Transcript
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.
