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

0:00 Speaker 1: Welcome to the Healthy, Wealthy and Wise podcast with Dr William Chokta, MDJD. Our mission is to empower you with the knowledge and the tools you need to thrive in all aspects of your lives. Join us now as we discuss everything from nutrition and exercise to money management and personal growth. Dr Chokta will provide insightful advice on how to improve your physical and financial health, as well as your emotional and mental well-being. Whether you're looking to boost your energy levels, unlock financial freedom or cultivate a more positive mindset, we've got you covered.

0:41 Get ready to become the best version of yourself? So let's get started. Here's Dr William Chokta, MDJD. Good morning. Speaker 2: Welcome to the Healthy, wealthy and Wise podcast. I'm Dr William Chokta and I will be your facilitator today. Today, we're going to talk about destroying myths about diabetes. Destroying myths about diabetes. I believe knowledge is power. I believe life is about service to others. I believe leaders can change the world, as we routinely do.

1:23 we will underlie the discussion today in the area of medicine and law. Well, let's take a look at our outline, and the purpose of the outline is to let you know what we're going to talk about, but more importantly or as importantly, it's to let you know when we're just about done. I realize that you're all very, very busy people and we're absolutely delighted to have you with us on this particular podcast, but today we're going to talk about diabetes, and particularly type 2 diabetes. We're going to talk about the relationship between diabetes and obesity. We'll further then discuss the body mass index, which is used to evaluate obesity as it relates to diabetes, but we're going to specifically talk about individual myths about diabetes, diabetes remission and then some of the medication that's new, relatively new and use to treat patients with diabetes. Well, what is the definition of diabetes? And again, we're talking about diabetes type 2.

2:31 Type 2 is called adult onset diabetes and basically it is defined as a chronic disease that occurs because the body is unable to use blood sugar, ie glucose, properly. Let me say that again, diabetes is a chronic disease that occurs because the body is unable to use blood sugar, ie glucose, properly. The exact cause of this malfunction is unknown, but genetic and environmental factors play a major part. Risk factors associated with diabetes include obesity and high levels of cholesterol. Well, how does the mechanism of diabetes work in terms of creating difficulty for patients? Well, primarily, the pancreas is an organ in the body that sits right adjacent to the stomach, in the mid part of the upper abdomen, and it basically digests or secretes insulin into the bloodstream whenever blood sugar is located in the bloodstream, and the purpose of this insulin is to take these molecules of glucose, ie sugar, and to modify them in a way that they could be used efficiently by the muscle. So you need the insulin for the

4:04 blood sugar to be used efficiently by the muscle, and what happens is that, if you are diabetic, you do not have either sufficient insulin or your insulin, more importantly, is not as effective in providing its physiological purpose in terms of helping blood sugar or glucose to go into the cells of muscles and other organs. Well, what are the causes of diabetes? And this is a huge issue that has changed over time, and one of the things to keep in mind is that health care is always growing, it is always changing, it is always advancing. It used to be felt that diabetes was primarily almost exclusively caused, according to some, by obesity. We now know that that's no longer true. Yes, obesity is a contributing factor to some who have diabetes, but what we've learned is there are other contributing factors, like stress, like an unhealthy diet and, most importantly, genes or your genetic makeup. What does that mean? That means what you have inherited from your parents and grandparents or great-grandparents over the years can many times dictate whether you will or will not

5:35 become diabetic. And this is independent of diet and exercise , independent of what you may or may not do, and it's important to keep that in mind And we'll expand on this idea later as we go through this discussion. It's important to keep in mind that when we look at something like diabetes, which affects every single ethnic group in our country, that there are differences in how it affects the different ethnic groups. So if one were to look at this as National Institute of Health Information if one were to look at the effects or the prevalence , if you will, of diabetes in different ethnic groups. Let's take five different ethnic groups of individuals in the United States of America. The group that has the lowest incidence of prevalence of diabetes is white. Non-hispanic or Caucasians do not have the lowest incidence of diabetes and that's usually around about seven or eight percent. The next highest, above them, is Asian Americans and their incidence is about nine percent. The next group is Hispanic and their incidence is approximately 12 percent. The next highest group

7:05 is African Americans and their incidence is about 13 percent, and the highest ethnic group in our country with diabetes is American Indians, slash Alaska Native. So American Indians have the single highest percentage of diabetes as an ethnic group, and Caucasians or white non-Hispanic have the lowest percentage of diabetes in this country. And so what that says is basically all groups get it. But the reason why it's important to understand the prevalence and incidence in the different racial groups is that when we make sweeping proclamations about diabetes in terms of cause and in terms of treatment, we have to understand that there is a difference in how it appears in these different ethnic groups and also how it can best be treated in these individual ethnic groups And, most importantly, it is not appropriate to take the largest ethnic group, which is the white non-Hispanic, and do studies that only include individuals in that ethnic group and then try to make broad statements about diabetes treatment, cause and effect of those other four ethnic groups in terms of what's best quality in their care. So what I'm saying is that you have to look at these groups individually and

8:35 you have to include all individuals in these particular groups in your study and your data to be able to predict accurately what's most effective in their management and treatment. One of the big areas of controversy that has been around for a long time is is diabetes is inherited or is and caused by behavior, particularly behavior in terms of overeating ? The reality is we know that a significant part of diabetes, or a significant percentage of individuals who have diabetes, have it purely from genetics, purely from their genes. We even know some of the genes that cause it. Capn10 is one of the genes that's been confirmed to cause type 2 diabetes. Tcf-l TCF-7L2 is a protein coding gene that has the strongest link to type 2 diabetes across all racial groups. So my point is the genes, or your genetic makeup, is a major cause, and many times the only cause, of diabetes in some patients, and we'll expand about this a bit more. So this changes the paradigm, if you will, of a lot of individuals that say no, no, no, no, no, don't blame this on your genes, you just need to have better habits, you just need to improve your behavior.

10:09 Well, the reality is that some people do have it just because of their genes. They have nothing to do with their behavior, they have it because of their genes And that's a scientific fact. And remember, health care grows in terms of knowledge and scope and intelligence, and this is one of the things that we have learned over time over the last 50 years that we did not know 50 years ago. In accordance with that, we physicians 50 years ago , many physicians used to do everything. I can remember the general practitioners who used to deliver babies, and some would do some surgeries, and then time progressed and then there were surgeons who did the surgery and general practitioners didn't do surgery, and then time progressed and there were OBGYN specialists who delivered babies. The obstetricians and the general practitioners didn't deliver the babies. And so my point is that , over time, as health care continues to mature and grow and become more intelligent and become more effective.

11:21 Specialists develop, and so is the case in terms of obesity and obesity that may be related to diabetes. Dr Fatima Stanford is a Harvard graduate and now Harvard professor in a specialty called Obesity Medicine, which is a relatively new specialty. Most of us, as physicians, have treated patients who were obese, and usually we gave the familiar mantra diet and exercise. Well, the reality is that doesn't work for everybody, and that's just the honest truth, and so one of the things that's important is that we not beat up on patients metaphorically in terms of telling them well, you just need to do better In situations where it does not matter what they do, particularly if they have a genetic reason for having type 2 diabetes, but instead focus on the root cause for that individual patient and treat them so they can live long and thrive. One of the issues that has also come up along the same lines is the body mass index has been a index that's been around for years, that we have used to determine who is overweight and who is underweight, or who is obese, who is not obese or morbidly obese, and the American Medical Association just recently came out with a ruling, and recently in terms of June of 2023. And, in essence, what it says is that the American

12:54 Medical Association has adopted a policy that encourages clinicians to reduce their focus on body mass index and health assessments, stating that the measurement is based on racially exclusive data. That has caused harm. What does that mean? That means that when this particular index was devised and developed , the individuals who were in the experimental group did not include racial minorities. Consequently, the outcome or the results or the recommendations may not be most beneficial to those racial minorities, even though it may benefit a separate racial majority. And so, to say it another way, if you want to have something that benefits all 370 plus million people in the United States of America, you've got to make sure that every particular ethnic group within that 370 million is represented in your study, so that you make sure that the needs and the individual specificities of the certain racial groups are represented, so that your outcomes can be beneficial to them also. So, in essence, the American Medical Association, which is the main body that sets up rules and regulations for repositions, recognizes the historical harm that the base metabolic body mass index has done and states that the metric

14:26 has been used for racist exclusion And again meaning that the data has been used in some instances to be more detrimental to certain individuals in certain ethnic groups. That has been contraindicated. That has caused challenges and prevented those individuals from achieving healthy, wealthy and wise existence, and so we want to correct. That is our point And this all boils down to the whole issues. Is obesity and or diabetes caused by bad behavior or by other things? And the point we're making in the point I want to make, summarize at this point is this caused by a number of other things, And one of those other things is genetics is in your genes, and when it's in your genes, it does not matter what you do in terms of causing you to get it or not get it. Okay, and because many times those of us in healthcare have mainly emphasized the behavior, part of it, saying things like well, you just have to be tough enough. Well, you just have to be stronger, you got to try harder When patients have been saying, dr, i've been dieting and I have been exercising, but I'm still gaining weight, and instead of believing them and coming up with different alternatives to manage them, we many times have

16:00 sort of pushed those patients even more, to no positive benefit. And so now we have learned better And, as our past use to teachers, when you learn better, then you need to do better. So we in healthcare need to do better, because a lot of these patients are diabetic and or morbidly obese because of their genetic makeup, irrespective of their behavior. One of the other points that's important to keep in mind is that our country is becoming more and more and more diverse, meaning that these various ethnic groups are growing in numbers, and the fastest growing of the ethnic groups is probably Hispanic ethnic group, and so my point is that the it's going to be more and more and more important that we include individuals in these various ethnic groups, along with a quite ethnic majority, to make sure that the data that we come up with to recommend treatment is truly representative and is beneficial to everybody, instead of just a certain segments of the population. One of the other things that's been extremely helpful is the pharmaceutical industry has come out with amazing medication or drugs that are now beneficial in treating diabetes more effectively and also in treating obesity more effectively, and now, with these medications, it allows these

17:33 patients, instead of following a lot of the over the counter or the media driven types of suggestions for how to live healthy. Now we have better science and we have a stronger scientific basis that allows us to be able to treat these patients more effectively and that can save their lives and cause them to have a healthy life. As a diabetic, certainly you're aware of the important things to have in your food pyramid and certainly at the bottom of your pyramid, that you can eat a lot of certain vegetables and fruits and dairy products, breads, and the top of the pyramid is meats. I'm sorry , at the top of the pyramid is sweets that you want to be careful and make sure that you don't eat a lot of sweets, but we're going to come back to the sweet part a bit later. So it is important to have a very, very balanced diet if you're a diabetic and it is important to watch what you eat, and one of the simple ways that I have found to do that that works is the more color in your diet, probably the healthier your diet is, and so if you have colors of green and orange and red and yellow in the foods that you eat , those foods probably tend to be more healthy than the other types of foods. Exercise, likewise, is just as important, and that one is not better than

19:06 the other. You want to do them both together. You can do. You can check your blood sugar, if you're diabetic, before you exercise and then check it after you exercise. But I encourage you to exercise and, again, do what works for you. Now some patients run marathon, some go out and run a couple miles a week, but let's say, maybe you're not one of those folks and that's okay. Incorporate your exercise into your normal daily activity, and one of the things that I've seen patients do is, for instance, when you go to grocery shopping, instead of parking your car right next to the store, park your car at the other end of the parking lot And then that way you get in more steps and you're exercising within your normal routine. When you're in the store, when you pick up the item that you want, take five or 10 minutes and walk all the way around the store area, maybe a couple of times. Again, you can pick up another four or five hundred steps. This is exercise. So the content of the exercise the location of the leg exercise is not is not important. The important thing is that you do it. So make it easier yourself, but just incorporate it into your normal routine And then that way you're more likely as compared to going to a gym. There's nothing wrong with going to a gym, but that takes time and effort and money. But do those things that work for you and you'll find that that'll be much more efficient and allow you to do the things that you need to do.

20:37 And, of course, we are familiar with the complications of diabetes, and these complications can include things like stroke or other cerebral vascular disease, eye damage, poor eyesight Diabetes is one of the leading causes of blindness in this country Heart disease, kidney disease, neuropathy, nerve pain and foot disease When you are diabetic. There are four important stages of your diabetes. One first stage is when you're first diagnosed. For a number of individuals again we're talking about adult onset diabetes This may be in your 40s , the 50s or 60s. That may be when you're first told that you're diabetic. Or you may have been told that you're pre-diabetic, meaning that your HV A1C that's the blood test that measures. Your blood glucose level is high, but it's not in the diabetic range, and so that's an important stage when you're initially diagnosed as a diabetic. The second important stage of your diabetes is when you develop a complication of the diabetes. You develop eyesight problems or eye pain or some other complications associated with diabetes. The third important step is when you're on your medication and as you're getting your regular blood tests, however your physician has prescribed it, she tells you

22:09 that for some reason, your HV A1C is increasing, in spite of the fact that you're on medication and doing different things. And the fourth stage of your diabetes management and self-management in education is when you become older, and my definition of older is when you become 60 plus, because we know that what happens is that there's some things that just occur to us as we get older. Is this like any other system that over time, becomes less and less efficient, and many times that combines with the diabetes that we may have and creates other additional problems. Well, let's specifically talk about the myths of diabetes. The first myth is diabetics can eat sugar.

23:01 That is not true. You can eat sugar if you are diabetic. Now you want to have it in moderate proportions, but this whole idea that grandpa can eat a piece of candy or a donut or whatever is just hogwash. You can eat sugar if you are diabetic. The second myth is diabetes is caused mainly by obesity Huge myth, wrong, wrong, wrong, wrong. Not true. As we have said earlier, there are some patients who become diabetic not because they are obese or overweight. They become diabetic because it was passed down to them in their genes. Okay, so obesity can be a contributing factor to diabetes , just like stress can be a contributing factor to diabetes, or poor exercise can be a contributing factor to diabetes, and genetics or genes can cause diabetes. Another myth is that you are too skinny to be a diabetic Not true. Again, as we've said before, you can be skinny and still develop adult onset diabetes, because maybe you're diabetic, because you inherited it from your parents and grandparents and the parts of your family tree, or there

24:32 may be other factors. But my point is this whole idea and if there's anything you remember from this discussion today, is that obesity is not the main cause of diabetes. It is not the only cause related to diabetes. It is a contributing cause of diabetes, like three or four other things. Another myth is you're too young to have diabetes. You can have diabetes at an early age And I'm talking about you can have type 1 diabetes, which you're born with . This discussion is not primarily on type 1 diabetes, but the difference, just very quickly, is that type 1 diabetic patients do not have insulin, so they have to take insulin from the time of birth. But most of our purposes today we're talking about adult onset diabetes. Another myth is it's possible to just have a little diabetes or a touch of diabetes. That is not true. Either you're diabetic or you're not diabetic . It's like being pregnant Either you're pregnant or you're not pregnant. You can't be a little pregnant or just have a touch of pregnancy. Diabetes is exactly the same Either you have it or you don't. Now, to avoid confusion, there may be some of these physicians who abuse the term pre-diabetic, and again, that's where your HB A1C is increasing, but it is not yet in the range of being diagnosed as

26:05 diabetes And a number of physicians will many times try to have patients, will try to intervene with patients at that time to start doing some things that may very well help them to mitigate the whole possibility of diabetes. And again, these are the ones where it's not genetically inherited, or maybe the majority who are not genetically inherited. Okay, one of the other areas that's important to mention before we finish is that you can't have remission of your diabetes, and I define remission is where your HB A1C is, say, 6.5 or 6.8 or 7 . And some things are done and those things that are done can help you to lower your HB A1C. That is possible. And in the more extreme case, and these individuals who are morbidly obese and who have elected to have gastric bypass surgery or some type of surgical procedure to mitigate their morbid obesity , some studies have shown that many times they have been able to have their HB A1C blood test lowered, the range of the HB A1C lowered into the non-diabetic range. The diabetes doesn't go away, but we just like to say it's dormant in terms of the negative effects or damage it can do to the body. But my point

27:37 is that's good news because there is hope that by doing some of the right things or having some things happen, the serious problems can be mitigated in some patients. Disease, among other types of problems, is probably one of the most expensive forms of healthcare or problems medically that you can have in the country, because it spreads and involves so many other organs and so many other organ systems, because blood sugar goes all over the body and it's used by all different parts of the body, so whenever there's a problem with the initial source of the diabetes, it can then affect those other organs that we talked about blindness, heart disease, stroke , etc. Etc. So, in summary, diabetes is a chronic condition and we physicians do not understand 100% the pathology of it. However, we do know that there are many causes of diabetes. Obesity is a contributing factor of diabetes, and we do know that diabetes can be inherited, so that things that we've used four to 50 years ago to evaluate patients with diabetes or obesity or other types of problems, many of those things are no longer appropriate in the 2023 area, and so we have to continue to stay abreast of the most recent

29:09 developments in terms of what's best for our patients. Also, we learned that there are a number of myths about diabetes, like diabetes can eat sugar, which is a myth. Like skinning people don't get diabetes, which is a myth. Like obesity is the main cause of diabetes, which is a myth. And finally, what we've learned is that diabetes can go into remission in some patients, and I've met these patients recently in my own experience. So it's an important problem. It's an important issue And, again, we believe knowledge is power, but the more you know, the more you are able to take care of your health and to take care of the health of those around you and the ones that you care about. My basic principles God is in charge. I am a position of faith and I believe very strongly that God has been the main reason why my life has been as well as it has and why I'm happy and healthy and wise. I don't have any bad days. I decided many years ago that I'd had enough bad days, so I decided that my days would be good days or great days. So I have no more bad days. I suggest to you that if I can eliminate my bad days, you can eliminate your bad days also. Number three

30:40 basic principle don't sweat the small stuff, and most stuff is small. I have learned that most times when things happen that they are really not that big a deal or not as big a deal as I think they are. So I have learned to put things in perspective more and to go more slowly and getting upset and angry about a situation. This basic principle forgiveness is therapy, that when someone does something to you that you can perceive to be negative. Forgive them immediately. It does not matter who's right or wrong. Just by forgiving them, you yourself will be empowered and, more importantly, you let it go and it does not cause an amount of stress on you and things that you have to deal with. My final basic principle is that everything is a relationship and relationships that are based on mutual respect, mutual trust and good communication. If you have those three things, you have a good relationship, whether it's husband and wife, boyfriend, girlfriend, parent, child, work in relationship, brother, sister. It's important in terms of minimizing stress in our lives, and the last words that I want to leave with you be the change you want to see in the world.

32:06 Speaker 1: Thank you, and have a wonderful day. Thanks for listening to the Healthy, wealthy and Wise podcast with Dr William Choctaw, mdjd. We hope you enjoyed this episode and, if you found it helpful, you can support and subscribe to the podcast on your favorite podcast platform with the key words Dr William Choctaw, click on the support the show and you've got it. This will also help ensure that you don't miss any future episodes, and then share this podcast with your family, friends and or your co-workers. They'll be glad you did. Until next time, live your best possible life the best possible way.