Approximately 9.4 percent of the U.S. population suffers from diabetes. If you are one of them, you know how frustrating it can be to manage your symptoms. But what if you could prevent it from occurring in the first place?
Dr. Nicholas Mezitis discusses ways to prevent diabetes so that you don't have to worry about managing it.
Selected Podcast
Can You Prevent Diabetes?
Featured Speaker:
Nicholas H.E. Mezitis, MD
Nicholas H.E. Mezitis, MD received his medical degree from Heidelberg University Medical School, Germany. He completed a residency in anatomic and clinical pathology at the George Washington University Medical Center, Washington, D.C., and a residency in internal medicine at the Thomas Jefferson University Hospital, in Philadelphia, Pennsylvania. He completed a clinical fellowship in diabetes and endocrinology at the Joslin Diabetes Center, New England Deaconess Hospital, Harvard University, in Boston, Massachusetts, a clinical fellowship in diabetes, endocrinology, and nutrition at St. Luke's/Roosevelt Hospital Center, Columbia University, New York, New York, a clinical fellowship in nutrition at Memorial Sloan-Kettering Cancer Center, Cornell University, New York, New York, and a research fellowship in diabetes and metabolism at St. Luke's/Roosevelt Hospital Center, Columbia University, New York, New York. Transcription:
Melanie Cole (Host): According to the Centers for Disease Control and Prevention, as many as 29 million people in the United States have diabetes. But up to eight million may be undiagnosed and unaware of their condition. My guest today is Dr. Nicholas Mezitis. He’s an endocrinologist with Memorial Health System. Welcome to the show Dr. Mezitis. What is diabetes? We have heard this term. We know there’s a type 1 and a type 2. Tell the listeners what it is.
Nicholas H. E. Mezitis, MD (Guest): Yes Melanie, the problem with diabetes needs to be understood as a fuel utilization disorder, which means that the food that we consume which is our fuel in effect whether that happens to be the carbohydrates, the proteins, the fats, the vitamins, even the fluids that we consume; all of this needs to get processed in order to become part of us. Because your food is you basically and you are what you eat. In order for this process to take place, there are a host of hormones in the body, insulin is one of these hormones that are involved in transforming the fuel that we consume, the food that we consume into an energy equivalent which is like an electric current. And that electric current allows us to function and it’s pretty much like we have any other device that needs to get plugged into an energy source. For us, the energy source is our food and the ability to transform the food from a chemical form into an electrical event is what the body does through its metabolism. And a central player in all of this is insulin.
Diabetes represents the disruption of this rhythm which is basically the equivalent of an orchestra with all sorts of harmonies of hormones taking place under the direction of certain pacemakers within our body. And if we have a disruption in the sequence because in this instance, insulin is either not present or not functioning properly or not getting the proper response from its receptors; then we begin to lose that rhythm and as a consequence, we experience all sorts of unpleasant events. Some of those we experience through our immediate level of consciousness, others we experience through the complications of diabetes. And these complications they are also are the face of diabetes that we see are number one premature aging, number two various forms of acquired immune deficiency, meaning that we don’t combat infections the way we should and in addition to that, obviously, our performance at any given level is not what it should be. We are feeling weak, we are feeling under par.
Melanie: Who is most at risk for some of these symptoms of diabetes? Is there a genetic component even to type 2 and while you are on that Dr. Mezitis, even children today because of the obesity epidemic used to be only type 1 is what you saw and type 2 was called adult onset? It’s not anymore, because you are seeing it in younger and younger people, so speak about the risk factors.
Dr. Mezitis: Very good. The risk factors are several. But the most important relates to weight and physical inactivity and that is actually what afflicts a lot of our youth these days. The fact that people are putting on weight due to the plethora of calories which are readily available and for which we don’t really need to do much because we can either call in it or just drive over and get whatever we need. So, it’s very simple as opposed to the hunter-gatherer of old that we used to have in generations past. So, this combination of physical inactivity and weight gain so that we are in higher levels the BMI that we call which is a relationship of your height and your weight expressed as a score. So, this sets the stage. Now the question about genetics obviously is relevant because no matter type 1 or type 2, there are genetic factors that impact both. So, there is always a predisposition. We don’t always know the details because we know that there are many genes that are involved in this particular picture. And we are not sure about the combinations and what ticks off particular sequence of events. But the fact remains, that genetics plays a role, that if you have several relatives, first-degree relatives certainly of importance, who have this problem; then you are actually at a much, much greater risk than someone else. However, if we live long enough, and if we have the lifestyle which I mentioned with inactivity and weight gain; I guess virtually anybody can become diabetic with few exceptions.
Melanie: So, while we are trying to focus today on prevention and we could do so many segments on medications and treatments and that sort of things. Let’s focus on prevention and lifestyle. How does our diet impact diabetes management and possibly prevention all together?
Dr. Mezitis: Well diabetes is the cornerstone of management and I always start my encounters with a patient or at least I close them with a discussion of diet and the meal planning because on one hand, obviously, even though people have been eating for a long while, obviously and have their ways of doing things set; very few are aware of two things. Number one that the food supply, the modern food supply is tainted if you will, through various chemicals, many of which are known as endocrine disrupting chemicals and that’s a whole new category that has been recognized by the Endocrine Societies at the present. So, these are in the food supply for a variety of reasons either as preservatives or as chemicals that are additives or have been fed to animals that we subsequently feed on. So, these endocrine disrupting chemicals in the food supply set the stage for problems and they may be estrogens and they may be preservatives as mentioned or other.
That’s the one component and the other component has to do with the amounts of food consumed and whether they are processed and refined or whether they are in the more simple form. And this is something that we try to educate people so that when they go in to shop; they are informed shoppers who are careful to pick up the things that they really need, the basic food elements for a good diet and then minimally processed without too much overcooking to put these on the plate in proportions so that again, we talk about so that we have representation of vegetables and fruits and protein and also the carbohydrates that people enjoy in proper proportions. And once that’s been structured on the plate, then that also has to be timed in such a way so that the bulk of the calories are consumed early in the day and as we come close to supper, we are kind of fading out with lighter meal.
And again, the activity component is something that we remind people that even though we are a carb-based society, we need to seek out opportunities either in the home or in some gym or track or whatever to spend some time and walk and give the body an opportunity to exercise, pretty much like we do with a pet; we are aware of the importance of exercise for them as well. So, that type of mindset I think sets the groundwork for prevention. In addition to that, there are situations where people may also be taking some medication which may help them. So, there are medications that have been checked like in the diabetes prevention program where they use metformin, it’s a drug that can facilitate the processing of glucose and kind of help the body and the liver do its work. So, that’s something that had been introduced. There are some other medications as well that have been used either to control the appetite or for other reasons. So, those are players too, but what’s actually been shown by many if not most of the studies is that diet and exercise activity and what we discussed earlier about stress and sleep; have the role that’s adequate to prevent the problem or delay it.
Melanie: Where does exercise, lifestyle management, all of these things, can you prevent diabetes by being a more active person? You mentioned sedentary lifestyle or obesity. Can you really prevent it by following these tips you are offering?
Dr. Mezitis: You can definitely prevent diabetes and when I say prevent, we can delay it so that when it occurs it occurs beyond our lifetime, because we do know that if we are looking at the beta cell which is our thermostat that sets the stage for insulin release in sort of response to a meal; when the thermostat begins to suffer and gradually loses its potency; it takes about fifteen years for this thermostat the pacemaker for the insulin production to lose – it takes about fifteen years for it to lose 50% of its capabilities. And when we reach that 50% mark roughly, then the sugars are in a range that we define as diabetes range. So, we have certain scores so that we consider to be thresholds. So, that fifteen-year period is what we are trying now to extend so that we can get more mileage out of that beta cell which may be fading for a variety of reasons. So, if I can get that to be twenty years, twenty-five years, thirty years before it reaches the 50% mark and then I develop the full-blown picture; that’s an achievement. That may be well beyond my life expectancy if you will. And therefore, I have achieved prevention. But again, we have that ability and the sooner we intervene, in other words, if we can start this process of intervention earlier in life; obviously we can postpone it much better than if we are two or three years shy of hitting that 50% threshold of function. So, that’s something that we emphasize to patients. So, when I’m speaking with a patient, who may be in their middle years; I’m interested also in having their son, daughter, granddaughter in the room to listen into the message because the message is more important to them, than it is to the patient in question. Because if they were to adopt similar lifestyle measures; they are likely to stay out of trouble.
Melanie: What great advice and what a good point that you are working with even the younger generation to get them to understand if they do have a family history and how important that is. Thank you so much doctor, for being with us today. You’re listening to Memorial Health Radio with Memorial Health System. For more information please visit www.mhsystem.org, that’s www.mhsystem.org. This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): According to the Centers for Disease Control and Prevention, as many as 29 million people in the United States have diabetes. But up to eight million may be undiagnosed and unaware of their condition. My guest today is Dr. Nicholas Mezitis. He’s an endocrinologist with Memorial Health System. Welcome to the show Dr. Mezitis. What is diabetes? We have heard this term. We know there’s a type 1 and a type 2. Tell the listeners what it is.
Nicholas H. E. Mezitis, MD (Guest): Yes Melanie, the problem with diabetes needs to be understood as a fuel utilization disorder, which means that the food that we consume which is our fuel in effect whether that happens to be the carbohydrates, the proteins, the fats, the vitamins, even the fluids that we consume; all of this needs to get processed in order to become part of us. Because your food is you basically and you are what you eat. In order for this process to take place, there are a host of hormones in the body, insulin is one of these hormones that are involved in transforming the fuel that we consume, the food that we consume into an energy equivalent which is like an electric current. And that electric current allows us to function and it’s pretty much like we have any other device that needs to get plugged into an energy source. For us, the energy source is our food and the ability to transform the food from a chemical form into an electrical event is what the body does through its metabolism. And a central player in all of this is insulin.
Diabetes represents the disruption of this rhythm which is basically the equivalent of an orchestra with all sorts of harmonies of hormones taking place under the direction of certain pacemakers within our body. And if we have a disruption in the sequence because in this instance, insulin is either not present or not functioning properly or not getting the proper response from its receptors; then we begin to lose that rhythm and as a consequence, we experience all sorts of unpleasant events. Some of those we experience through our immediate level of consciousness, others we experience through the complications of diabetes. And these complications they are also are the face of diabetes that we see are number one premature aging, number two various forms of acquired immune deficiency, meaning that we don’t combat infections the way we should and in addition to that, obviously, our performance at any given level is not what it should be. We are feeling weak, we are feeling under par.
Melanie: Who is most at risk for some of these symptoms of diabetes? Is there a genetic component even to type 2 and while you are on that Dr. Mezitis, even children today because of the obesity epidemic used to be only type 1 is what you saw and type 2 was called adult onset? It’s not anymore, because you are seeing it in younger and younger people, so speak about the risk factors.
Dr. Mezitis: Very good. The risk factors are several. But the most important relates to weight and physical inactivity and that is actually what afflicts a lot of our youth these days. The fact that people are putting on weight due to the plethora of calories which are readily available and for which we don’t really need to do much because we can either call in it or just drive over and get whatever we need. So, it’s very simple as opposed to the hunter-gatherer of old that we used to have in generations past. So, this combination of physical inactivity and weight gain so that we are in higher levels the BMI that we call which is a relationship of your height and your weight expressed as a score. So, this sets the stage. Now the question about genetics obviously is relevant because no matter type 1 or type 2, there are genetic factors that impact both. So, there is always a predisposition. We don’t always know the details because we know that there are many genes that are involved in this particular picture. And we are not sure about the combinations and what ticks off particular sequence of events. But the fact remains, that genetics plays a role, that if you have several relatives, first-degree relatives certainly of importance, who have this problem; then you are actually at a much, much greater risk than someone else. However, if we live long enough, and if we have the lifestyle which I mentioned with inactivity and weight gain; I guess virtually anybody can become diabetic with few exceptions.
Melanie: So, while we are trying to focus today on prevention and we could do so many segments on medications and treatments and that sort of things. Let’s focus on prevention and lifestyle. How does our diet impact diabetes management and possibly prevention all together?
Dr. Mezitis: Well diabetes is the cornerstone of management and I always start my encounters with a patient or at least I close them with a discussion of diet and the meal planning because on one hand, obviously, even though people have been eating for a long while, obviously and have their ways of doing things set; very few are aware of two things. Number one that the food supply, the modern food supply is tainted if you will, through various chemicals, many of which are known as endocrine disrupting chemicals and that’s a whole new category that has been recognized by the Endocrine Societies at the present. So, these are in the food supply for a variety of reasons either as preservatives or as chemicals that are additives or have been fed to animals that we subsequently feed on. So, these endocrine disrupting chemicals in the food supply set the stage for problems and they may be estrogens and they may be preservatives as mentioned or other.
That’s the one component and the other component has to do with the amounts of food consumed and whether they are processed and refined or whether they are in the more simple form. And this is something that we try to educate people so that when they go in to shop; they are informed shoppers who are careful to pick up the things that they really need, the basic food elements for a good diet and then minimally processed without too much overcooking to put these on the plate in proportions so that again, we talk about so that we have representation of vegetables and fruits and protein and also the carbohydrates that people enjoy in proper proportions. And once that’s been structured on the plate, then that also has to be timed in such a way so that the bulk of the calories are consumed early in the day and as we come close to supper, we are kind of fading out with lighter meal.
And again, the activity component is something that we remind people that even though we are a carb-based society, we need to seek out opportunities either in the home or in some gym or track or whatever to spend some time and walk and give the body an opportunity to exercise, pretty much like we do with a pet; we are aware of the importance of exercise for them as well. So, that type of mindset I think sets the groundwork for prevention. In addition to that, there are situations where people may also be taking some medication which may help them. So, there are medications that have been checked like in the diabetes prevention program where they use metformin, it’s a drug that can facilitate the processing of glucose and kind of help the body and the liver do its work. So, that’s something that had been introduced. There are some other medications as well that have been used either to control the appetite or for other reasons. So, those are players too, but what’s actually been shown by many if not most of the studies is that diet and exercise activity and what we discussed earlier about stress and sleep; have the role that’s adequate to prevent the problem or delay it.
Melanie: Where does exercise, lifestyle management, all of these things, can you prevent diabetes by being a more active person? You mentioned sedentary lifestyle or obesity. Can you really prevent it by following these tips you are offering?
Dr. Mezitis: You can definitely prevent diabetes and when I say prevent, we can delay it so that when it occurs it occurs beyond our lifetime, because we do know that if we are looking at the beta cell which is our thermostat that sets the stage for insulin release in sort of response to a meal; when the thermostat begins to suffer and gradually loses its potency; it takes about fifteen years for this thermostat the pacemaker for the insulin production to lose – it takes about fifteen years for it to lose 50% of its capabilities. And when we reach that 50% mark roughly, then the sugars are in a range that we define as diabetes range. So, we have certain scores so that we consider to be thresholds. So, that fifteen-year period is what we are trying now to extend so that we can get more mileage out of that beta cell which may be fading for a variety of reasons. So, if I can get that to be twenty years, twenty-five years, thirty years before it reaches the 50% mark and then I develop the full-blown picture; that’s an achievement. That may be well beyond my life expectancy if you will. And therefore, I have achieved prevention. But again, we have that ability and the sooner we intervene, in other words, if we can start this process of intervention earlier in life; obviously we can postpone it much better than if we are two or three years shy of hitting that 50% threshold of function. So, that’s something that we emphasize to patients. So, when I’m speaking with a patient, who may be in their middle years; I’m interested also in having their son, daughter, granddaughter in the room to listen into the message because the message is more important to them, than it is to the patient in question. Because if they were to adopt similar lifestyle measures; they are likely to stay out of trouble.
Melanie: What great advice and what a good point that you are working with even the younger generation to get them to understand if they do have a family history and how important that is. Thank you so much doctor, for being with us today. You’re listening to Memorial Health Radio with Memorial Health System. For more information please visit www.mhsystem.org, that’s www.mhsystem.org. This is Melanie Cole. Thanks so much for listening.