The Hidden Truths of Diabetes and Obesity Interplay with Dr. William Choctaw

1 00:00:00,480 --> 00:00:02,404 Speaker 1: Welcome to the Healthy, Wealthy and Wise 2 00:00:02,524 --> 00:00:08,064 podcast with Dr William Chokta, MDJD. Our mission is to empower 3 00:00:08,125 --> 00:00:11,897 you with the knowledge and the tools you need to thrive in all 4 00:00:12,099 --> 00:00:16,184 aspects of your lives. Join us now as we discuss everything 5 00:00:16,285 --> 00:00:19,842 from nutrition and exercise to money management and personal 6 00:00:19,862 --> 00:00:24,733 growth. Dr Chokta will provide insightful advice on how to 7 00:00:24,774 --> 00:00:28,064 improve your physical and financial health, as well as 8 00:00:28,103 --> 00:00:31,460 your emotional and mental well-being. Whether you're 9 00:00:31,481 --> 00:00:35,930 looking to boost your energy levels, unlock financial freedom 10 00:00:35,930 --> 00:00:40,228 or cultivate a more positive mindset, we've got you covered. 11 00:00:41,799 --> 00:00:45,901 Get ready to become the best version of yourself? So let's 12 00:00:45,941 --> 00:00:51,901 get started. Here's Dr William Chokta, MDJD. Good morning. 13 00:00:53,304 --> 00:00:55,969 Speaker 2: Welcome to the Healthy, wealthy and Wise 14 00:00:56,411 --> 00:01:01,609 podcast. I'm Dr William Chokta and I will be your facilitator 15 00:01:01,630 --> 00:01:05,346 today. Today, we're going to talk about destroying myths 16 00:01:05,787 --> 00:01:12,662 about diabetes. Destroying myths about diabetes. I believe 17 00:01:12,742 --> 00:01:17,248 knowledge is power. I believe life is about service to others. 18 00:01:17,248 --> 00:01:23,081 I believe leaders can change the world, as we routinely do. 19 00:01:23,201 --> 00:01:28,831 we will underlie the discussion today in the area of medicine 20 00:01:29,332 --> 00:01:32,620 and law. Well, let's take a look at our outline, and the purpose 21 00:01:32,620 --> 00:01:34,808 of the outline is to let you know what we're going to talk 22 00:01:34,868 --> 00:01:38,346 about, but more importantly or as importantly, it's to let you 23 00:01:38,367 --> 00:01:42,046 know when we're just about done. I realize that you're all very, 24 00:01:42,046 --> 00:01:45,301 very busy people and we're absolutely delighted to have you 25 00:01:45,301 --> 00:01:49,381 with us on this particular podcast, but today we're going 26 00:01:49,400 --> 00:01:54,471 to talk about diabetes, and particularly type 2 diabetes. 27 00:01:55,439 --> 00:01:58,087 We're going to talk about the relationship between diabetes 28 00:01:58,147 --> 00:02:04,007 and obesity. We'll further then discuss the body mass index, 29 00:02:04,087 --> 00:02:07,033 which is used to evaluate obesity as it relates to 30 00:02:07,072 --> 00:02:10,145 diabetes, but we're going to specifically talk about 31 00:02:10,286 --> 00:02:16,924 individual myths about diabetes, diabetes remission and then 32 00:02:17,024 --> 00:02:20,872 some of the medication that's new, relatively new and use to 33 00:02:20,932 --> 00:02:26,969 treat patients with diabetes. Well, what is the definition of 34 00:02:27,009 --> 00:02:30,207 diabetes? And again, we're talking about diabetes type 2. 35 00:02:31,381 --> 00:02:36,150 Type 2 is called adult onset diabetes and basically it is 36 00:02:36,210 --> 00:02:41,123 defined as a chronic disease that occurs because the body is 37 00:02:41,304 --> 00:02:46,980 unable to use blood sugar, ie glucose, properly. Let me say 38 00:02:47,020 --> 00:02:51,705 that again, diabetes is a chronic disease that occurs 39 00:02:51,806 --> 00:02:57,804 because the body is unable to use blood sugar, ie glucose, 40 00:02:57,924 --> 00:03:02,931 properly. The exact cause of this malfunction is unknown, but 41 00:03:02,931 --> 00:03:08,039 genetic and environmental factors play a major part. Risk 42 00:03:08,060 --> 00:03:14,031 factors associated with diabetes include obesity and high levels 43 00:03:14,031 --> 00:03:19,286 of cholesterol. Well, how does the mechanism of diabetes work 44 00:03:19,526 --> 00:03:25,205 in terms of creating difficulty for patients? Well, primarily, 45 00:03:25,245 --> 00:03:29,818 the pancreas is an organ in the body that sits right adjacent to 46 00:03:29,818 --> 00:03:35,568 the stomach, in the mid part of the upper abdomen, and it 47 00:03:35,608 --> 00:03:44,421 basically digests or secretes insulin into the bloodstream 48 00:03:44,923 --> 00:03:49,039 whenever blood sugar is located in the bloodstream, and the 49 00:03:49,060 --> 00:03:53,930 purpose of this insulin is to take these molecules of glucose, 50 00:03:53,930 --> 00:03:59,227 ie sugar, and to modify them in a way that they could be used 51 00:03:59,367 --> 00:04:04,003 efficiently by the muscle. So you need the insulin for the 52 00:04:04,044 --> 00:04:09,216 blood sugar to be used efficiently by the muscle, and 53 00:04:09,256 --> 00:04:15,245 what happens is that, if you are diabetic, you do not have 54 00:04:16,346 --> 00:04:20,740 either sufficient insulin or your insulin, more importantly, 55 00:04:21,120 --> 00:04:27,218 is not as effective in providing its physiological purpose in 56 00:04:27,257 --> 00:04:32,406 terms of helping blood sugar or glucose to go into the cells of 57 00:04:32,507 --> 00:04:38,425 muscles and other organs. Well, what are the causes of diabetes? 58 00:04:38,425 --> 00:04:42,935 And this is a huge issue that has changed over time, and one 59 00:04:42,954 --> 00:04:45,644 of the things to keep in mind is that health care is always 60 00:04:45,704 --> 00:04:51,255 growing, it is always changing, it is always advancing. It used 61 00:04:51,295 --> 00:04:57,906 to be felt that diabetes was primarily almost exclusively 62 00:04:58,026 --> 00:05:03,259 caused, according to some, by obesity. We now know that that's 63 00:05:03,259 --> 00:05:07,862 no longer true. Yes, obesity is a contributing factor to some 64 00:05:07,923 --> 00:05:11,259 who have diabetes, but what we've learned is there are other 65 00:05:11,259 --> 00:05:16,677 contributing factors, like stress, like an unhealthy diet 66 00:05:17,218 --> 00:05:22,680 and, most importantly, genes or your genetic makeup. What does 67 00:05:22,701 --> 00:05:26,882 that mean? That means what you have inherited from your parents 68 00:05:26,882 --> 00:05:30,636 and grandparents or great-grandparents over the 69 00:05:30,716 --> 00:05:35,264 years can many times dictate whether you will or will not 70 00:05:35,386 --> 00:05:40,322 become diabetic. And this is independent of diet and exercise 71 00:05:40,322 --> 00:05:44,177 , independent of what you may or may not do, and it's important 72 00:05:44,478 --> 00:05:48,180 to keep that in mind And we'll expand on this idea later as we 73 00:05:48,240 --> 00:05:52,298 go through this discussion. It's important to keep in mind that 74 00:05:52,338 --> 00:05:55,675 when we look at something like diabetes, which affects every 75 00:05:55,735 --> 00:06:00,589 single ethnic group in our country, that there are 76 00:06:00,649 --> 00:06:04,315 differences in how it affects the different ethnic groups. So 77 00:06:04,716 --> 00:06:10,449 if one were to look at this as National Institute of Health 78 00:06:10,550 --> 00:06:17,165 Information if one were to look at the effects or the prevalence 79 00:06:17,165 --> 00:06:20,237 , if you will, of diabetes in different ethnic groups. Let's 80 00:06:20,278 --> 00:06:24,230 take five different ethnic groups of individuals in the 81 00:06:24,312 --> 00:06:28,139 United States of America. The group that has the lowest 82 00:06:28,860 --> 00:06:33,329 incidence of prevalence of diabetes is white. Non-hispanic 83 00:06:34,235 --> 00:06:37,747 or Caucasians do not have the lowest incidence of diabetes and 84 00:06:37,747 --> 00:06:42,735 that's usually around about seven or eight percent. The next 85 00:06:42,735 --> 00:06:50,447 highest, above them, is Asian Americans and their incidence is 86 00:06:50,447 --> 00:06:58,423 about nine percent. The next group is Hispanic and their 87 00:06:58,583 --> 00:07:05,197 incidence is approximately 12 percent. The next highest group 88 00:07:05,579 --> 00:07:10,767 is African Americans and their incidence is about 13 percent, 89 00:07:11,795 --> 00:07:16,524 and the highest ethnic group in our country with diabetes is 90 00:07:16,684 --> 00:07:21,956 American Indians, slash Alaska Native. So American Indians have 91 00:07:21,956 --> 00:07:26,086 the single highest percentage of diabetes as an ethnic group, 92 00:07:26,735 --> 00:07:30,266 and Caucasians or white non-Hispanic have the lowest 93 00:07:31,228 --> 00:07:35,197 percentage of diabetes in this country. And so what that says 94 00:07:35,298 --> 00:07:39,298 is basically all groups get it. But the reason why it's 95 00:07:39,377 --> 00:07:41,805 important to understand the prevalence and incidence in the 96 00:07:41,845 --> 00:07:45,482 different racial groups is that when we make sweeping 97 00:07:46,324 --> 00:07:50,059 proclamations about diabetes in terms of cause and in terms of 98 00:07:50,521 --> 00:07:54,853 treatment, we have to understand that there is a difference in 99 00:07:54,875 --> 00:07:59,228 how it appears in these different ethnic groups and also 100 00:07:59,228 --> 00:08:03,120 how it can best be treated in these individual ethnic groups 101 00:08:03,595 --> 00:08:08,571 And, most importantly, it is not appropriate to take the largest 102 00:08:08,571 --> 00:08:12,279 ethnic group, which is the white non-Hispanic, and do 103 00:08:12,339 --> 00:08:16,447 studies that only include individuals in that ethnic group 104 00:08:16,447 --> 00:08:20,062 and then try to make broad statements about diabetes 105 00:08:20,141 --> 00:08:25,759 treatment, cause and effect of those other four ethnic groups 106 00:08:27,442 --> 00:08:30,995 in terms of what's best quality in their care. So what I'm 107 00:08:31,036 --> 00:08:35,630 saying is that you have to look at these groups individually and 108 00:08:35,630 --> 00:08:38,561 you have to include all individuals in these particular 109 00:08:38,600 --> 00:08:42,517 groups in your study and your data to be able to predict 110 00:08:42,839 --> 00:08:46,993 accurately what's most effective in their management and 111 00:08:47,052 --> 00:08:50,604 treatment. One of the big areas of controversy that has been 112 00:08:50,644 --> 00:08:56,440 around for a long time is is diabetes is inherited or is and 113 00:08:56,480 --> 00:09:02,052 caused by behavior, particularly behavior in terms of overeating 114 00:09:02,052 --> 00:09:08,912 ? The reality is we know that a significant part of diabetes, or 115 00:09:08,912 --> 00:09:12,058 a significant percentage of individuals who have diabetes, 116 00:09:12,519 --> 00:09:17,336 have it purely from genetics, purely from their genes. We even 117 00:09:17,336 --> 00:09:22,559 know some of the genes that cause it. Capn10 is one of the 118 00:09:22,580 --> 00:09:30,096 genes that's been confirmed to cause type 2 diabetes. Tcf-l 119 00:09:30,618 --> 00:09:37,307 TCF-7L2 is a protein coding gene that has the strongest link to 120 00:09:37,347 --> 00:09:42,317 type 2 diabetes across all racial groups. So my point is 121 00:09:43,058 --> 00:09:48,631 the genes, or your genetic makeup, is a major cause, and 122 00:09:48,692 --> 00:09:52,576 many times the only cause, of diabetes in some patients, and 123 00:09:52,596 --> 00:09:56,519 we'll expand about this a bit more. So this changes the 124 00:09:56,558 --> 00:10:00,168 paradigm, if you will, of a lot of individuals that say no, no, 125 00:10:00,315 --> 00:10:03,697 no, no, no, don't blame this on your genes, you just need to 126 00:10:03,738 --> 00:10:08,303 have better habits, you just need to improve your behavior. 127 00:10:09,014 --> 00:10:12,144 Well, the reality is that some people do have it just because 128 00:10:12,183 --> 00:10:14,039 of their genes. They have nothing to do with their 129 00:10:14,059 --> 00:10:17,076 behavior, they have it because of their genes And that's a 130 00:10:17,136 --> 00:10:20,720 scientific fact. And remember, health care grows in terms of 131 00:10:20,840 --> 00:10:24,677 knowledge and scope and intelligence, and this is one of 132 00:10:24,677 --> 00:10:28,525 the things that we have learned over time over the last 50 133 00:10:28,586 --> 00:10:33,515 years that we did not know 50 years ago. In accordance with 134 00:10:33,556 --> 00:10:40,607 that, we physicians 50 years ago , many physicians used to do 135 00:10:40,769 --> 00:10:47,304 everything. I can remember the general practitioners who used 136 00:10:47,325 --> 00:10:51,639 to deliver babies, and some would do some surgeries, and 137 00:10:51,700 --> 00:10:55,056 then time progressed and then there were surgeons who did the 138 00:10:55,116 --> 00:10:57,845 surgery and general practitioners didn't do surgery, 139 00:10:57,845 --> 00:11:02,423 and then time progressed and there were OBGYN specialists who 140 00:11:02,423 --> 00:11:06,758 delivered babies. The obstetricians and the general 141 00:11:06,778 --> 00:11:10,457 practitioners didn't deliver the babies. And so my point is that 142 00:11:10,457 --> 00:11:16,234 , over time, as health care continues to mature and grow and 143 00:11:16,234 --> 00:11:19,301 become more intelligent and become more effective. 144 00:11:21,326 --> 00:11:26,283 Specialists develop, and so is the case in terms of obesity and 145 00:11:26,283 --> 00:11:31,178 obesity that may be related to diabetes. Dr Fatima Stanford is 146 00:11:31,559 --> 00:11:36,268 a Harvard graduate and now Harvard professor in a specialty 147 00:11:36,268 --> 00:11:41,044 called Obesity Medicine, which is a relatively new specialty. 148 00:11:42,034 --> 00:11:44,923 Most of us, as physicians, have treated patients who were obese, 149 00:11:44,923 --> 00:11:48,062 and usually we gave the familiar mantra diet and 150 00:11:48,123 --> 00:11:51,722 exercise. Well, the reality is that doesn't work for everybody, 151 00:11:51,722 --> 00:11:56,918 and that's just the honest truth, and so one of the things 152 00:11:56,977 --> 00:12:02,027 that's important is that we not beat up on patients 153 00:12:02,106 --> 00:12:07,023 metaphorically in terms of telling them well, you just need 154 00:12:07,023 --> 00:12:11,405 to do better In situations where it does not matter what 155 00:12:11,446 --> 00:12:14,659 they do, particularly if they have a genetic reason for having 156 00:12:14,659 --> 00:12:18,773 type 2 diabetes, but instead focus on the root cause for that 157 00:12:18,773 --> 00:12:22,783 individual patient and treat them so they can live long and 158 00:12:22,802 --> 00:12:27,625 thrive. One of the issues that has also come up along the same 159 00:12:27,725 --> 00:12:32,181 lines is the body mass index has been a index that's been around 160 00:12:32,181 --> 00:12:36,135 for years, that we have used to determine who is overweight and 161 00:12:36,135 --> 00:12:40,664 who is underweight, or who is obese, who is not obese or 162 00:12:40,705 --> 00:12:44,442 morbidly obese, and the American Medical Association just 163 00:12:44,543 --> 00:12:49,182 recently came out with a ruling, and recently in terms of June 164 00:12:49,201 --> 00:12:54,461 of 2023. And, in essence, what it says is that the American 165 00:12:54,522 --> 00:12:57,397 Medical Association has adopted a policy that encourages 166 00:12:57,778 --> 00:13:02,892 clinicians to reduce their focus on body mass index and health 167 00:13:02,951 --> 00:13:07,020 assessments, stating that the measurement is based on racially 168 00:13:07,020 --> 00:13:11,556 exclusive data. That has caused harm. What does that mean? That 169 00:13:11,556 --> 00:13:15,509 means that when this particular index was devised and developed 170 00:13:15,509 --> 00:13:20,342 , the individuals who were in the experimental group did not 171 00:13:20,462 --> 00:13:25,274 include racial minorities. Consequently, the outcome or the 172 00:13:25,274 --> 00:13:30,785 results or the recommendations may not be most beneficial to 173 00:13:30,826 --> 00:13:35,123 those racial minorities, even though it may benefit a separate 174 00:13:35,123 --> 00:13:39,336 racial majority. And so, to say it another way, if you want to 175 00:13:39,375 --> 00:13:43,845 have something that benefits all 370 plus million people in the 176 00:13:43,924 --> 00:13:47,337 United States of America, you've got to make sure that every 177 00:13:47,418 --> 00:13:52,629 particular ethnic group within that 370 million is represented 178 00:13:52,815 --> 00:13:57,842 in your study, so that you make sure that the needs and the 179 00:13:57,984 --> 00:14:04,158 individual specificities of the certain racial groups are 180 00:14:04,238 --> 00:14:07,725 represented, so that your outcomes can be beneficial to 181 00:14:07,765 --> 00:14:11,082 them also. So, in essence, the American Medical Association, 182 00:14:11,123 --> 00:14:15,616 which is the main body that sets up rules and regulations for 183 00:14:15,697 --> 00:14:21,667 repositions, recognizes the historical harm that the base 184 00:14:22,528 --> 00:14:26,740 metabolic body mass index has done and states that the metric 185 00:14:26,780 --> 00:14:32,296 has been used for racist exclusion And again meaning that 186 00:14:32,296 --> 00:14:39,408 the data has been used in some instances to be more detrimental 187 00:14:39,408 --> 00:14:44,124 to certain individuals in certain ethnic groups. That has 188 00:14:44,163 --> 00:14:49,375 been contraindicated. That has caused challenges and prevented 189 00:14:49,416 --> 00:14:55,288 those individuals from achieving healthy, wealthy and wise 190 00:14:56,552 --> 00:15:00,922 existence, and so we want to correct. That is our point And 191 00:15:00,942 --> 00:15:05,133 this all boils down to the whole issues. Is obesity and or 192 00:15:05,192 --> 00:15:10,605 diabetes caused by bad behavior or by other things? And the 193 00:15:10,644 --> 00:15:13,956 point we're making in the point I want to make, summarize at 194 00:15:13,996 --> 00:15:17,905 this point is this caused by a number of other things, And one 195 00:15:17,946 --> 00:15:23,605 of those other things is genetics is in your genes, and 196 00:15:23,625 --> 00:15:28,375 when it's in your genes, it does not matter what you do in terms 197 00:15:28,375 --> 00:15:35,066 of causing you to get it or not get it. Okay, and because many 198 00:15:35,125 --> 00:15:39,321 times those of us in healthcare have mainly emphasized the 199 00:15:39,360 --> 00:15:43,094 behavior, part of it, saying things like well, you just have 200 00:15:43,134 --> 00:15:46,201 to be tough enough. Well, you just have to be stronger, you 201 00:15:46,240 --> 00:15:49,717 got to try harder When patients have been saying, dr, i've been 202 00:15:49,857 --> 00:15:52,687 dieting and I have been exercising, but I'm still 203 00:15:52,746 --> 00:15:56,600 gaining weight, and instead of believing them and coming up 204 00:15:56,620 --> 00:16:00,115 with different alternatives to manage them, we many times have 205 00:16:00,254 --> 00:16:06,144 sort of pushed those patients even more, to no positive 206 00:16:06,184 --> 00:16:10,798 benefit. And so now we have learned better And, as our past 207 00:16:10,859 --> 00:16:13,208 use to teachers, when you learn better, then you need to do 208 00:16:13,249 --> 00:16:16,960 better. So we in healthcare need to do better, because a lot of 209 00:16:17,000 --> 00:16:21,015 these patients are diabetic and or morbidly obese because of 210 00:16:21,057 --> 00:16:26,149 their genetic makeup, irrespective of their behavior. 211 00:16:27,972 --> 00:16:30,599 One of the other points that's important to keep in mind is 212 00:16:31,179 --> 00:16:34,948 that our country is becoming more and more and more diverse, 213 00:16:35,774 --> 00:16:40,783 meaning that these various ethnic groups are growing in 214 00:16:40,884 --> 00:16:45,136 numbers, and the fastest growing of the ethnic groups is 215 00:16:45,197 --> 00:16:50,015 probably Hispanic ethnic group, and so my point is that the it's 216 00:16:50,015 --> 00:16:53,369 going to be more and more and more important that we include 217 00:16:53,490 --> 00:16:56,437 individuals in these various ethnic groups, along with a 218 00:16:57,379 --> 00:17:02,148 quite ethnic majority, to make sure that the data that we come 219 00:17:02,268 --> 00:17:07,287 up with to recommend treatment is truly representative and is 220 00:17:07,406 --> 00:17:11,537 beneficial to everybody, instead of just a certain segments of 221 00:17:11,557 --> 00:17:15,188 the population. One of the other things that's been extremely 222 00:17:15,268 --> 00:17:18,740 helpful is the pharmaceutical industry has come out with 223 00:17:18,800 --> 00:17:23,911 amazing medication or drugs that are now beneficial in treating 224 00:17:24,391 --> 00:17:28,787 diabetes more effectively and also in treating obesity more 225 00:17:28,827 --> 00:17:33,220 effectively, and now, with these medications, it allows these 226 00:17:33,359 --> 00:17:38,111 patients, instead of following a lot of the over the counter or 227 00:17:38,511 --> 00:17:43,884 the media driven types of suggestions for how to live 228 00:17:43,943 --> 00:17:47,891 healthy. Now we have better science and we have a stronger 229 00:17:47,951 --> 00:17:51,346 scientific basis that allows us to be able to treat these 230 00:17:51,405 --> 00:17:56,181 patients more effectively and that can save their lives and 231 00:17:56,221 --> 00:18:00,214 cause them to have a healthy life. As a diabetic, certainly 232 00:18:00,255 --> 00:18:03,826 you're aware of the important things to have in your food 233 00:18:03,866 --> 00:18:09,443 pyramid and certainly at the bottom of your pyramid, that you 234 00:18:09,443 --> 00:18:13,032 can eat a lot of certain vegetables and fruits and dairy 235 00:18:13,073 --> 00:18:20,087 products, breads, and the top of the pyramid is meats. I'm sorry 236 00:18:20,087 --> 00:18:22,993 , at the top of the pyramid is sweets that you want to be 237 00:18:23,034 --> 00:18:26,326 careful and make sure that you don't eat a lot of sweets, but 238 00:18:26,346 --> 00:18:31,328 we're going to come back to the sweet part a bit later. So it is 239 00:18:31,328 --> 00:18:33,917 important to have a very, very balanced diet if you're a 240 00:18:33,938 --> 00:18:37,426 diabetic and it is important to watch what you eat, and one of 241 00:18:37,446 --> 00:18:41,983 the simple ways that I have found to do that that works is 242 00:18:42,384 --> 00:18:45,835 the more color in your diet, probably the healthier your diet 243 00:18:45,835 --> 00:18:50,186 is, and so if you have colors of green and orange and red and 244 00:18:50,267 --> 00:18:55,799 yellow in the foods that you eat , those foods probably tend to 245 00:18:55,839 --> 00:19:00,127 be more healthy than the other types of foods. Exercise, 246 00:19:00,469 --> 00:19:06,126 likewise, is just as important, and that one is not better than 247 00:19:06,166 --> 00:19:09,817 the other. You want to do them both together. You can do. You 248 00:19:09,958 --> 00:19:12,585 can check your blood sugar, if you're diabetic, before you 249 00:19:12,645 --> 00:19:16,082 exercise and then check it after you exercise. But I encourage 250 00:19:16,102 --> 00:19:19,469 you to exercise and, again, do what works for you. Now some 251 00:19:19,509 --> 00:19:23,788 patients run marathon, some go out and run a couple miles a 252 00:19:23,848 --> 00:19:26,740 week, but let's say, maybe you're not one of those folks 253 00:19:26,759 --> 00:19:31,011 and that's okay. Incorporate your exercise into your normal 254 00:19:31,051 --> 00:19:35,122 daily activity, and one of the things that I've seen patients 255 00:19:35,182 --> 00:19:40,451 do is, for instance, when you go to grocery shopping, instead of 256 00:19:40,451 --> 00:19:44,609 parking your car right next to the store, park your car at the 257 00:19:44,730 --> 00:19:48,843 other end of the parking lot And then that way you get in more 258 00:19:48,923 --> 00:19:53,936 steps and you're exercising within your normal routine. When 259 00:19:53,936 --> 00:19:56,943 you're in the store, when you pick up the item that you want, 260 00:19:58,146 --> 00:20:01,432 take five or 10 minutes and walk all the way around the store 261 00:20:01,901 --> 00:20:05,387 area, maybe a couple of times. Again, you can pick up another 262 00:20:05,729 --> 00:20:10,787 four or five hundred steps. This is exercise. So the content of 263 00:20:10,826 --> 00:20:14,382 the exercise the location of the leg exercise is not is not 264 00:20:14,442 --> 00:20:18,075 important. The important thing is that you do it. So make it 265 00:20:18,276 --> 00:20:21,406 easier yourself, but just incorporate it into your normal 266 00:20:21,446 --> 00:20:24,880 routine And then that way you're more likely as compared to 267 00:20:24,900 --> 00:20:27,946 going to a gym. There's nothing wrong with going to a gym, but 268 00:20:27,988 --> 00:20:31,923 that takes time and effort and money. But do those things that 269 00:20:31,983 --> 00:20:34,150 work for you and you'll find that that'll be much more 270 00:20:34,190 --> 00:20:37,290 efficient and allow you to do the things that you need to do. 271 00:20:37,972 --> 00:20:40,542 And, of course, we are familiar with the complications of 272 00:20:40,583 --> 00:20:44,595 diabetes, and these complications can include things 273 00:20:44,595 --> 00:20:49,786 like stroke or other cerebral vascular disease, eye damage, 274 00:20:50,106 --> 00:20:53,773 poor eyesight Diabetes is one of the leading causes of blindness 275 00:20:53,773 --> 00:21:00,288 in this country Heart disease, kidney disease, neuropathy, 276 00:21:00,630 --> 00:21:07,786 nerve pain and foot disease When you are diabetic. There are 277 00:21:07,885 --> 00:21:11,443 four important stages of your diabetes. One first stage is 278 00:21:11,463 --> 00:21:14,577 when you're first diagnosed. For a number of individuals again 279 00:21:14,617 --> 00:21:18,146 we're talking about adult onset diabetes This may be in your 40s 280 00:21:18,146 --> 00:21:21,580 , the 50s or 60s. That may be when you're first told that 281 00:21:21,621 --> 00:21:25,748 you're diabetic. Or you may have been told that you're 282 00:21:25,808 --> 00:21:30,104 pre-diabetic, meaning that your HV A1C that's the blood test 283 00:21:30,424 --> 00:21:33,837 that measures. Your blood glucose level is high, but it's 284 00:21:33,917 --> 00:21:38,007 not in the diabetic range, and so that's an important stage 285 00:21:39,509 --> 00:21:42,641 when you're initially diagnosed as a diabetic. The second 286 00:21:42,681 --> 00:21:47,230 important stage of your diabetes is when you develop a 287 00:21:47,290 --> 00:21:52,003 complication of the diabetes. You develop eyesight problems or 288 00:21:52,003 --> 00:21:56,752 eye pain or some other complications associated with 289 00:21:56,772 --> 00:22:01,991 diabetes. The third important step is when you're on your 290 00:22:02,071 --> 00:22:05,641 medication and as you're getting your regular blood tests, 291 00:22:05,942 --> 00:22:09,347 however your physician has prescribed it, she tells you 292 00:22:09,907 --> 00:22:15,585 that for some reason, your HV A1C is increasing, in spite of 293 00:22:15,605 --> 00:22:18,471 the fact that you're on medication and doing different 294 00:22:18,511 --> 00:22:23,590 things. And the fourth stage of your diabetes management and 295 00:22:23,631 --> 00:22:28,002 self-management in education is when you become older, and my 296 00:22:28,063 --> 00:22:33,232 definition of older is when you become 60 plus, because we know 297 00:22:33,394 --> 00:22:35,906 that what happens is that there's some things that just 298 00:22:35,967 --> 00:22:40,602 occur to us as we get older. Is this like any other system that 299 00:22:40,682 --> 00:22:45,576 over time, becomes less and less efficient, and many times that 300 00:22:45,636 --> 00:22:51,211 combines with the diabetes that we may have and creates other 301 00:22:51,271 --> 00:22:55,301 additional problems. Well, let's specifically talk about the 302 00:22:55,402 --> 00:23:01,516 myths of diabetes. The first myth is diabetics can eat sugar. 303 00:23:01,516 --> 00:23:06,506 That is not true. You can eat sugar if you are diabetic. Now 304 00:23:06,625 --> 00:23:11,759 you want to have it in moderate proportions, but this whole idea 305 00:23:11,759 --> 00:23:17,012 that grandpa can eat a piece of candy or a donut or whatever is 306 00:23:17,012 --> 00:23:23,628 just hogwash. You can eat sugar if you are diabetic. The second 307 00:23:23,628 --> 00:23:29,366 myth is diabetes is caused mainly by obesity Huge myth, 308 00:23:29,708 --> 00:23:35,547 wrong, wrong, wrong, wrong. Not true. As we have said earlier, 309 00:23:35,586 --> 00:23:40,375 there are some patients who become diabetic not because they 310 00:23:40,375 --> 00:23:44,150 are obese or overweight. They become diabetic because it was 311 00:23:44,210 --> 00:23:50,832 passed down to them in their genes. Okay, so obesity can be a 312 00:23:50,832 --> 00:23:55,104 contributing factor to diabetes , just like stress can be a 313 00:23:55,163 --> 00:24:00,272 contributing factor to diabetes, or poor exercise can be a 314 00:24:00,313 --> 00:24:07,133 contributing factor to diabetes, and genetics or genes can cause 315 00:24:07,133 --> 00:24:12,913 diabetes. Another myth is that you are too skinny to be a 316 00:24:12,973 --> 00:24:17,872 diabetic Not true. Again, as we've said before, you can be 317 00:24:17,951 --> 00:24:23,665 skinny and still develop adult onset diabetes, because maybe 318 00:24:23,705 --> 00:24:27,734 you're diabetic, because you inherited it from your parents 319 00:24:27,775 --> 00:24:31,971 and grandparents and the parts of your family tree, or there 320 00:24:32,011 --> 00:24:35,990 may be other factors. But my point is this whole idea and if 321 00:24:36,010 --> 00:24:40,367 there's anything you remember from this discussion today, is 322 00:24:40,428 --> 00:24:45,865 that obesity is not the main cause of diabetes. It is not the 323 00:24:45,865 --> 00:24:51,410 only cause related to diabetes. It is a contributing cause of 324 00:24:51,430 --> 00:24:56,426 diabetes, like three or four other things. Another myth is 325 00:24:56,507 --> 00:25:00,931 you're too young to have diabetes. You can have diabetes 326 00:25:00,990 --> 00:25:04,611 at an early age And I'm talking about you can have type 1 327 00:25:04,651 --> 00:25:08,826 diabetes, which you're born with . This discussion is not 328 00:25:08,866 --> 00:25:12,776 primarily on type 1 diabetes, but the difference, just very 329 00:25:12,816 --> 00:25:16,914 quickly, is that type 1 diabetic patients do not have insulin, 330 00:25:17,325 --> 00:25:22,205 so they have to take insulin from the time of birth. But most 331 00:25:22,205 --> 00:25:25,272 of our purposes today we're talking about adult onset 332 00:25:25,854 --> 00:25:32,032 diabetes. Another myth is it's possible to just have a little 333 00:25:32,073 --> 00:25:36,708 diabetes or a touch of diabetes. That is not true. Either you're 334 00:25:36,708 --> 00:25:40,096 diabetic or you're not diabetic . It's like being pregnant 335 00:25:40,244 --> 00:25:42,527 Either you're pregnant or you're not pregnant. You can't be a 336 00:25:42,606 --> 00:25:47,566 little pregnant or just have a touch of pregnancy. Diabetes is 337 00:25:47,586 --> 00:25:52,666 exactly the same Either you have it or you don't. Now, to avoid 338 00:25:52,708 --> 00:25:55,753 confusion, there may be some of these physicians who abuse the 339 00:25:55,794 --> 00:26:01,270 term pre-diabetic, and again, that's where your HB A1C is 340 00:26:01,371 --> 00:26:05,898 increasing, but it is not yet in the range of being diagnosed as 341 00:26:05,898 --> 00:26:09,234 diabetes And a number of physicians will many times try 342 00:26:09,255 --> 00:26:12,767 to have patients, will try to intervene with patients at that 343 00:26:12,827 --> 00:26:17,597 time to start doing some things that may very well help them to 344 00:26:18,144 --> 00:26:22,387 mitigate the whole possibility of diabetes. And again, these 345 00:26:22,448 --> 00:26:26,135 are the ones where it's not genetically inherited, or maybe 346 00:26:26,155 --> 00:26:31,170 the majority who are not genetically inherited. Okay, one 347 00:26:31,170 --> 00:26:33,878 of the other areas that's important to mention before we 348 00:26:33,919 --> 00:26:38,644 finish is that you can't have remission of your diabetes, and 349 00:26:38,664 --> 00:26:47,137 I define remission is where your HB A1C is, say, 6.5 or 6.8 or 7 350 00:26:47,137 --> 00:26:52,451 . And some things are done and those things that are done can 351 00:26:53,873 --> 00:26:58,967 help you to lower your HB A1C. That is possible. And in the 352 00:26:59,008 --> 00:27:01,637 more extreme case, and these individuals who are morbidly 353 00:27:01,719 --> 00:27:08,275 obese and who have elected to have gastric bypass surgery or 354 00:27:08,335 --> 00:27:13,646 some type of surgical procedure to mitigate their morbid obesity 355 00:27:13,646 --> 00:27:17,835 , some studies have shown that many times they have been able 356 00:27:17,894 --> 00:27:24,233 to have their HB A1C blood test lowered, the range of the HB A1C 357 00:27:24,233 --> 00:27:28,509 lowered into the non-diabetic range. The diabetes doesn't go 358 00:27:28,568 --> 00:27:33,364 away, but we just like to say it's dormant in terms of the 359 00:27:33,443 --> 00:27:37,506 negative effects or damage it can do to the body. But my point 360 00:27:37,506 --> 00:27:43,457 is that's good news because there is hope that by doing some 361 00:27:43,457 --> 00:27:47,731 of the right things or having some things happen, the serious 362 00:27:47,751 --> 00:27:52,026 problems can be mitigated in some patients. Disease, among 363 00:27:52,125 --> 00:27:55,973 other types of problems, is probably one of the most 364 00:27:56,414 --> 00:28:01,535 expensive forms of healthcare or problems medically that you can 365 00:28:01,535 --> 00:28:05,027 have in the country, because it spreads and involves so many 366 00:28:05,086 --> 00:28:08,761 other organs and so many other organ systems, because blood 367 00:28:08,781 --> 00:28:11,170 sugar goes all over the body and it's used by all different 368 00:28:11,191 --> 00:28:14,810 parts of the body, so whenever there's a problem with the 369 00:28:14,851 --> 00:28:18,286 initial source of the diabetes, it can then affect those other 370 00:28:18,405 --> 00:28:23,173 organs that we talked about blindness, heart disease, stroke 371 00:28:23,173 --> 00:28:29,863 , etc. Etc. So, in summary, diabetes is a chronic condition 372 00:28:30,443 --> 00:28:35,198 and we physicians do not understand 100% the pathology of 373 00:28:35,198 --> 00:28:39,781 it. However, we do know that there are many causes of 374 00:28:39,821 --> 00:28:45,179 diabetes. Obesity is a contributing factor of diabetes, 375 00:28:45,179 --> 00:28:52,140 and we do know that diabetes can be inherited, so that things 376 00:28:52,140 --> 00:28:55,872 that we've used four to 50 years ago to evaluate patients 377 00:28:55,912 --> 00:28:59,961 with diabetes or obesity or other types of problems, many of 378 00:28:59,961 --> 00:29:04,681 those things are no longer appropriate in the 2023 area, 379 00:29:05,775 --> 00:29:09,183 and so we have to continue to stay abreast of the most recent 380 00:29:09,203 --> 00:29:13,959 developments in terms of what's best for our patients. Also, we 381 00:29:14,039 --> 00:29:17,611 learned that there are a number of myths about diabetes, like 382 00:29:17,932 --> 00:29:22,218 diabetes can eat sugar, which is a myth. Like skinning people 383 00:29:22,258 --> 00:29:27,400 don't get diabetes, which is a myth. Like obesity is the main 384 00:29:27,480 --> 00:29:31,396 cause of diabetes, which is a myth. And finally, what we've 385 00:29:31,436 --> 00:29:35,686 learned is that diabetes can go into remission in some patients, 386 00:29:35,686 --> 00:29:41,205 and I've met these patients recently in my own experience. 387 00:29:42,434 --> 00:29:47,115 So it's an important problem. It's an important issue And, 388 00:29:47,135 --> 00:29:50,538 again, we believe knowledge is power, but the more you know, 389 00:29:51,522 --> 00:29:54,614 the more you are able to take care of your health and to take 390 00:29:54,634 --> 00:29:58,984 care of the health of those around you and the ones that you 391 00:29:58,984 --> 00:30:03,715 care about. My basic principles God is in charge. I am a 392 00:30:03,756 --> 00:30:08,566 position of faith and I believe very strongly that God has been 393 00:30:09,166 --> 00:30:15,263 the main reason why my life has been as well as it has and why 394 00:30:15,284 --> 00:30:21,195 I'm happy and healthy and wise. I don't have any bad days. I 395 00:30:21,215 --> 00:30:26,376 decided many years ago that I'd had enough bad days, so I 396 00:30:26,417 --> 00:30:31,317 decided that my days would be good days or great days. So I 397 00:30:31,377 --> 00:30:36,143 have no more bad days. I suggest to you that if I can eliminate 398 00:30:36,182 --> 00:30:40,855 my bad days, you can eliminate your bad days also. Number three 399 00:30:40,855 --> 00:30:43,803 basic principle don't sweat the small stuff, and most stuff is 400 00:30:43,863 --> 00:30:48,587 small. I have learned that most times when things happen that 401 00:30:48,628 --> 00:30:51,619 they are really not that big a deal or not as big a deal as I 402 00:30:51,680 --> 00:30:54,738 think they are. So I have learned to put things in 403 00:30:54,798 --> 00:31:00,438 perspective more and to go more slowly and getting upset and 404 00:31:00,617 --> 00:31:07,142 angry about a situation. This basic principle forgiveness is 405 00:31:07,362 --> 00:31:12,582 therapy, that when someone does something to you that you can 406 00:31:12,622 --> 00:31:17,337 perceive to be negative. Forgive them immediately. It does not 407 00:31:17,397 --> 00:31:21,019 matter who's right or wrong. Just by forgiving them, you 408 00:31:21,461 --> 00:31:26,355 yourself will be empowered and, more importantly, you let it go 409 00:31:26,896 --> 00:31:31,566 and it does not cause an amount of stress on you and things that 410 00:31:31,566 --> 00:31:34,642 you have to deal with. My final basic principle is that 411 00:31:34,722 --> 00:31:37,676 everything is a relationship and relationships that are based on 412 00:31:37,676 --> 00:31:41,395 mutual respect, mutual trust and good communication. If you 413 00:31:41,435 --> 00:31:43,923 have those three things, you have a good relationship, 414 00:31:44,304 --> 00:31:47,058 whether it's husband and wife, boyfriend, girlfriend, parent, 415 00:31:47,118 --> 00:31:52,236 child, work in relationship, brother, sister. It's important 416 00:31:52,276 --> 00:31:57,656 in terms of minimizing stress in our lives, and the last words 417 00:31:57,676 --> 00:32:01,384 that I want to leave with you be the change you want to see in 418 00:32:01,404 --> 00:32:01,826 the world. 419 00:32:06,643 --> 00:32:10,115 Speaker 1: Thank you, and have a wonderful day. Thanks for 420 00:32:10,155 --> 00:32:12,625 listening to the Healthy, wealthy and Wise podcast with Dr 421 00:32:12,625 --> 00:32:17,384 William Choctaw, mdjd. We hope you enjoyed this episode and, if 422 00:32:17,384 --> 00:32:20,435 you found it helpful, you can support and subscribe to the 423 00:32:20,476 --> 00:32:24,684 podcast on your favorite podcast platform with the key words Dr 424 00:32:24,724 --> 00:32:28,863 William Choctaw, click on the support the show and you've got 425 00:32:28,923 --> 00:32:33,387 it. This will also help ensure that you don't miss any future 426 00:32:33,468 --> 00:32:36,679 episodes, and then share this podcast with your family, 427 00:32:36,898 --> 00:32:41,315 friends and or your co-workers. They'll be glad you did. Until 428 00:32:41,454 --> 00:32:45,317 next time, live your best possible life the best possible 429 00:32:45,357 --> 00:32:45,577 way.