When it comes to caring for his patients with type 2 diabetes, Tony Hampton, MD, takes a different route than most doctors. Dr. Hampton emphasizes that healing from chronic disease can only occur when physicians shift their focus to the root cause of the illness. To do that, he uses the mnemonic, “Nest Rope.”
“It’s our job as physicians to play detective and try to piece through a patient’s condition. If you have an easy way to remember it, then you’ll always think about these things,” said Dr. Hampton, a family physician and obesity medicine specialist at Advocate Medical Group in Chicago. He is also the physician lead for Advocate's Healthy Living Program and regional medical director for the South Region of Advocate Medical Group.
“Our job is not just to be very evidence-based and follow the guidelines,” he said. “Our job is to be a friend and a coach, find out what’s giving our patients issues and guide them on their journey—that’s what a real doctor has to do.”
Following the mnemonic, “Nest Rope,” this is how Dr. Hampton gets to the root cause of the illness with his patients.
To start, the “N” in “Nest” stands for nutrition. Dr. Hampton works with his patients to identify healthy foods and what to stay away from.
“In my clinic, I encourage patients with diabetes—and most patients in general—to reduce sugar, starchy vegetables and excessive grains,” said Dr. Hampton.
For example, a serving of Kellogg’s Raisin Bran has 38 grams of carbohydrates, which might sound like a healthy breakfast. However, there are “nine and a half spoonfuls of sugar,” he said. “That’s exactly the same number of carbs found in soda.”
Physicians need to speak with their patients about exercise. This includes how often they should exercise, as well as tips or recommendations to point them in the right direction.
However, “the key to exercise is that you need recovery,” said Dr. Hampton. “I tell my patients, ‘Consider exercising three to four times a week and always have enough time for recovery.’”
Stress and sleep
The “S” in “Nest” has two focuses: stress and sleep. By focusing on both, patients with type 2 diabetes can make healthier decisions.
“They have to have less stress because that increases cortisol, which causes your liver to make more glucose—that’s going to make your sugars high,” said Dr. Hampton. “Then, if you don’t get enough sleep—seven to eight hours—then you’re going to do the same thing.”
“That’s stressful to the body. It is going to lead to cortisol and that’s going to cause your sugars to go up,” he said.
Think and trauma
For the “T,” there are two focuses: how a person thinks and the trauma they might be experiencing.
“We need to encourage people to have a positive attitude about this,” said Dr. Hampton. “I encourage patients to listen to inspirational things on a regular basis, so they won’t lose their confidence and get rid of fear.”
Traumatic experiences and stress can contribute to negative moods and coping mechanisms, which can further complicate type 2 diabetes. This can raise their glucose.
“We need a rope to climb up to our nest,” said Dr. Hampton, adding that the “R” in “Rope” stands for relationships.
“You need to know what kind of relationships your patients are in—are they in relationships that are stressing them out, causing them to have high sugar?” he said. “This is so true for our patients it’s unbelievable.”
For example, a grandmother who is taking care of her grandchildren can be experiencing heightened stress. This can increase her glucose. However, relationships are also an important resource for many people because they provide additional support when caring for their type 2 diabetes.
Next up on the Rope is the “O,” which stands for organism. This is important because patients with type 2 diabetes need to be cautious of who they encounter, especially if someone has COVID-19.
“If you follow the principles, you will protect yourself from harm from organisms,” said Dr. Hampton. “You want to be able to protect yourself so that you won’t be exposed to someone who is sick because it will flare up your diabetes. That’s the bottom line.”
“The ‘P’ is for pollutant,” he said. “A good example for diabetes would be to eat real food instead of food with a lot of chemicals” or added preservatives.
“If possible, encourage your patients to eat food that is organic or grass-fed,” said Dr. Hampton, adding that he doesn’t go into that too much because it is more important to “check the labels and make sure you don’t have additives that can be harmful to the body.”
Emotion and life experiences
“The last two are for emotion and life experiences,” said Dr. Hampton. “For emotions, if my patient is depressed or anxious, they’re going to have high sugars, so I need to know about that.”
“Then the other part is their life experiences,” he said, adding that if “they have to eat cornbread with their greens or they have to have a tortilla with every meal, that could harm their blood sugar.”
“I need to know what life experiences they have that are old beliefs that are harming my patient,” said Dr. Hampton. Understanding this can help physicians work with their patients to explore new practices that fit their beliefs but are healthier options.
“As a physician, if I’m thinking about all of these factors then what’ll happen is I’ll understand if they’re eating well, exercising and sleeping, then I need to search for other causes that may be messing up their sugars,“ he said. “If you don’t deal with the root cause of their stress then you’ll never help them.”
The AMA is addressing America’s growing chronic disease epidemic and helps health care organizations use targeted strategies to prevent type 2 diabetes in their patient populations.