Participants: Christine Salter
Series Code: WM
Program Code: WM000341
00:36 Welcome to Wonderfully Made
00:38 Our topic today: Pre-diabetes and Diabetes. 00:42 Hello! 00:44 My name is Dr. Christine Salter 00:45 I'm board certified in family medicine and 00:48 now I'm the medical director of Vibrant Health Family Medicine 00:51 St. Louis, Missouri 00:53 Our topic today, Diabetes and Pre-diabetes 00:57 is very important. 00:58 We really want you to pay close attention. 01:02 First of all, 01:03 How many people are affected by Diabetes? 01:07 Well, the US ranks only third behind India and China 01:12 for Diabetes prevalence. 01:15 There are 300 million people worldwide, 01:19 affected by Diabetes. 01:21 In the US alone there are 18 million people with Diabetes 01:26 and that's slated to increase to 30 million by 2030 01:32 Before we discuss the risk factors, 01:35 and how to treat Diabetes, 01:37 let's just talk about the complications, 01:40 so we can really get a perspective here. 01:42 Diabetes affects the brain, via 01:45 It's action on atherosclerosis increasing the risk of stroke, 01:51 it affects the eyes, being one of the leading causes 01:55 of blindness, 01:56 It affects the heart as considered a coronary equivalent 02:00 that is if you have Diabetes you're considered to have 02:03 heart disease. 02:05 It affects the kidneys. 02:06 It's the No. 1 cause of dialysis in the US 02:12 for renal failure, 02:14 also increases the risk for renal cell carcinoma, 02:18 a malignancy of the kidney. 02:21 It also affects the nerves. 02:24 Peripheral neuropathy, 02:27 a very disabling and painful condition 02:30 that diabetics may develop with uncontrolled Diabetes. 02:34 Pain in the toes, pain in the fingers. 02:39 It's very difficult to treat. 02:41 The best way to avoid that is 02:43 to avoid Diabetes in the first place 02:46 or to adequately control Diabetes. 02:49 And what other systems are affected? 02:53 The immune system. 02:55 Poor healing when there's an infection. 02:59 Increased risk for deep seated infections 03:03 So, Diabetes clearly is a problem, 03:07 and we want to avoid it at all cost. 03:11 That is why we are discussing Pre-diabetes. 03:15 And what is pre-diabetes? 03:17 We have to consider it as a continuum. 03:21 We have euglycemia, which is normal glycemia 03:26 or normal blood glucose, 03:27 and then we have pre-diabetes or impaired fasting glucose 03:34 or impaired glucose tolerance 03:37 2 different situations, but both pre-diabetic, 03:41 and then we have hyperglycemia and then after that 03:47 we have disability and death 03:50 we've already listed what some of those are. 03:52 In addition to what we've rightly mentioned 03:55 erectile dysfunction is another problem of the 03:59 uncontrolled diabetes as is amputation. 04:04 And so, between euglycemia and pre-diabetes, that is 04:11 reversible. and that is where we want to diagnose and find people 04:18 to prevent them going on to the hyperglycemia 04:21 and the on to diabetes, and then on to disability and death. 04:28 So, let's talk about impaired fasting glucose. 04:33 If you go to see your doctor and you'd not even breakfast, 04:38 and did not eat after midnight 04:40 and your doctor checks the fasting blood sugar, 04:44 your sugar should easily be less than 19 mg/dl. 04:51 If your blood glucose is 100 or above, but less than 126, 04:58 we say that you have impaired fasting glucose. 05:03 On the other hand. If you had a meal or a carbohydrate load 05:08 and we checked your blood sugar 2 hours later 05:14 and it is greater than 140 but less than 199 05:19 we say, you have impaired glucose tolerance. 05:23 So, that's the problem with elevated blood sugar after 05:29 eating Both of these states are pre-diabetic, 05:34 and we can reverse this state, an that's the good news. 05:40 A large trial was done recently. 05:43 And that trial showed that 05:47 physical activity and proper diet 05:52 was superior to drugs for reversing the pre-diabetic state 05:59 to the normal glycemic state. 06:05 Normal diet or a good diet and physical activity, 06:10 2 lifestyle factors that can cause a reversal 06:16 of the pre-diabetic state into the normal diabetic state 06:21 what are those dietary factors? 06:24 First of all, we want you to limit the high glycemic foods. 06:31 what are those "high glycemic" foods? 06:33 Those foods cause a spike in the blood sugar, 06:38 causing the insulin to go to high, 06:43 and than that coupled with insulin resistance, 06:47 you may have heard of that term, 06:48 insulin resistance, 06:51 when the insulin is released in response to a glucose load, 06:56 the glucose needs to go to the peripheral tissues 07:00 like the muscles, the liver. 07:03 If there's insulin resistance. 07:06 there's a problem with the receptors at the periphery. 07:10 It's like a lock and key mechanism. 07:12 somehow the key comes in, but the lock is blocked. 07:19 and so the insulin unable to do it's job to get the glucose 07:23 into those cells. 07:25 Consequently we have this elevated blood sugar. 07:30 and that's a problem. 07:32 Glucose is very good when it's used for energy 07:35 in the right place, but when it's in the wrong place 07:38 it causes problems, such as end of field dysfunction and 07:43 contributing to atherosclerosis. 07:48 And so, when you eat and insulin is released there needs to be 07:55 a mechanism to get the glucose into the peripheral cells. 08:01 And exercise is one of those mechanisms 08:04 But let's talk about the high glycemics again. 08:07 So, what are those high glycemic foods, 08:10 that causes spiking insulin 08:12 and just too much glucose too quickly into the bloodstream 08:18 Unrefined carbohydrates, 08:22 and what we want to have, refined carbohydrates, 08:26 are high glycemics. 08:29 White bread, white rice, white flour, products made with these, 08:36 white pasta, juices, alcohol, 08:42 cakes, pastries, pretzels, 08:46 sounds familiar? 08:48 These are the common foods if you go to a restaurant, 08:53 or to a party gathering, 08:56 what do you find? 08:57 juice, 08:58 chips, 08:59 pastries, 09:00 cakes, 09:01 these are high glycemics. 09:03 These cause a spike in the level of insulin, 09:08 and just too much glucose in the bloodstream. 09:12 So we want you to limit those high glycemic foods. 09:18 but we also want you to exercise, 09:21 because that is the other half of the puzzle. 09:25 Eating properly 09:27 and exercising. 09:30 When we exercise the large muscles, 09:33 the large muscles work and they will bring in the glucose 09:37 under the influence of insulin. 09:41 But, if you go to a party, or after dinner, 09:45 and you eat cakes, pretzels, drink a glass of juice 09:50 and then go and sit down in front of the TV. 09:55 That is a recipe for insulin resistance 09:59 and high blood sugar, 10:01 and the damaging effects that it causes. 10:05 So, you can understand why in this large trial, 10:08 that proper eating and exercise 10:12 decreased the risk for diabetes 10:16 by reverting from the pre- diabetic state 10:20 to the normal glycemic state. 10:24 from the pre-diabetic state 10:26 to the normal glycemic state. 10:29 with proper diet and exercise. 10:33 But the diet isn't about what you shouldn't eat, 10:37 the high glycemics, 10:38 it's also about what you should eat. 10:42 Foods that are high in fiber. 10:45 These help to stabilize the blood sugar. 10:50 So, those high glycemic foods as the white bread 10:55 replace that with whole grain bread. 10:58 The white pasta, replace that with whole grain pasta. 11:04 The white flour products, replace that with 11:07 whole wheat flour or oatmeal flour, 11:11 the complex carbohydrates 11:14 We are not advocating a high protein, low carbohydrate diet, 11:21 what we are advocating is that you avoid 11:25 the refined carbohydrates and you replace them 11:28 with the complex carbohydrates. 11:33 What else is important? 11:36 Phytonutrients, that we find in fruits and vegetables. 11:42 These phytonutrients help regenerate and protect 11:46 the vessels of the eyes, of the brain, of the heart, 11:48 of the kidneys, of the nerves. 11:49 It's important that you eat these foods. 11:57 So, whole grains, fruits and vegetables, legumes, 12:03 seeds and nuts. 12:05 What are in these seeds and nuts? 12:07 Well, the brazil nut for instance is very high 12:10 in the mineral selenium, 12:14 and selenium is rather important 12:17 as it is a powerful antioxidant. 12:21 Why do we want you to have antioxidants in your blood 12:26 steam? Because oxidation is a normal fact of life. 12:32 If you exercise, you're going to get oxidation. 12:35 If you breathe, you're going to get oxidation. 12:39 If you have pre-diabetes, 12:42 you're going to have a lot more oxidation. 12:44 So, we need to have those antioxidants in the blood stream 12:48 to mop up all the oxidants to prevent the damage. 12:53 Oxidants prevent damage, 12:54 antioxidants mop the up. 12:59 and improve the lining, 13:02 so, oxidants cause damage, antioxidants prevent damage. 13:09 And so, fruits, vegetables, whole grains 13:13 coupled with seeds and nuts, and regular exercise, 13:18 is going to be protective, and will reverse the process 13:23 of pre-diabetes, 13:25 back to a normal glycemic state. 13:30 But, if you do not follow these things, 13:35 then we will have a problem. 13:39 How can you tell, that you're at risk 13:42 for being pre-diabetic? 13:46 Well, there's certain body habitus factors, 13:49 that can let us know this. 13:52 First of all, 13:54 are you obese or are you overweight? 13:57 You can tell that by simply getting' on the scale, 14:00 and checking your height. 14:03 If your Body Mass Index is greater than 25 14:07 than you are overweight, 14:08 and if it's greater than 30, than you are obese. 14:12 Obesity is increasing in an alarming rate. 14:16 Not only in the US, but also in other developed countries 14:20 and this is all linked with the increase in diabetes. 14:27 What is the problem with obesity? 14:30 Let's talk about that for a second. 14:35 We are concerned about abdominal obesity. 14:39 or the "apple" shaped body. 14:44 Abdominal obesity. 14:50 is very active, metabolically, and is producing 14:55 all kinds of what we call inflammatory cytokines. 14:59 that are damaging the blood vessels. 15:04 We are not as concerned about obesity around hip area, 15:09 but we're very concerned about abdominal obesity. 15:13 So, in a man: if your waist circumference 15:17 is greater than 40 inches 15:20 that's a problem, 15:22 that's abdominal obesity. 15:24 and in a woman, greater than 35, that's abdominal obesity. 15:29 So, when you go to your physician, 15:32 we want to know what your body mass index is, 15:34 we want to know what your waist circumference is. 15:38 Because these are risk factors for insulin resistance 15:44 and pre-diabetes. 15:46 We also want to know 15:48 about your lifestyle, are you sedentary? 15:52 Family history is important. 15:54 If your mother, father, brother, or sister have diabetes 15:57 you are the significant risk for diabetes. 16:02 What are the organs that are affected with diabetes? 16:10 Well, we've talked about the major organs, 16:14 but the pancreas is the organ that produces the insulin. 16:19 The beta cells of the pancreas. 16:22 Now, it is thought that in some individual they are targeted 16:28 or genetically predisposed for those beta cells to fail. 16:33 What I mean by that? 16:35 Those beta cells produce the insulin. 16:41 so, the insulin helps to deal with glucose. 16:46 The large muscles help to get rid of the glucose 16:51 If we have a situation where those cells are failing, 16:56 so they are not producing the insulin 16:59 to deal with the glucose that's coming in, 17:01 from all those high glycemic foods, 17:04 and then there is no exercise or minimal exercise to... 17:09 the glucose into those cells, 17:11 then we have a situation of hyperglycemia and diabetes. 17:16 What are the numbers for the diagnose of diabetes? 17:20 If on two occasions you have a fasting blood glucose of 126, 17:26 that is a diagnosis of diabetes. 17:29 On the other hand, 17:31 if I just did a random blood sugar 17:34 and this is greater than 200, 17:36 that is the diagnose of diabetes right there. 17:40 I do recall a case of a gentleman, 17:43 who was complaint of erectile dysfunction 17:46 and as I mentioned earlier 17:48 that is one of the areas affected by diabetes. 17:51 so right away I new that I needed to check him diabetes 17:55 as well as for his cholesterol and for his high blood pressure. 17:59 He assured me that diabetes was not in the family, 18:03 and that he did not have a problem with that. 18:06 However I went ahead and I checked a random glucose 18:12 and that was greater than 200, closer to 250. 18:18 That is a diagnosis of diabetes. 18:22 And so with that diagnosis, he is taken to a higher category 18:28 as far as risk assessment for coronary artery disease. 18:32 and not only for coronary artery disease, 18:34 but all the other conditions, we mentioned. 18:37 The kidneys, the brain, the eyes, the feet, the nerves. 18:43 That is the reason why we are so concerned 18:45 about diabetes in the first place. 18:49 Now, 18:51 the foods we eat, the fiber content, 18:55 the exercise, are the mainstay of the treatment of diabetes. 19:00 We can use medications, 19:02 and there are some reasonable medications out there 19:06 that can help in diabetes, 19:08 but they do have their side effects too. 19:10 So, the ideal situation is to use the diet and lifestyle, 19:16 the same diet and lifestyle that causes reversal 19:19 of the pre-diabetic state to the normal glycemic state, 19:23 will also treat the diabetic state 19:26 to prevent further progression to disability and death. 19:35 Some of those drugs are Metformin or Glucophage, 19:40 again can be useful 19:41 But in a certain individuals that medicine is contraindicated 19:47 If you have severe renal disease, 19:52 if you have congestive heart failure, 19:55 than you're not a candidate for Glucophage or Metformin. 20:00 So, please don't ever go and take that drug 20:03 that belonged to your mother, or your brother, or your sister 20:06 without first being checked up by a physician to make sure, 20:10 that you are a candidate for that medicine. 20:12 Again. 20:14 Medications are secondary to lifestyle. 20:20 Diet and exercise. 20:23 Even the standard American diabetic diet, 20:25 when fruits 20:28 just a few servings of fruit was added to that diet 20:31 they had a lower level of blood sugar than before. 20:37 So, we see the importance of the fiber, the soluble fiber, 20:42 that we find in fruits, 20:43 the soluble fiber that we find in oats, 20:47 and as well as the fiber, we find in the whole grains. 20:50 These are important to keep that blood sugar stabilized. 20:56 The Bible says, there's nothing new under the Sun, 21:00 the same problems and conditions and lifestyle facts that cause 21:04 coronary artery disease, 21:06 that contributes to high blood pressure, 21:09 are also a problem with diabetes. 21:12 So we could save ourselves a lot of trouble, 21:17 as far as those conditions are concerned, 21:19 if we'd eat fruits, vegetables, whole grains and exercise. 21:24 but in addition, it is important 21:27 to drink an adequate amount of water. 21:30 A large study was done on over 70.000 women, 21:36 and they looked at the water intake, 21:40 and they found that drinking at least 5, 8-ounce glasses 21:44 of water, 21:45 significantly cut the coronary vascular disease risk. 21:50 Why is that? 21:52 When we are properly hydrated, the blood is thin. 21:58 and it can flow through the vessels nicely. 22:02 With diabetes, the blood flow is slow and sluggish. 22:09 You've seen syrup. 22:10 If you pour syrup, it's very slow and sticky. 22:15 Just imagine, what your blood stream looks like, 22:18 if you've got all this glucose in it. 22:22 It is thick and sticky. 22:25 If you have diabetes, make sure that you're not drinking sodas, 22:30 caffeinated beverages, for your fluid intake. 22:35 Make sure that your main fluid intake is pure water, 22:39 to keep your blood nice and hydrated and flowing freely. 22:46 So, as you drink your water, eat a plant based diet 22:50 with fruits, vegetables, whole grains. 22:54 Exercising for at least 30 minutes, 22:57 on most days of the week. 22:59 If you have pre-diabetes, 23:01 you will revert to normal glycemia, 23:06 if you have diabetes, you'll prevent the progression 23:11 on to more serious conditions involving the brain, 23:16 the heart, the kidneys, the nerves, 23:22 the feet, preventing amputation. 23:26 This will be a good thing and it is simple. 23:31 If you are still not getting control, 23:35 and you want to give yourself at least 3 months, 23:39 on the lifestyle diet and exercise, 23:45 then we can add some of the medications 23:48 to help control the blood sugar. 23:52 I've had the wonderful opportunity of treating patients 23:55 with diabetes, and getting them off medicines, 24:00 sometimes using herbs that will help regenerate 24:06 the pancreatic cells, 24:08 to help with the insulin production, 24:11 thereby lowering the blood glucose. 24:16 But we don't want to use herbs as a band aid. 24:20 In the same way we don't want to use medicines as a band aid. 24:24 We want to go to the source, to the cause, 24:28 we want to treat the root cause. 24:30 And if the root cause is poor diet, 24:35 inadequate physical activity, 24:37 than that is where we need to begin. 24:42 So, as you plan to exercise, 24:46 just think to yourself. 24:48 This exercise is like medicine. 24:53 This exercise is like medicine. 24:56 It is decreasing the ... of blood stream. 25:00 It is improving the circulation to all the vessels, 25:02 it is improving insulin resistance. 25:09 We want to share with you some additional parameters 25:13 to look for, 25:15 regarding insulin resistance. 25:17 When you get your fasten glucose profile done 25:20 and we hope that you will do that, 25:23 we want make sure to look at your triglyceride levels, 25:26 that's the fat in the blood stream, 25:28 if it's greater than 150, that's a problem. 25:32 We want to look at your "good" cholesterol level, 25:35 or the HDL, 25:37 we wanted to be greater than 50, 25:39 if it's less than 50 in women or less than 40 in men, 25:43 that's a problem. 25:45 If your waist circumference in men is greater than 40, 25:49 or greater than 35 in women, 25:52 that is also a problem. 25:54 If you have elevated blood pressure, 25:57 that is also a problem. 26:00 And if you have impaired fasting glucose, 26:04 that is also a problem. 26:06 That consolation, those 5 things I've mentioned, 26:10 constitute the Metabolic syndrome, 26:14 or the syndrome that's associated with pre-diabetes, 26:18 is almost a link into full blown diabetes. 26:23 So, if you see your doctor, 26:25 and your blood pressure just slightly elevated, 26:27 you have these other consolation symptoms, 26:30 that is the metabolic syndrome, 26:32 that increase your risk for coronary events as well as 26:38 diabetes. 26:40 The good news is, 26:42 these things can be reversed. 26:45 Exercise will raise the good cholesterol. 26:50 Limiting and avoiding the high glycemics 26:54 will lower the triglycerides. 26:57 As you exercise and loose weight, 27:01 that will change the abdominal circumference, 27:05 thereby, decreasing abdominal obesity. 27:08 And you remember that abdominal fat 27:11 is highly metabolically active, 27:13 producing inflammatory cytokines. 27:17 Did you also know that there is another lifestyle factor, 27:20 that affects diabetes? 27:21 and that is, not getting enough sleep. 27:25 We want you to get adequate sleep, 27:27 especially before midnight, 27:29 because that helps 27:30 in the circadian regulation of the hormones. 27:33 We are truly fearfully and wonderfully made. 27:37 The Lord made the pancreas and all the other endocrine 27:42 organs to work together to maintain normal blood glucose, 27:47 and so if we do this simple lifestyle factors, 27:50 adequate sleep, proper diet, high fiber, regular exercise, 27:55 avoiding the high glycemic foods, 27:59 drinking at least 5, 8 ounce glasses of water, 28:03 you can prevent diabetes, 28:07 reverse pre-diabetes, 28:09 so I wish you above all things that you'll prosper 28:11 and be in health, even as your soul prospers. |
Revised 2014-12-17