Taking Control Of Your Diabetes® - The Podcast!

We got things that are pro-inflammatory, anti-inflammatory. Every commercial talks about inflammation. So, we're going to talk about today: what is inflammation? What are signs and symptoms that you might have increased inflammation? What are things that you can do about it that might help with your overall health or diabetes?

We're really going to try to break that down today for you on this edition of the Taking Control of Your Diabetes Podcast. I am one of your hosts, Dr. Jeremy Pettis, joined as always by my good friend and colleague, Dr. Steve Edelman. And if you're just tuning in, we are both endocrinologists. We both have had type 1 diabetes since we were 15. We work at the University of California, San Diego, and we work here at Taking Control of Your Diabetes to empower patients through education to do what, Steve?

Take control of their diabetes. That's a good name for our organization.

Yeah. You know what? Thank you. So, we have a very special guest to talk about this pretty broad topic, but we think we have the perfect person to help guide us through it. So, who is that, Steve?

That's Dr. Jenny Luna. Jenny is an endocrinologist, but with a special interest in obesity medicine. She works at Scripps in their obesity clinic, but also nutrition. And also, she is an advocate of education and has done a lot of stuff online. And what's your most recent degree, Jenny?

I have a Master's in Healthcare Administration.

Yeah. So, she's going to be running UCSD one of these days and oh, God knows they need help. Well, Jenny has done a lot of things with us, and you're very unusual because you know so much about nutrition, and but you're also an endocrinologist and you're not, you know, you're not a quote-unquote dietitian. Nothing wrong with that. But you do bring together a lot of science, a lot of medical information, and you have a lot of experience with all those obesity drugs that Jeremy and I just did a podcast on regarding what's going to be coming out in 2026 in regards to the newer agents.

It's great to be here. This is actually my second time here, which is so exciting. And I'm really looking forward to talking about inflammation because it really is a hot topic and it's confusing as well. So, I'm glad that we're going to kind of comb through those details today.

Yeah. And we think Jenny was our very first guest on the podcast back when we did it in the old office. So, all right, let's start with what we need to know. So, if you had to—what is inflammation? How would you break that down for people?

Yes. So inflammation actually is a natural response of the body and it is needed to a certain extent. So there's acute inflammation and then there's chronic inflammation. Acute inflammation is when, let's say, we're fighting the common cold or a sore throat or there's a foreign virus or bacteria that comes into our body. So then this triggers the immune system. I always tell patients the immune system is kind of like your internal army. So if it senses something is there, it starts to release these inflammatory cells that start to attack whatever is there.

The symptoms of that would be fever, a sore throat, or if you—for instance, I got stung by a stingray two weeks ago. My skin turned red and swollen.

Hold on. How did this happen?

I was going to surf in the morning and literally just getting in. I didn't do the shuffle. Please do the shuffle, guys. And it stung me.

So, you stepped on it.

I stepped on it.

Well, the shuffle for you guys that live outside of San Diego is what they teach you. When you walk in the sand, you don't pick up your feet. You shuffle. So, you can kick these things without stepping on them.

Yeah, or let them know that you're coming. So, needless to say, I had a lot of inflammation in my toe. Versus with chronic inflammation, it's different. Now, there's a dysregulation in that entire system where it's chronic, meaning it's more than months or even years, and now the body is triggered by something else. It could be a condition, it could be the lifestyle of the person, which we'll get into. And then now, instead of harming something foreign like a bacteria or virus, it's actually harming good tissue in the body.

Yeah. So, I think our listeners would know, we all understand if you step on a stingray, you get inflammation, you get a cut—that kind of thing. But what about, you know, I'm sitting here living my life. How do I know if I'm inflamed, right? I can feel the heat coming off... we're going to get into my diet. I can feel it coming.

Oh, there's no way you're going to get around that, buddy. But what would be signs and symptoms of that? It all depends where the inflammation is coming from or what the source is. So, some of the symptoms could be fatigue, difficulty sleeping, changes in bowel movements, weight gain, as well as having mental fog. For instance, if your blood sugar is high, that then triggers inflammation and we have some level of insulin resistance, which then feeds the loop again of a high blood sugar that's going to make you feel kind of run down and not well.

But I was going to say, Jeremy, I think part of the problem with inflammation is that there are no symptoms when it's chronically ongoing. I like to bring up the example of periodontal disease. Since the beginning of time, they said if you have periodontal disease—inflammation of your gums—you have inflammation in your heart. So I don't know how true that is, but they've been saying that a long time. And I think this low level of inflammation affects every organ in our body. I sound like an expert, but you know, that's basically where the danger comes in.

It's true, and it is subclinical because some people are walking around and they have no idea. The body is like a machine of balance, right? So, it just tries to maintain that balance and you don't really feel it. But sometimes these symptoms are kind of vague. Like that fatigue, that general—everyone's walking around with fatigue and brain fog. So, a lot of times you'll hear, especially in our patient population, people might have symptoms but they don't realize it. You hear all the time like, "Man, I cut gluten out of my diet and I didn't even realize how bad I was feeling."

All right. We're talking kind of generally. When somebody comes in to see you with diabetes or obesity or whatever it is, how does inflammation fit into that specific patient?

Right. So, basically, let's say with someone that has type 2 diabetes and there's a lot of that insulin resistance, which we hear—"Oh, I'm insulin resistant." What does that mean? So, again, those inflammatory cells start to affect the communication between the receptor—or the key that's supposed to open up the cell to allow that sugar to go in. So, basically, insulin can't communicate with the cell appropriately. Then, now you have this rise in sugar. The liver is like, "What the hell's going on?"

You can say that. Steve says way worse.

I keep it clean. I just came from Sunday school. So yeah, "What's going on over here?" the liver says, and it starts to pump more sugar. That in itself then starts triggering more inflammation. It's just like a vicious cycle. And then this is where we see the complications, right? The micro and macrovascular conditions where you have retinopathy and the kidney issues because all of that blood sugar and inflammation shouldn't be there.

Is it fair to say that inflammation is one of the main issues going on with fatty liver or chronic kidney disease as kind of a platform for all these other conditions we see in metabolic syndrome? We know inflammation is important with the heart.

Right. And those three seem to go together in everything we talk about these days, right? The metabolic syndrome where you've got that central weight gain, that increase in cytokines and inflammation. The liver as well struggling with that, the muscle having extra fat within it—it's also feeding the insulin resistance. So yeah, it's all tied in interestingly, which is beautiful because when we help our patients lose weight, it's like all these things get better.

So that's kind of what I was going to ask. Okay, if I'm a patient, I come see one of us, we're going to work on controlling blood sugars, reducing weight, making sure blood pressure and cholesterol are in line. If you're doing all those things, do you need like a separate column of "Now I'm going to address inflammation," or have you kind of already taken care of it by addressing those things?

So I love to teach, especially to my patients. I tell them: if we target your weight, we're going to target everything. The insulin resistance will improve, their pre-diabetes will go into remission or their type 2 diabetes will go into remission. And it's not just the scale; it's metabolic health and body composition as well, which is super important. In the case of patients that struggle with weight and are living with obesity, the fat cell is the troublemaker here because when it's in excess, it starts to release those inflammatory cells on its own, which causes more inflammation in the liver and the rest of the body, making it really hard for patients to lose weight.

Is there a blood test that you order in your patients to see if they have inflammation?

Yeah, CRP. I also love ordering the insulin resistance receptor as well. So yeah, there are ways to check it, but it's also just—once the patient starts losing weight and their blood sugars are improving, their blood pressure is improving, we can tell that that inflammation is improving as well.

And beyond the medications and these other things that we're already working on, is all weight loss the same, or are there different things that I guess lifestyle-wise that you recommend to everybody?

So, everyone is aware of course if we eat healthful foods—foods that are naturally very colorful—but with high fiber, that also helps with creating what we call short-chain fatty acids in the gut. Once the good bacteria start to digest that fiber, it starts to release this anti-inflammatory property that goes to the blood and it's super beneficial. But then there are these other silent triggers, which is stress. We live in a very stressful society. People just run on stress and they have no idea they're so stressed until they go on vacation. That releases cortisol, which also can trigger that inflammation.

Lack of sleep is so important. Not getting those seven to eight hours increases insulin resistance and causes hunger hormones like ghrelin to go up. You're not going to want to have a quinoa salad; it's like, "Give me the pizza." So, that—and of course, smoking and excessive alcohol, all of these things can definitely flare up the immune system.

Let's focus on diet because I think that's probably what people ask you a lot about. That's such a big topic. How do you tackle that? For example, if I see somebody with type 2 diabetes, there's certain things that we focus on that are kind of more "bang for your buck" in terms of improving blood sugars. We'll say everything in moderation, you got to meet with a dietitian, things like that. But you really have to cut out like juice and soda—don't drink your calories. That's going to spike your blood sugar. So, are there things that you target that are the highest yield?

So, I also like to teach patients that there are no "bad" foods. Soda is kind of a hard sell because it's just not good for anything, but that way there's a little bit more of a balance in how the patient is approaching the food. I feel like when we say you can't have this, it's probably the only thing they're going to think about. So it's more of eating food that came from the earth—food that's alive and has a purpose in our body.

As less processed as possible. I always tell patients: eat the most expensive thing on your plate first, which is usually your protein. Eat your protein, your veg, and then your carb. Especially when they're on GLP-1s, where halfway through the plate they're already full. If they start with the carb—the pasta or something—they don't eat the protein and there's an issue.

Also, I'm big on having patients do time-window eating. I feel like that also helps with inflammation and dropping the insulin level. It gives patients a little bit of structure, right? They're like, "Okay, I'm going to eat from 9 to 6. I won't eat past six." They can drink water or black coffee.

Intermittent fasting?

Yes, time-window eating.

That's a new phrase for time-restricted eating. We just did this news segment where I sent you the clip about a study where people only ate during a four-hour window and surprise, surprise, people lost weight. I'm like, that's ridiculous. Four hours is insane. But I could get behind 9 to 6. I think for some people it's easier to just cut off a time rather than analyzing each food you eat. Is that something you practically set up for them?

No, we discuss it. I'm big on understanding how my patient lives their life; no two patients are the same. So, if I have a shift worker, it's going to look very different from a school teacher. We run through when it's possible for them to do that. It's really important to take those extra minutes because then they leave the office with that front-of-mind.

I always have them see the nutritionist because I feel like there are so many details that we don't pick up. And then just focusing on making it easy. Maybe it's buying some pre-made chicken or our local supermarkets like Trader Joe's have really healthy pre-made meals. That way it's not so cumbersome and they don't have to really think about it. That's the issue when they're so busy but then they have to think about what to eat as well.

I guess as I'm listening, too, I'm starting to think—man, it sounds expensive to eat healthy. How do you respond to that?

It's not actually... it doesn't have to be. For instance, getting a bag of frozen blueberries, which are actually more nutrient-dense because they're picked from the farm and then frozen. Those are great for a good smoothie—not packed with high-sugar fruits. There's like Costco that sometimes has really good portions of chicken that can be pre-made. It is hard; prices are definitely going up. But if you think about it, it's actually more expensive to go to your fast food restaurant and then think about what that's going to do to your body. It takes a little bit of creativity, but it's definitely possible.

Well, what is it going to do to your body—fast food? Because there are better fast foods than others, but I worry about my good friend Jeremy who goes to fast food quite a bit. Not me, your other friend Jeremy. He's busy, I don't think he cooks very much, and he exposes his kids to fast food as well.

That is not true. I eat it in the car in shame before I go home! Well, I say a flip side of that—a positive way to ask—let's say somebody adopts your healthy eating. What are things that you hear when they come back to you? Obviously people are trying to lose weight, but hopefully there's a whole program there with medications. Let's say their weight didn't change at all, but they adopted better eating habits. What do you see?

Often when patients do make the changes, let's say they don't lose weight, but they feel like their pants are looser—they're losing inches. One of the biggest factors for why people get fast food is lack of time; convenience is the main reason. So then it's learning how to tackle that. How can we make eating something a little healthier doable? It doesn't have to be perfect. Maybe it is stopping by Chick-fil-A and getting a grilled chicken choice.

That's what I do. I always get the grilled chicken nuggets.

I'm proud of you for that. How about the crunchy Cheetos this morning?

Well, that was different. Blood sugar was a little low and I needed it.

Cheetos for your blood sugar? You know that orange powder is generally good for you, right?

Not really.

But Jenny, being serious, when you say people make the changes, I'd like you to get a little more granular. What could someone be eating before and then realistically go to that is healthier?

Let's say someone wakes up, has coffee and maybe a baked good. They don't eat anything throughout the entire day because they're busy, maybe have a Red Bull, and then they come home and eat all their calories at the end of the day—sweets, maybe they wake up in the middle of the night because they're hungry. There's no structure and a lack of thought of nourishing themselves. Now when they see us, it's more like: we need to consume protein to help control your hunger hormones. So you wake up, maybe have a protein shake, or if they like cottage cheese with some fruit, or a parfait with Greek yogurt that's really high in protein. If they do prefer something like cereal, there are better options out there as well.

What's your take on eggs?

Eggs are great.

See, Steve? This is another thing that we argue on. All the amino acids and vitamins. He uses the like fake eggs and I think the pendulum has swung back on eggs. They used to be considered bad and high cholesterol, and now they're like—we can eat eggs again, right?

It's also what you eat with the eggs.

But Jenny, my point is here he is taking very expensive cholesterol-lowering medications and he thinks he can eat five eggs with his omelet.

That's not what... look, I got four chickens in my backyard and they're popping out eggs every day. I got to keep up with these. But seriously, like that's a good source of protein or something that can really help sustain you because breakfast for people with diabetes is the toughest. It tends to be very high carb. You wake up in the morning, that's usually when you're most insulin resistant and your blood sugars are high. And guess what? Here comes a bagel or cereal or a muffin. These kind of quick grab-and-go things are really tough.

Exactly. So it's about figuring out that you could have a cup of Greek yogurt that has 20 grams of protein and it's going to make me feel pretty good throughout the day. Lunchtime is where we could maybe consume a little bit more of those carbs because it's the middle of the day. If you like rice or whatever carb it is that you choose, it's good to have it at midday, and then dinner would be a protein and a veg. So then that way when you go to bed, it's not like your body is still digesting all those carbs.

Two things that come up a lot: putting your food into a diary log and meal prep. Tell us how effective those are.

I'm not big with patients doing a lot of work with counting calories and having a diary where they write everything down because then it becomes like homework. My number one goal is that I want it to feel very natural. Meal prep—that's great if you have time, but when I have patients that are single moms with two jobs, the weekend comes and they have to do laundry and all these other things. It's not realistic for every patient. Ideally, yeah, that would be cool. But even ingredient prep—where you bake a piece of chicken and then you just cut it and eat it throughout the week. When you go to the supermarket, you start to think: "Okay, this is going to be three different types of breakfast." I love overnight chia seed pudding, which is super easy. Costco has this huge bag of chia seeds; you put three spoons of that with whichever milk you like.

Chia seeds. I have a vague concept of chia seeds.

They're delicious and they're very anti-inflammatory.

A lot of the things you've mentioned for breakfast have a lot of carbs in it. That's tough for a type one because even yogurt—I know there's different types, but I find it tough. In the olden days on an airplane, they would bring you breakfast and it was cold cereal, pancakes with syrup, orange juice, a piece of bacon, yogurt, and a muffin. Oh my god. Just carbs, carbs, carbs.

Honestly, when I do go to fast food, it's usually for lunch because I don't eat breakfast. It's like this thing you're describing. I guess I have an intermittent fasting diet, but then it makes it really difficult to make good choices at lunch when you're like, "Well, I haven't eaten all day, I deserve it, and I'm starving." That's something that comes up a lot with these intermittent fasting diets—they may be helpful, but then there is this tendency to overeat. How do you help people with that?

It's not just following that window; it's thinking it through. If you're hungry at lunch, you're not going to pick anything that's super healthy. So, for you, it would probably be a good idea to try the overnight chia seeds. It has a lot of fiber, so it might not spike your blood sugar as much. You can just prepare it at night and leave it in the fridge.

What do you like on your scrambled eggs?

Cheese, butter.

I knew he was going to say that. If he takes the chia seeds, I want you to make a video.

I'll make some for you. It's like a pudding. It's delicious. And it's good for your bowels, too.

I'm going to create an Instagram account just all about chia seeds and my journey to finding these things. Absolutely. So, all right, the goal of this is weight loss and reducing inflammation. Is there anything specific on the horizon that targets specific inflammation—like a new therapy? When I think about anti-inflammatories, I think about Advil, but of course, we don't just pop Advil all day because it has side effects. Is that an area of pharmaceutical exploration?

Interestingly, a lot of the GLP-1s have shown that they have this kind of anti-inflammatory process that happens in the body. Some patients on a GLP-1 will say, "I feel less inflamed, I'm less achy." They start saying that even in the first month when they start taking the GLP-1. So it'll be interesting to see long-term what the target is going to be for that, in addition to neurodegenerative conditions which are also inflammatory issues. I feel like there's a lot in that space.

And it's interesting because we know now that these drugs do everything—help blood sugars, help weight, help reduce issues with your heart, kidneys, and liver. For some of those things, we don't really know why. There's a whole lot of theories, but certainly, inflammation is likely playing a role as a unifying force.

If you think about it, a GLP-1 makes the body more insulin sensitive and then there's that caloric deficit that consumes those fat cells.

We don't have a ton of time left, but you mentioned stress. That's a whole different one. How do we get rid of stress? To me, the best thing to get rid of stress is I just pull into McDonald's and get something to eat and then I feel happy.

What do you order there?

It depends. I don't want to get into it. I'll shoot you an email.

But people want to hear because you're relating to a lot of people.

It depends on how good I've been, if I worked out, if I didn't eat—honestly sometimes I'll get chicken nuggets, but if I really feel like I deserve it, a Big Mac is my favorite thing with extra Big Mac sauce.

So there's that reward circuit that gets triggered when we work really hard or when we're stressed. There's that desire for dopamine. For some people, it's shopping; for most people, it's food. That's what's going on there.

There's the whole other topic of the fast food industry making the foods more addictive in terms of the taste and the flavor. I like McDonald's; I like a Big Mac. And to be honest, I think there is a piece of nostalgia for me. I started eating it when I was a kid, and I think there's almost a comfort food element there, too. But pro tip: I always get it modified with something like extra Big Mac sauce so they have to make it special for me.

But what about sleep? Is there any takeaway—like pro tips for how to get more sleep and better sleep?

A lot of people are walking around with undiagnosed sleep apnea. It's quite common. If you're having difficulty staying asleep, if you're waking up in the middle of the night, or if you're tired throughout the day, I would recommend having a sleep study. Aiming for those seven to eight hours of good, deep sleep is the way to go.

Isn't it true that people with sleep apnea have a much more pro-inflammatory state?

Absolutely, yes. It triggers the immune system. Inflammation is everywhere.

What about other quick tips like watching TV in bed or blue light?

When you're going to bed, that's what your bed should be for—sleeping and other things—but mainly for that. You shouldn't be watching TV in your bed. You shouldn't be using your phone or doom-scrolling. If you have that phone there, your brain is super active. Making yourself fall asleep after that is almost impossible. Take a warm bath. Kind of make a whole ritual out of it.

I would say this—it's good to talk about this topic specifically because it comes up in all these different areas. If we're realizing that it goes beyond getting stung by a stingray—these are chronic things that you might be doing to your body with these everyday choices of diet and sleep and stress—you can modify some of those by picking one or two things and seeing how it goes. Baby steps.

And hopefully there's some positive reinforcement there that might be independent of weight loss. "I feel better. I have less mental fog. Waking up in the morning is a little bit easier." It really is about practical tips and incorporating that into your lifestyle. And we didn't even touch on exercise—that is the most powerful anti-inflammatory thing to do. Actually, even walking 10 minutes after you eat is great for your insulin, for the inflammation, and for digestion.

Surfing is great unless you step on a stingray.

Yes, exactly. You have to shuffle, guys. Shuffle.

It comes down to just living a healthy lifestyle. Getting to the ideal body weight, eating foods that are less inflammatory, and trying to reduce the stress in your life. Don't over-drink and exercise balance. You got like seven things to work on.

Micro-changes. Pick one or two things at a time.

Well, thanks Jenny. It's always great having you. We'll have you back again soon. Hope everybody enjoyed watching or listening. Be sure to like, subscribe, follow, and share. All those metrics really are helpful to keep us going. Steve, you have one last comment.

I was just going to say that we're going to be filming some short reels with Jenny in our TCOYD kitchen giving examples of foods that are good for you and foods that are not. You mentioned colorful foods—well, we got a bowl of tricks waiting for you. Seriously, it's in there. We got Wonderbread, we got yogurt, we got all kinds of great examples. So, keep an eye out for her on social, Instagram, Facebook—all that kind of stuff.

Well, thanks again, Jenny. And we'll see you and you'll hear us on the next one.

Awesome. Bye.