Wonderfully Made

Diabetes

Three Angels Broadcasting Network

Program transcript

Participants: Christine Salter

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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.


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Revised 2014-12-17