Three ways to prevent diabetes | Professor Naveed Sattar

certainly my patients biggest myth often when I tell them that they may have type two or at risk is that they don't eat much sugar type 2 diabetes aborally is a disease of excess weight to a level in themselves that leads to too much fat in the wrong places including within the liver nid satar is a professor of metabolic medicine at The Institute of cardiovascular and medical Sciences at the University of Glasco and an honorary consultant in metabolic medicine at the Glasgow Royal infirmary you know there's 100 million people with pre-diabetes in the US people no longer store fat peripherally and that excess fat gets deposited into some of the key organs in the body that are exquisitly sensitive to too much fat you will disrupt their ability to control sugar levels I think that's both a bit scary but also really clear is there a difference between men and women in terms of their risks of diabetes women have a lower risk of type 2 diabetes than mainasons linked to where they store body f is it possible to reverse some of this if you want to reduce risk of diabetes the key aspects are welcome to Zoe science and nutrition where World leading scientists explain how their research can improve your [Music] health Navid really ly to see you again thank you for joining me today pleasure Jonathan so we have this tradition on the show that we always start with a quick fire round of questions from our listeners uh and the rules are really simple you can say yes or no or if you absolutely have to you can have a one sentence to answer it it's specially designed to be really hard for professors are you willing to give it a go cool for it yeah absolutely yeah all right are there millions of people around the world who don't know they are living with type 2 diabetes yes does type 2 diabetes significantly increase my risk of other diseases like heart disease and cancer yes is it true that almost 100 million Americans have pre-diabetes that seems a high number it's possible I think it's probably slightly overestimated in my opinion okay let's go and dig into that that is a quote from the CDC so I'm I'm intrigued to go into that if the food I eat leads to Big blood sugar spikes day after day after day can this significantly increase my risk of type 2 diabetes probably yes um but it would generally tend to do so through weight gain are women better at controlling their blood sugar than men women have a lower risk of type 2 diabetes than men for reasons linked to where they St body F I think we'll definitely want to talk about that and then finally last question and and you you definitely can have a sentence or two for this one nid what's the biggest myth about type 2 diabetes that you come across as an expert in this area certainly my patients biggest myth often when I tell them that they may have type two or at risk is that they don't eat much sugar type 2 diabetes predominantly is a disease of excess in most people excess weit to uh to a level in themselves that leads to too much fat in the wrong places including within the liver got it and so they're saying hey but I don't eat loads of sugar so how can I have type two diabetes and the answer is they still do they still do and it's predominantly they people can put on excess weight from a number of reasons not necessar just high sugar but also obiously lots of fat hi now it means a lot to me and the whole team that you are listening to this each week we put such a lot of hours into this podcast and we release this show for free without ads to help millions of people improve their health with Cutting Edge science in return all I ask is that you help us on this Mission by hitting the Subscribe button below it really helps thank you and on with the show well look let's um let's start to dive into all of this um and you know just to start with I think many listeners to this podcast know I have a personal interest in in blood sugar because my own blood sugar control is actually really quite poor um but I actually didn't know this was happening inside me at all until I wore a continuous glucose monitor when I took part in the very first Zoe predict uh clinical trial which is about five or six years ago and it was a complete eye opener for me understanding that my blood sugar would often be very high for hours after I ate certain foods and was quite High you know even uh you know when I when I woke up in the morning fasting because I didn't feel anything I had no idea about this um so you know I'm really fascinated in this topic now before I get carried away though and jump to all the things that I'd love to discuss about what I could do to improve my blood sugar control can we just start right at the beginning like and maybe just start with like what is blood sugar and why does it matter well sugar is one of the fuels one of the key fuels that many body cells require for making energy and for conducting the normal function so particularly of course the brain dependent upon PE for it to function and it's it source of fuel for it to work for the cells to work um as well as requiring oxygen it's also when we are sick the body is very good at preserving trying to preserve sugar for your immune cells the cells that fight off infection or help um repair tissues um and again they require lots of fuel for that for those mechanisms fight off infection or repair tissues and therefore when you are sick it makes sense the body tries to preserve sugar more for those cells but it's required sugar is required for all body cells basically for them to function normally it's and one of the things I think that often gets people often mention when they talk about diabetes you often hear this word insulin um what is insulin and and why does it ever come up in a discussion around blood sugar and and diabetes so insulin is uh it's a hormone um so if I was to and I've just eaten a banana and I my body is breaking down that banana putting its breakdown products one of which is sugar into my blood but I will don't want it to be my blood for very long I want to be able to store that energy in various tissues insulin is a bit like a key that opens up some of my cells to take in that sugar and store it when I don't need it this also stops my own body making sugar when I don't need it so I've just had a lot of sugar hopefully my insulin starts to go up put the sugar in the right places and it's also probably signaling to my liver stop you don't need to make any more sugar because there's already Lots coming in so it's like a master regulator of keeping sugar levels within the right levels in the blood putting it in the places where you need it to store for future needs and also helping you liberate it when you need it um and that that actually happens when the insulin levels go right down so that perhaps when you're sleeping and you're not having sugar in your body your sugar levels uh your insulin is low down and the liver keeps making sugar sufficient to feed all the cells and your brain Etc um you know to for normal Bly function so insulin is a master regulator in all of us for our sugar levels and thank you n is really really clear I think so you've got this sort of insulin keeping things level I guess the obvious question is why doesn't our body just let all the sugar hang around in our blood you know like the fridge you just keep putting more stuff in it and then you know my brain or whatever else could take the sugar out um when they want it why is it why can't I just let it get higher and higher yeah I know that's a brilliant question so when if you think about sugar if you spill sugar particularly in the context of water it becomes very sticky when sugar becomes levels become very high in the blood it starts to stick to low of our bodily proteins and changes their function makes them abnormal so for example um some of the damage that happens in the eye is because the sugar very high level starts to stick so lots of proteins are relevant to to to um aspects of an eye function and disrupts it and you lead to what's known as retinopathy damage to the eyes the same thing happens in the kidneys the same things happens to some of the bodily Parts proteins that relevant to nerve function so sugar levels when they're high effectively disrupts lots of uh uh raw materials proteins in our body and disrupts therefore lots of normal function and causes damage I think that's both very clear and very it's quite scary this analogy with like the sugar on the table sticky I can see that that's not what you want sort of causing through your blood it it's it's a process partly called gation and effectively it changes the structure of your molecules from what's normal to abnormal and then that means it's almost if if you think about it is you know if you're building a house and you start to make bricks and the wrong shape that building is going to be disrupted and will potentially not be have the same level of integrity and will be disrupted and fall apart that's effectively what's happening inside your eyes your kidneys your nerve cells if your sugar levels are high you're you're changing the structure of protein so they they no longer do what's healthy and you you're building up tissues and an abnormal way that leads to disease thank you so much nid I think that's both a bit scary but also really clear could you explain then what happens when someone gets pre-diabetes or type 2 diabetes what what does that actually mean so this is an area of um yeah this is a question that's often happened people living with pre-diabetes uh do have a higher risk of obviously developing diabetes they don't inevitably develop diabetes so the so the the term pre-diabetes is doesn't mean that it's always inevitable people who have pre-diabetes some stay in that level for years others can actually go back to normal levels of sugar or that because if they prove their lifestyle um but if you do have pre-diabetes your risk of developing diabetes is clearly higher equally your risk of heart disease is about double compared to people have normal GL you know sugar levels don't have pre-diabetes or healthy levels of glucose um I just want to make sure I got that you're saying that if you have pre-diabetes your risk of heart disease is actually double the level if you don't have pre-diabetes roughly speaking but here's the here's the rub it at the level of pre-diabetes that risk is not nestly caused by sugar levels because they're not at the level of diabetes what what is caused by is the processes that have led to you to develop pre-diabetes in the first place so for example for for me to develop pre-diabetes I would probably need to put another four or five Kil gr of weight on that excess weight will also mean my blood pressure will go up it will also mean my blood fats and my cholesterol levels will be disrupted so then I will have higher weight higher blood pressure more abnormal um toxic levels of lipids and possibly also other changes and those are the things that cause my higher risk of heart disease um they will also in a sense they're they're they're stressing my sugar levels I'm able to keep them still within the non-diabetes range but they're being stressed because I've put fat in the wrong places in my body and nid ju I just want to make sure because you that we all understand what PRI pre-diabetes and diabetes is and then I'd love to understand more the way these are linked so what does it mean for someone to have pre-diabetes or or type two diabetes and how is that linked to their blood sugar that we were talking about a minute ago so let me explain it in the terms of a hemoglobin A1c level which is a common test that we use um that gives us an average sugar level for an individual over three months so our normal hemoglobin A1c uh in the UK doesn't really matter about the units is you know is is 41 milles per mole or under hopefully you and I sitting here have got levels of you know I don't know somewhere between 32 and 41 okay pre-diabetes within UK and uh other you know in Europe is between 42 and 47 diabetes is when you get to 48 and above and that in America pre-diabetes is criteria is a bit wider than we use in the UK it's from 39 to 47 which is probably why the category perhaps over 100 million I don't think it's quite as high as that there's always some interpretation based on CDC data that they have to extrapolate and Bas you know a few caveat but nevertheless that's what it is um in in older hemoglobin A1 terms the levels we had in our mind was diabetes is at 6.5% we use the percentage pre-diabetes is from 6 to 6.4 in the UK or from 5.7 to 6.4 in the US and effectively that's hemoglobin A1c and it's capturing your average sugar levels your average exposure to sugar levels for 3 months it's a very good stable measure that we we measure in the clinic all the time increasingly is used to diagnose diabetes or diagnose pre-diabetes and I've heard doctors often refer to this as hba1c is that right hb1c hemoglobin e1c and so the way I understand I just want to make sure I'm playing it back right the way I understand it is you know your blood sugar is changing all the time so you ate that banana right now and your blood sugar is probably starting to like shoot up then you'll put in the insulin you describe not come back down and this hba1c is sort of like this average measure of your blood sugar like a sort of like something on the tank on the car that's is telling you like what the average is over like months um rather than this thing that's changing all the time is that that's that's perfectly correct so um you know if I'm able to after my banana keep my sugar levels from going too high and keeping within the normal range might you know and I and every time I eat food if I keep it relative within the normal range my hba1c will stay within the normal range because on average my sugar levels are I've been kept normal amazing and so to make sure that I um I just want to make sure that that I've got this you're sort of saying you know we all have um like a level of sugar that we would normally have in our blood we can measure it with this this hba1c and if somebody's been diagnosed who's listening to this with pre-diabetes or type 2 diabetes this is higher than it should be um and this is the concern and we'll then talk a bit more about um uh about what it means and what you might be able to do about it that's broadly correct I mean and the reason I think I'm you know clearly we can measure sugar levels they can also give us an indication you know particularly when you're fasting that you know we think the sugar level should be below 7 mli mes per liters we can do it fasting but the move in certainly in the UK and also in the US and many other countries in the world to diagnose diabetes they've increasingly started using HB hba1c because of its stability because it doesn't need to be done fasting because it can also be measured when people have infections or admitted to hospital because none of those things are going to change on average for three months so it's a very good aggregated marker now it's not perfect all the time there are some circumstances like people have very severe anemia or they have a certain different type of hemoglobin so-called hemoglobinopathy you know we have to be slightly careful but that's a very very small small percentage of the population for the so therefore the vast majority of circumstances hba1c is a very good aggregated measure of sugar exposure that your body has been exposed to and gives us an indication of whether you have pre-diabetes diabetes or an anol AG so I think the obvious F on question is it's why has there been this enormous explosion in people with diabetes and pre-diabetes the team was sharing again some of these stats and apparently there's a sort of fourfold increase in the number of people with diabetes around the world to like hundreds and hundreds of millions of people um and I know that when we look at our own data of people doing the Zoe study of who there's hundreds of thousands you just see this ex you see there's lots of people whose levels are far far lower than the levels you're describing of people with diabetes so clearly you know there's a big shift I guess from I think about like my children I I don't know what their hba1c is but I'm pretty confident it's a long way below these these levels right they aren't there so what's what's going on what is what is causing what I think I I think we could sort of describe as an epidemic of type 2 diabetes with all the scary um implications you're describing and why is it like so much um more common now like even when I was a child growing up okay so I think that's you know it's obviously a brilliant question I'm sure many listeners can work out some of the major causes and one of them of course is um Rising levels of weight and and waste girths in society um because as you put on more weight as people put on more weight and as as average body mass index levels or whatever waste circumference levels have risen in the communities that means um people more people have got to the point where they can no longer store fat peripherally and that fat excess fat gets deposited into some of the key organs in the body that are exquisitly sensitive to too much fat and it and and and and are relevant to how well you either make or store Sugar and if you put too much fat in some of these organs you will disrupt their ability to control sugar levels so for example too much fat in the liver means that it will continue to make excess sugar in excess of the body's needs when you don't need it too much fat in muscles means that your body will not take up the sugar in response to insulin as well as it normally would do if your fat levels and the muscles were less as a simple example so weight gain is one of them another key factor is actually it's actually linked to success in part another risk factor for diabetes actually living longer older so as life expectancies have gone up and more and more people living longer we get more diabetes and part of that reason happens is this in my simple mind there's three things that determine diabetes risk the weight you reach and how much fat you put in your organs your muscle mass because that's your engine to burn up sugar and how well your pancreas works now two of those three things probably all three things change with age as we age our muscle mass goes down a pancreas becomes less which is the organ that makes insulin becomes less plastic as it were I it's its capacity to make more insulin to keep the sugar levels down becomes less over time and also as with age we tend to put on more weight in our stomachs and we tend to lose fat from our peripheries and our arms and legs and our you know in peripheral reasons so with people living longer we're also uh increasing the likelihood of diabetes and that's not just in high income countries if you think about all the millions of people billions in fact in low-income countries as they've prove their hygiene gradually and you know industrialization people are no longer dying in their 30s and 40s are living to the 40s and 50s so they're able to develop diabetes in the 50s and 60s when they didn't because they died with infection or something else so there's multiple reasons but so weight gain increase life expectancy are probably the two major ones and so n i i i just want to I want to unpack that and make sure that um that I've understood it and our listeners have understood it um fully so maybe to start with the first one I think you said something really interesting which is um it's about Rising levels of weight in particular places so it's not just generically whether um someone has put on weight you're saying it's about the fact that that weight is actually being stored so that fat is actually being stored inside crucial organs in our body and that that is really what starts to um trigger the diabetes did I understand that right so yes that's so-called ectopic fat fat where it normally isn't supposed to be in any sort of high level so as an example um all of our liver fat level should be below 5% ideally usually if you look at the normal range under 2% but when the liver accumulates more fat because you your your body has been unable to store the fat in other areas because your weight's got to such a level the body is looking for other places so that excess fat one of which then tends to be the liver as the liver fat levels go up that disrupts the liver's ability to regulate sugar levels normally and the liver actually starts to make excess sugar beyond the body's needs which then keeps the sugar levels high so that's one of the examples uh so ectopic fact it's not the only cause some people also have um shall we say pancreases which make insulin which are unable to make as much insulin uh as perhaps an healthy individual so that for each even when they're not very overweight their pancreas pancreas is ability to make insulin becomes diminished with age very quickly and then and it's a pancreatic driven type 2 diabetes but even there if you know genetically if you can't make as much insulin as the other person it's still usually weight gain that's to trigger for diabetes and people then tend to have to put on less weight to get that diabetes so there's an interaction between how well you put Incas can make insulin how much fat you put in the wrong organs and how good is your muscle mass I sorry n can I just just before you jump on because I think the weight in your organs affecting the way that they work that makes sense and you're describing the pancreas as an as as one of these examples it's so important it's making the insulin could you just explain the muscle mass for a minute why does the muscle mass have any impact on Diabetes so the key sort of organ you know muscle mass is often uh it's uh measure of how active you are so activity plus um you know as an example you know my muscle mass used to be not so good it's actually probably a bit better now I've got a dog and a psycle and so on congratulations that's yeah well you know and my HDL has gone up and I can see it I can see it as a Bome it's gone up you know really almost doubled um which is a good thing which is a very good thing because I do have a I have a family history so I think my pancreas probably genetically South Asian of fan history is it's got a it's it's got a lower Reserve to keep making insulin to the levels I need to overcome you know this any resistance in my tissues as it were so by building up muscle and being more active I have a an engine that burns sugar more so that means I'm I've got an engine that can burn sugar that means that sugar is not going to stay as high if that makes sense oh also will burn fat as well so by having more muscles it's actually going to pull the sugar out of my blood it's going to burn it up so that's like it's improving everything and if I don't have that I'm more likely to store it in my liver and my p a car it's a bit exactly it's like having a very efficient engine um and a bigger engine for the amount of fuel if you overpack the car with fuel you know too much oil the oil will disrupt the engine um you know and if you've got if you keep the engine clean and bigger it may be able to coope with more oil is that you know is that kind of simple analogy you and can I can I follow up on the the point about the differences between people because I'm really interested in that and um you were just talking about being you know South Asian Heritage and love to understand a bit more about that but I I the other thing I was interested in is sort of difference between men and women because I know that when we've had other conversations to do with other risk factors um we've had this conversation about women particularly before menopause sort of storing uh fat in different places and is that um is there a difference between men and women in terms of their risks of diabetes as as well so I'm really curious about for people listening how these things might be different per on who they are yeah well let's explain all those risks in the prism of where you store the fat um so women generally have a much greater subcutaneous you know so they able to store fat peripherally uh thighs legs and obviously you know the shape of women is such that you know they have other stores of fat shall we say so women generally um in a sense have a greater storage capacity for fat in the peripheral area that means they have to put on more weight over all before that fat starts to seep into the liver and peripheral just to make sure basically because for anybody who's not seen the video where nid is helping to indicate you're basically saying everywhere that's not sort of in my torso and around my my belly that women can store a lot more fat there and part the reason women have to store more fat is partly because women have children they have to feed the children they have to breastfeed they have to supply nutrients to the child you know one of the things that happens in pregnancy is the placenta can suck lots of nutrients from Mom so if Mom you know if and if Mom doesn't have enough fat storage they can't often get pregnant you see that in athletes so you like need like your body is like you talking about like Evolution over millions of years years not like necessarily doesn't mean you as a person listening to this have to get pregnant but the point is that's how our bodies have evolved yeah that's exactly right so if you compare men and women in terms of how much fat they have in their liver even in healthy levels men tend to have higher levels of fat within their liver compared to women that means uh and also men when they generally put on weight it usually is accompanied by their waste circumference going up straight away because they tend to store it you know they're all all closer already to the threshold of uh fat going into the wrong places so with a little weight gain men's fat usually goes into the wrong places women however generally can put more fat in in peripheral regions into the thighs and other areas before it goes into the more harmful places like the liver and muscle as it were so that explains why men in every ethnic group at a higher risk of diabetes and women for type 2 diabetes it probably also explains in part why men at higher risk of heart disease than women in all ethnicities by and large and with that same prism if you compare you and I Jonathan uh you're you know you're sitting there you know you're you're Caucasian or white I'm South Asian we know that South Asians on average have 10% on average lower muscle mass and carry more fat Mass already and I we also have higher levels of liver fat even when we're healthy so me compared to you I've got higher level fat so I'm closer to where I'm going to put too much fat in my liver sufficient to develop diabetes than you are you are closer than the average you know say an age comparable women so that explains the men versus women risk it also explains the whites versus nonwhites and every nonwhite individual compared to whites are at higher diabetes risk one of the reasons is where people put the fat it's not the only other reason blacks I think there's another mechanism we don't fully understand is maybe to do with how well your pancreas can make insulin but certainly for South Asians we're in a sense our body makeup is such that we are for less weight gain we will start putting fat into the wrong places and therefore we will develop diabetes at lower average weight gains than wh hi I want to take a quick break here and tell you about something new we've created a free guy that will Kickstart your journey to a better gut health so how can you nurture your gut in the best way which food swaps can you try to nourish these good bacteria what does a high fiber Shopping List look like our free gut health guide shares it all emails and actionable tips that are designed to put you in control of your gut health to get yours for free simply go to zoe.com gutu You'll also find the link in the show notes and these are quite big differences you're describing aren't they NV because I feel like in general when you talk to a lot of scientists um then it feels like often they they've ended up coming to the conclusion that you know even genetics in general never mind ethnic differences are sort of you know ending up being quite small versus environment but here you're talking about quite important differences it sounds like in terms of risk factors based on sort of your ethnicity is that did I understand that right yeah no you're correct so roughly speaking South Asians risk for diabetes so you know comparing age by age and you know sex by sex um somewhere between two to fourfold higher risk of type 2 diabetes two to four times higher so that is an enormous difference in in RIS and even within the southe you know South Asian groups there is a gradient of RIS so the highest groups in the big countries is actually in Bangladesh then it's Pakistan then it's India and a nice re you know a potential explanation for why Bangladesh's compared to pakistanis is height and and early growth because height is aoxy for how much muscle you have Bangladesh is tend to be shorter than Pakistani so tend to be shorter than Indian on average it's it's fascinating the one thing I would say is of course these are just averages and so you can have this huge because I mean and listeners will have heard this I don't want to bore them but um I uh actually have quite a lot of fat stored around my belly in terrible places and very little anywhere else which I had no idea of until as part of that first Zoe clinical study I actually had a Dexter scan and I remember the face I remember the look on the nurse doing it who was like really surprised and the answer was I'm apparently what's I think it's called like a toffee or something like this um and it turns out that I have um uh fat nicely stored around my liver and elsewhere and I remember Tim explaining to me that this was really bad news um and so of course there are these ethnic differen but there's obviously also very big personal variation which is why you know some person I guess is much more risk of diabetes than um than something else I mean and there may be various genes that play as well and and you know the question I would ask if if you were my you know if you were one of my patients Jonathan is do you have a family history of type two diabetes your BMI is obviously not high it's pretty good um and you know it may not be that actually this is a BMI Factor clearly because you're not you know you're clearly you not heavy it may be that you've got a specific Gene that doesn't allow you to export liver fat out of your liver into your circulation I don't know but that's something for you to interrogate it's but by and large I'm going to be following this up in detail after this call I'm conscious that I I I need to to I want I want to move on because I don't want to I know you had limited time before you had to be back in clinic I'd love to talk for a minute before we talk about what we do like what are the symptoms um so let's say that somebody's listening to this and they're like oh I'm um I wonder if I um if I do have diabetes what are the symptoms that I'm going to be experiencing that that are going to answer that question for me so most Pat most individuals who have type 2 diabetes who do move into their sugar levels going high generally have very vague symptoms and some lots are completely asymptomatic as or because that change has been so gradual that they haven't so asymptomatic means they're not aware of any symptoms at all yes yeah the symptoms come generally when the sugar levels go really high at that point when the sugar goes very high the kidney's ability to to to uh reabsorb that Sugar it gets diminished and you you push more sugar out into your your urine sugar cannot go on its own it has to carry water with it so you tend to pee a lot pee more during the day pee more during the night so-called polyurea you may then get more infections because you've got higher sugar levels as well you tend to f tired and fatigued partly because if you're starting to pee out sugar your body's efficiency and how it uses the sugar for optimal function is diminished so you're fatigued so fatigue uh more infections um passing out more urine other kind of major you know kind of symptoms and it sounds like those symptoms you're describing they aren't when you first it's not like when you get a cold or something you don't get these symptoms when you first get pre-diabetes or even diabetes this is is like when it's already lived with it yeah exactly you know the sugar levels are going up relatively slowly and it's you know and so most people generally don't you know maybe they have some vague feeling of I'm don't have as much energy as they used to I'm sleeping a bit more erratically and just you know vague symptoms and and some may not it depends how how fast that sugar level is rising it depends over what period it's rising it depends what age you are we know that younger people develop diabetes the sugar levels Rises faster than older people also excess weight is a much bigger factor in younger people develop diabetes and older people so there's lots of different dimensions the thing I would say we did a study of 100 Asian men and and and and and white men of those 100 Asians 13 had diabetes and didn't know about it okay didn't know they had diabetes so you had a 100 Asians that you studied none of them thought they had diabetes none of them thought knew they had and 13 one in 13 turned out yeah so that's huge 13% had this and they had no idea that they had this serious disease exactly yeah yeah so that's I think everybody list to this is now are going to be a little bit scared if they haven't like spoken to somebody is it all right if you think you have some concern so maybe I think you're describing some of the reasons like you think maybe you have put on more weight around your tummy and you well it's it's it's more than that Jonathan yeah so the things you should do there are simple scores you can look up you know what is my risk for diabetes High lower medium you know and you can do that this what's this this this the the diabetes UK risk score which you can get online there's the leester diabetes score there's what's known as Q diabetes online and the the the risk scores capture your age your family history of diabetes uh your ethnicity whether you're a male or female U and your and generally your weight and and a couple few other things and they will give you an idea and it may be when you put that risk or it comes up for the vast majority is going to be actually low which case don't worry about it it's very unlikely you have diabetes if it comes up medium or high then at that point you might want to reach out to your GP and say look I've done this score could you potentially do my hb1c test I would like to know and and just get anot as it were and that's what we just just to make sure that makes sense to everybody not in the UK listening who may not know what anot is um what you're saying is I think if I if I play that back right is firstly there's a there's a score and we will put a link in the show notes for anyone listening to this who can find the the right um way to score this for for their country which basically gives you an indication of your likelihood of risk and what you're saying I think is if that risk is medium or high then don't feel bad about going and speaking to your to your doctor your physician and that there is this very um is it a very difficult test to do to then find out this hba1c no it's effectively it's a uh it's a blood test um that the GP you know or or the healthcare professional or can take um um or a flist can take any time of the day um and it gets costs about in in British terms one to2 pound you know it's not very exp and probably a bit more expensive in the US and some other the places so it's not very cheap it's not very expensive the test always a lot more expensive in the US yes but we won't go and discuss that right now that's that's a completely different but anyway it's relatively easy it's done you know get the result within a day and it he comes up with the hog glob A1 test so and you wouldn't be because I think sometimes people people say oh you know if you're not really sick you shouldn't you know are you just like creating all these people worrying for no reason are you go on the vast majority of listeners when they do this test the risk will come up as low okay the vast majority and then they're reassured doesn't mean to say they can you know they still have to everyone has to try and live the best life they can and enjoyable life in the way as well and um but as an example be somebody like myself I have a family of diabetes so I have number I have a risk factor I'm also getting older you know that in itself isn't a risk factor but because I have a family history and I'm South Asian you know then that probably you motivate if I do my diabetes RIS it comes up as something like 15% chance over the next 10 years so it's a one in six or seven chance that I would and I have had a hemoglobin A1 test done and it came back as it's actually okay but it's getting in you know it's getting close to the pre-diabetes range which fits with my family history the reason I've I've kept kept it down because I've kept my muscle mass up you know my father and my mother both developed diabetes in their 40s and 50s you know what that is a brilliant transition Point um um because I'd love to to talk about like so what do you do you know to avoid getting hopefully diabetes pre-diabetes in in in the first place and it sounds n that you're literally living this yourself so um I'm fascinated and you mentioned I wasn't sure was was getting the dog part of this solution but tell me like I think you you've you've painted a pretty clear picture that you would really like to avoid this because of all the serious implications so if someone's listening to this and they're saying like they'd they want to make the right actions could you talk through I think based on your own research but also I think fascinating to hear what you're doing yourself as as an expert I mean it's not even my research I think it's based on the kind of global evidence that we know from all randomized trials all the various studies and around the world you know the evidence based is the following is that if if you want to reduce your risk of diabetes the key aspects are keeping us healthy way as you possibly can so you know diet makes a big sense and you know and you probably all the listeners here are well tuned to that and keeping relatively Physically Active um and those are the two major things we cannot stop aging you know um the one thing I would also say and I think I've hinted at this Jonathan um I'm now 56 six um if I can delay developing diabetes till I'm 75 I'm far less worried because if I if my sugar level start to escape high level I then I don't have many more years for that sugar to cause damage High sugars immediately do not cause damage it takes about you know 5 to 10 to 15 years and also the older you become to get diabetes the slower your sugar will Elevate because it's less linked to weight gain the younger you develop diabetes it's more toxic it's a more toxic disease because sugar levels rise faster you tend to have to need more weight the reason you tend to need to have more weight to C to trigger diabetes because when you're young you tend to have a bigger muscle because you're young and your pancreas is healthier because you're young so in other words to overcome those um you know your better buffering capacity because you're younger you need to put on you need to stress the system more by putting more fat in the wrong places but that comes with all the other risk factors that means your risk is much higher yeah so you're saying if I can hold it off till I'm 75 then at that point maybe you could start to eat the uh you could eat chocolate quason all day is that there's re think but but but I know that the diabetes then is is you know but you're less worried about the DI diabetes it's because not going to it's not going to massively impair my life expectancy if at all it's not going to lead me to have raging eye or kidney disease or nerve disease if at all you know whereas so if if you're in your 40s and 50s and you're in pre-diabetes some small sustainable Lifest child changes that means that you either stay the same we put on a bit of muscle mass or else lose three or four kilograms and sustain that and and able to keep healthy with a little bit of activity to stop you putting on weight means that you will probably delay developing diabetes for five you know three four or five or 10 year you know up to 10 years some people can delay this for a long time or even revert back to normal sugar levels so it's it's it's effectively improving your muscle mass cutting your weight ectopic fat sufficient to dstress your glucose control mechanisms and nid could we talk a little bit about I I'd love to talk about what you've done yourself and you touched on it maybe briefly but I'd love to understand it sounds like this is a real live risk for you you describe the fact that like both your parents developed it um when they very young and it sounds like this is really on your and it just reminds me a little bit of Tim when he making his own changes for his health like it sounds like this is live for you what what have you how does it affect what you do um you know I'm obviously fortunate to live you know you know in an area with there's an ability to do more physical activity I think the dog wasn't an effort necessary to to keep my diabetes a we but the side product of the dog is that I am I've increased my walking much more than I ever did before and I enjoy it um I've now cycled to work for the last 10 years and I love it so what I've I've almost I've almost changed my own identity and Who I Am by becoming more physically active and finding things that I phys that really enjoy the side product of that is my muscle mass I can feel it has gone up uh I probably reduced a little bit of excess fat within my liver 25 years ago I was a bit heavier and one of my signals for diabetes was incredibly High and then you know and it's come right down um because effectively it built more muscle got rid of some of that fat mass and some of those changes have been very gradual equally I've also made some diety changes as well you know cutting out some of the refined sugars increasing the variety of the foods I eat more fiber rich you know retrain my pallet to have different taste which takes a bit of time to get used to you know would you believe I even enjoy Shredded Wheat now you know I love Shredded Wheat but that's taking me a few weeks to get used to that taste and texture but I love it okay add two or three grapes on it for a little bit of sweetness but that's fine again so in a sense I've been on this gradual step by step by step journey to become a become eating a better quality fuel having a better quality activity that's in a sense stopped me putting fat in the wrong places keep my engine better to stop me pushing into diabetes in my 40s or 50s and hopefully I can keep doing that by staying active to you know even if I get diabetes in my late 60s I'm not worried about it because we now have better I could undergo weight loss intervention I could go undergo this you know met forming there's a some better drugs coming forward as well for someone who's listening to this who already has you know type two diabetes or maybe they've been told they have pre-diabetes um is it possible to actually reverse some of this can you actually lower um the blood sugars that you were were were talking about yeah absolutely it's so in every individual um we all have a different slope between weight gain and the hog globin the hb1c level so in a sense there's almost a straight line between it each of us and my line is steeper than yours Jonathan because of my family history so for a smaller amount of weight gain my HBA want will Elevate because I'll put fat in the wrong places and you know so we've shown in the direct trial that if you have a person who's developed diabetes with the last 3 to 4 years if they lose 10 kilg about 46% after 1 year or 33% after 2 years no longer have diabetes because they've got rid of fat the liver fat comes right down then the liver responds far better to insulin that the liver makes less sugar your sugar normalizes in lot so so there's a straight line between how much weight people lose and how what well their HB once he improves by and large and and it works the other way as well there's a straight line between how much weight you put on and he just that slope of that line is different for different individuals based on whether you're male or female South Asian or or or or white and wherever age you're at and so on and so on and so that that does mean you know wherever you are there is something you can do and it's not just absolutely so I had a patient this morning um in the clinic who has diabetes who'd undergone surgery for weight loss they'd lost a lot of weight that sugar levels had plummeted you know they're still within the diabetes range and the thing I discussed with them was and they they was starting to worry about Mobility was can you actually now increase your muscle mass you've done you've lost and they had lost seven Stone because of surgery but clearly they could but they could do some resistance exercise a bit more physical activity to improve the mobility so to improve the engine side of it so everyone listening can do something but what they need to do is find something that they can sustain or enjoy to reinvent a new version of themselves that they enjoy and they can sustain for Better Health as well whether that's dietry physical better sleep all the things that you've discussed in Zoe in various you know podcasts um you know better sleep gives you better appetite allows you to control your appetite better Mo you know destress maybe more physical activity all those things and trying do it in a way that either small steps that you can get to um slightly better health to to keep some of these diseases away and also to increase the life expectancy of healthy life as it were and contract it unhealthy life for later years which I think everyone listening to this podcast is interested in can I ask one final question before we then get to like the the summary um there are some new drugs that have been in the news like a zenic and there's been a lot of discussion um we're really lucky to speak to somebody who's one of the world's experts on Diabetes what's your view about these so now you know in some respects I wish we would didn't need to have those tools you know um because I wish we could change the environment make it easier for people to leave easier lives because it's not easy changing your diet it's not easy becoming more physically active you know we talked about it and and we have to overcome weight stigma we have to talk about helping people navigate the environment that they live in if you get if you're surrounded by or food it's very hard yeah it's almost impossible I I so you know I don't want people to think that I think it's easy it's not easy you know some of the changes that we've all had to make we've had to work at them but even then for a lot of people willpower is not enough the environment live is not enough so I wish we having several of that there's millions of people living with um obesity and chronic diseases these drugs are good powerful tools that help people control their appetite um lose quite considerable amount of weight and therefore reduce and improve and you reduce the risk of a number of chronic diseases not only diabetes but more recently you reduce the risk of heart attacks or Strokes improve um symptoms and heart feel reduce the risk of kidney disease improve the quality of life so I'm GL glad they're there they're expensive we don't have great availability so we need to work out in all Healthcare Systems how do we get them to the people who need them the most to get the maximum benefit from those individuals and society and that's a big ask and hopefully over the next 10 years we'll have more of those tools the prices will come down they'll be proven to be long-term safe and the benefits outwear any potential risks but it sounds like you are expecting to be prescribing these to some people I've already prescribed them to some people because we have to but we need to do both prevention and treatment we can't do just one and uh that is a whole another podcast that I would like to get you back it is na I would love to do a wrap up and for you to make sure whether I've got this right before you shoot Off to See Another patient if if that's right sure so um I think we started by talking about like why would you worry about blood sugar at all and you you get this brilliant analogy of like sort of spilling sugar on the table and getting it wet and um that that's this sticky mess and you do not want that in uh in your blood vessels and what happens is if you lose this control over your blood sugar because for example you're starting to get all this fat in your lier and your panc C all the rest of actually you're getting this stickiness in these like little blood vessels and this is damaging your your eyes and your nerves and it doesn't sound good so it's very clear that we don't want that and then the question is well why is this happening because it's now happening where you know there's a 100 million people with pre-diabetes according to CDC in the US and you know this this big increase and you're saying like the biggest reason is we're starting to get um number one that we're getting fat stored in our organs in a way that is really bad for them and and didn't really happen in the past and you particularly talked about it being in your liver and in your pancreas um and that interestingly one of the reasons why we see so much variation between the the risks of diabetes is that different people have very different likelihood to store excess weight in those places and so you describe that for example women before menopause are much lower risk for diabetes because they tend to store their weight in almost anywhere other than the liver but interestingly as as as a man you're saying almost the first place that I'm going to store this excess weight and in my case in particular that's obviously very true is like right in the liver and then it starts to cause all of these um problems that interestingly there are big ethnic differences and I think you described that sort of anyone who isn't Caucasian I think you said actually has significantly higher risk and then there's further differences between ethnicity that there is a uh there's some online tools to look at this and we will share those links in the show notes so you can understand your own um risks which are averages because I think what we always we see with Zoe is there's a lot of personal variation but this is a a free first step and that if it looks High you you should go to your doctor and check and then I think we talked about the fact that I think one of the things that's quite scary about this is that many people feel no symptoms and so you can have diabetes for a long time and this damage is starting to happen and you just don't even realize which is again a reason to really believe in preventive health care and then we talked about what to do um and I think the main answer is we you know for many people listening to this is do what nid has done so firstly get a dog um secondly cycle to work um so basically find ways to be more physically active you're saying because it increases your muscles compared to just this very uh you know non-moving way we tend to be and try and figure out how to control your weight which you know is a topic we talk about a lot on other podcasts and we know is hard but fundamentally if your weight is just going up year after year after year then you you've got this this problem um so physically active healthy weight so the right health um uh diet and a lot of people need support in that obviously yeah K and Jonathan sorry absolutely um and you know we part of what we talk obviously a lot on the podcast is is about this and and of course we uh we want people ultimately to decide they'd like to try the like the personalized program that's really focused for them which which we talk about and I thought one thing you said that was really interesting is in your minds I actually what you want to do is delay diabetes in your perspective if you got diabetes when you're 75 you're actually not too stressed about it because it takes quite a long time for there to be damaged to you so it's not like having a heart attack when you get diabetes it's more like a risk and so you're saying um you want to push that out because actually if you know maybe you're quite high risk if you could push it out till 75 you're going to be okay and then the final thing you said which I thought was really positive is you can reverse diabetes right it's not like having cancer or a heart attack like it's not a one-way Street actually by removing this fat out of your your liver you can actually get to the point where you don't have diabetes or PRI pre-diabetes and I thought that was a a beautiful positive way to wrap it up perfect that's a fantastic summary Jonathan y nid thank you so much I know that we like jumped over a lot of this this very big topic and I know you're doing a lot of research in these these areas uh I hope that I can I can tempt you back in the future and and we can delighted yeah absolutely particularly whatever the feedback to try and unpick some of the other you know because obviously it's hard to go into VAR specifics there are some variations in various things but I've given you the broad picture for the vast majority people in terms of type two we would love to do that and we'll talk a lot more about the diet side of it as well of course there been Zoe n thank you so so much for taking the time pleasure thank you nid for joining me on Zoe science and nutrition today it's been fascinating to learn so much about blood sugar how type 2 diabetes impacts our health and how we can prevent and even reverse it if you want to hear more insights from the podcast you can download our free guide with our 10 most impactful findings by going to zoe.com podcast and if after this conversation you want to understand your own blood sugar levels in more detail and how they respond to the food that you eat as I have done myself then you can learn more about becoming a Zoe member and getting personalized advice about how to eat the best foods to reduce your blood sugar spikes you can also get 10% off your membership Again by going to zoe.com podcast as always I'm your host Jonathan wolf Zoe science and nutrition is produced by yellow huin Martin Richard Willen and Tilly fford see you next time

Channel: ZOE

Views: 153,197

Keywords: diabetes uk, diabetes uk hypo, diabetes uk video, does exercise prevent diabetes, health interview, health podcast, how to prevent diabetes, how to prevent diabetes if it runs in your family, prevent diabetes, prevent diabetes 2, prevent diabetes diet, prevent diabetes exercise, put diabetes in remission, reverse diabetes, science podcast, type 2 diabetes, type 2 diabetes explained, ways to prevent diabetes, zoe health, zoe podcast, zoe science and nutrition

Id: JfZgR9NoKj0

Length: 56min 29sec (3389 seconds)

Published: Thu Mar 21 2024