s a big-ticket item. Not only the calories but that you also tend to snack when you drink, especially in social situations. I’m big on cue-induced behavior, and drinking comes with a lot.
I never encourage patients to drink and, when asked, remind patients that alcohol has a narrow therapeutic window, meaning it’s easy to overdrink and there are clear harms to overdrinking.
EH: What’s one small change you’ve made — dietary or otherwise — to eat healthier?
SK: In California, we’re blessed with a year-round farmers market where I can find lettuce and kale. When I get home, I wash it and keep it in a fresh container. And I add it to whatever I can.
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EH: What’s one small change anyone can make to help better manage diabetes?
SK: Find ways to sneak in vegetables every chance you get. If you’re following a ketogenic diet and you’re having an omelet with egg and cheese, you should put all the vegetables you possibly can into the omelet.
EH: Any final thoughts on the link between eating choices and diabetes?
SK: There is this thing called the halo effect in patients who have undergone bariatric surgery. Because they have to change their diet so dramatically, it can have this halo effect [of weight loss and healthy behavior on family members]. I try to tell people to surround themselves with people who can foster what they’re trying to do.