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The Wellness Blueprint: With Dr. Caleb Davis
Welcome to The Wellness Blueprint with Dr. Caleb Davis, where we uncover the secrets to living a long, active, and pain-free life. Hosted by Dr. Caleb Davis, an orthopedic surgeon and fitness enthusiast, this podcast is your ultimate guide to musculoskeletal health, injury prevention, and wellness.
Dr. Davis combines his expertise as a shoulder and elbow specialist with a passion for empowering people to take charge of their health. From deep dives into cutting-edge restorative medicine to practical tips on avoiding surgery and optimizing recovery, The Wellness Blueprint offers valuable insights for anyone seeking to preserve their body and thrive at every stage of life.
Join us each week for professional guidance, fascinating medical discussions, and actionable strategies that help you move better, feel stronger, and stay functional for years to come. Whether you're an athlete, a weekend warrior, or someone looking to age gracefully, The Wellness Blueprint provides the tools to design a healthier you.
The Wellness Blueprint: With Dr. Caleb Davis
Episode 10: The Diabetes Blueprint: How to Prevent, Manage, and Reverse It
Get ready to transform your health with The Wellness Blueprint with Dr. Caleb Davis! Formerly known as the Dr. Big Guy podcast, this rebranding reflects our mission to empower you with practical tools and insights for building a strong health foundation.
In this episode, we kick off by exploring the global impact of diabetes, challenging the common perception that it's irreversible. With actionable lifestyle changes and expert insights, we provide guidance on managing or preventing diabetes, so you can take control of your health.
Discover the keys to preventing and reversing type 2 diabetes on this episode of The Wellness Blueprint with Dr. Caleb Davis! We dive into the differences between type 1 and type 2 diabetes, shedding light on the diagnostic criteria and the importance of blood glucose management. Learn how carbohydrates and sugars affect blood sugar levels and insulin response, debunking common misconceptions along the way. We also share personal stories about managing prediabetes and the vital role of community support in making significant lifestyle modifications. Together, let's lay the blueprint for a healthier, more functional life.
Join us as we uncover the impact of diabetes on society and explore the strategies for reversing this condition on The Wellness Blueprint with Dr. Caleb Davis! We discuss the severe consequences of unmanaged diabetes, from heart attacks to amputations, and emphasize the importance of regular screenings and proactive health management. Discover the multifaceted approach to managing diabetes, prioritizing lifestyle changes over medication. From understanding the benefits of hydration and physical activity to debunking misconceptions about health-conscious living, we provide you with the tools you need to reverse diabetes and embark on a journey towards a healthier, more fulfilling life.
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Hey everybody and welcome back to another episode of the podcast. So, after a lot of deliberation, we have decided that we have some changes to make around here, and the biggest one is that we are changing the name of the podcast and rebranding the Dr Big Guy podcast, sadly, will be no more.
Speaker 1:Some of you will be excited about this and some of you will be very sad to see Dr Big Die disappear. I'm a little bit sad about it.
Speaker 2:We had a lot of deliberation about changing the name and although it's a very beloved name and it captures how we're funny and whimsical and lighthearted, we ultimately decided that we had to make a little bit of a change. So why the change? The new name of the podcast is the Wellness Blueprint, with Dr Caleb Davis, and I think that reflects a little bit of a clearer vision of what the podcast is all about. Our mission is to help you build a strong foundation for your health by focusing on injury and illness prevention and musculoskeletal and joint health. The old name, while fun, didn't really fully capture the heart of what we're creating here. And while it's a fun title, the new name gives capture the heart of what we're creating here. And while it's a fun title, the new name gives people a better idea what our goals are.
Speaker 2:The Wellness Blueprint is about giving you practical tools, actionable insights and a roadmap to live healthier and be more functional and happy. This change is also a step toward growing the podcast reach and connecting with even more listeners and positioning us as a trusted resource in the healthcare and wellness space. By refining our focus and our name, we're taking the podcast to the next level, while staying true to our goal empowering you to preserve your health, avoid unnecessary interventions and optimizing your well-being. I'm so excited for this next chapter and I want to thank all of you for your support in this journey so far. Now let's dive into today's topic and start laying the blueprint for your best health.
Speaker 3:The information shared on this podcast is intended for educational and entertainment purposes only. The content of this podcast should not be considered medical advice, nor is it a substitute for professional consultation with a qualified physician. The views on this podcast do not necessarily represent the views of Dr Davis's Medical Practice Group. If you have health concerns or conditions, it is recommended that you seek the advice of your own physician, who knows your medical history and can offer you personalized recommendations.
Speaker 2:So what if I told you that there is a condition that affects over 500 million people worldwide and it can lead to blindness, amputation and even heart attacks, but in many cases it could be preventable. We're talking about diabetes, and 500 million may be a shocking number to some, but it's only climbing every year, and there's an estimate that prediabetes affects up to one out of every three Americans, and 80% of those people aren't even aware that they are prediabetic.
Speaker 1:What is the qualifier for what makes you diabetic or prediabetic?
Speaker 2:We will get into the semantics of that and actually define what the criteria is for that a little bit later. So November is actually Diabetes Awareness Month. I feel like a lot of people are going to hear diabetes and they're just going to be like we don't need to listen to this episode because I don't have diabetes. But I would like to persuade you to stick around because, as we'll discuss, diabetes affects a lot of people in very different ways and a shocking amount of people are dealing with pre-diabetes and may not even know it.
Speaker 1:I'd also like to say that, at least in our culture, it seems like it's something that's taken in a very lighthearted sort of way. I can't tell you how many jokes myself or others have made about like oh, I just ate three pieces of cake, I'm going to get the beaties.
Speaker 2:Or people just say, oh, I'm going to go into a diabetic coma.
Speaker 1:Right.
Speaker 2:It's certainly something that's in the vernacular and part of American culture, but maybe people don't quite understand what it is, how it affects people or how serious it is.
Speaker 1:Yeah, and I always get the impression if you told somebody your loved one suffered from whatever ailment, they'd get that hushed tone of oh, I'm so sorry. But if you tell them, yeah, so-and-so suffers from diabetes, type 2, they're just like oh, doesn't everyone?
Speaker 2:Yeah, it seems to be getting to that point, isn't it?
Speaker 1:Yeah.
Speaker 2:One of the things I really want to discuss today is diabetes reversible or not? If I asked you, nicole, is diabetes reversible?
Speaker 1:what would you say? I would say, based on my own personal health history, prediabetes is certainly reversible and I would venture to say that diabetes can be managed. But I would actually guess no. Once you get diabetes, you're kind of stuck with it.
Speaker 2:I think a lot of people think that. So that's one of the reasons I wanted to touch on that today in this episode too, because in a lot of instances, type 2 diabetes might be reversible. You may be more prone to getting it based on genetics and environmental factors, and if you've ever been diagnosed with diabetes, you may be vulnerable to developing it again. The fact of the matter is, I don't think most people ever do successfully reverse diabetes, so it's pretty uncommon. So I think that's one of the reasons most people may have this perception that diabetes is permanent and something you live with your whole life after diagnosis.
Speaker 2:It's a little bit of a controversial statement to say that diabetes is reversible, actually even in the medical world, especially with prediabetes. Just so that people understand that just because you haven't been diagnosed with diabetes doesn't mean you're out of the woods and safe. There's a lot of different lifestyle factors like diet, sleep, exercise, sedentary lifestyles that might make you predisposed to developing prediabetes, which could ultimately lead to a whole host of health problems down the road, not just high blood sugar. Let's talk a little bit about that. Nicole, can you name some medical problems or conditions that are associated with diabetes?
Speaker 1:I know that Are you talking about like heart disease.
Speaker 2:Yeah, just anything you think of that might be associated with diabetes. First things that come to mind Obesity. Okay, obesity, so being overweight.
Speaker 1:High blood pressure, cardiac issues.
Speaker 2:Okay, yeah.
Speaker 1:Cholesterol issues.
Speaker 2:Okay.
Speaker 1:That's everything I can think of.
Speaker 2:Yeah, you basically listed all the things that doctors refer to as metabolic syndrome, so obesity, heart disease, hypercholesterolemia or hyperlipidemia, meaning high cholesterol and high blood pressure. Some of the other things that you may not think about when dealing with diabetes is amputations become very, very common.
Speaker 1:I wasn't aware of the amputation factor until you entered the field of orthopedics and I learned just how common that was.
Speaker 2:It is very common and I've even read some stats, although they seem a little dubious to me, to be completely honest that around the world, every 20 seconds, somebody loses a limb to diabetes.
Speaker 1:What counts as a limb? I mean, if we're talking a finger, is that a limb?
Speaker 2:Right, and I think that's probably where the numbers get boosted. It's not like they're having their whole leg cut off, but if you're talking about a toe, maybe it really could be approaching up. To. Every 20 seconds, somebody has something removed because of diabetes, so it's very common. You are basically about 10 times more likely to lose a limb if you're diabetic versus not.
Speaker 2:Now, as you've discussed, losing a limb can mean multiple things. It doesn't mean your whole leg has to get cut off. It might just mean you lose a toe. You're also three times more likely to develop an infection of any kind related to any issue if you're diabetic versus not. Think even a scrape on your finger might not heal as well and might get infected if you're diabetic versus not. A couple other things that you might deal with diabetes is kidney disease. A lot of people who are diabetic have poor kidneys, which can lead to a whole host of problems and, unfortunately, to requiring dialysis, where they need a machine to live to clean their blood. The number one cause of blindness in the United States is also related to diabetes.
Speaker 1:Now, does that cause cataracts or is that separate Cataracts?
Speaker 2:can be separate from diabetes, but I believe that you're more prone to developing them if you are diabetic. The reason that we have diabetes-related blindness has to do with damage to the blood vessels to the eyes. My specialty shoulders also has a problem that you see often in diabetics, and that would be the frozen shoulder. Have you ever heard of frozen shoulder?
Speaker 1:I sure have yeah.
Speaker 2:Do you know anyone who's ever had to deal with that?
Speaker 1:I have met someone recently who told me that they dealt with that, and I know someone in my family who also dealt with that.
Speaker 2:Some studies show that up to 30% of people who have diabetes may experience a frozen shoulder at some point in their life, where the thick capsular tissue that surrounds the shoulder becomes thickened and hardened. And I tell my patients it's like shrink wrap it just sucks down on the shoulder joint and it doesn't allow you to move. Sometimes, if left untreated, that condition can last for up to two years.
Speaker 1:Let's just explain it to someone who's never heard of it before, so they're not imagining Arnold Schwarzenegger as Mr Freedies or whatever.
Speaker 2:Just like touching your shoulder Really it just means your shoulder is aching and painful all the time, especially when you sleep, and that you literally can't be moved. If I were to try to take your shoulder and move it, it's stuck.
Speaker 1:Is it stuck in a lifted position or a down position?
Speaker 2:No, it's usually just down at your side. Okay, yeah.
Speaker 1:But also really, Dr Big Guy, I was hoping that you could make an Arnold Schwarzenegger impression. Yeah, I'm sure you were.
Speaker 2:That's for paying guests. Ultimately, once we start the Patreon account, that'll be like a bonus content. Why does this topic matter? Why am I really hoping that people without diabetes and people with diabetes listen to this episode? Diabetes is a global health crisis. It affects pretty much every country in the world, although obviously what we think of as Western countries are affected more, and it's skyrocketing in prevalence. It climbs every single year and it affects every single body part and it can affect every organ system in your body, and it can affect people of all ages, unfortunately, and I think the key to preventing it or treating it is to identify it early and understand what you can do to make it more manageable or reverse it. I'm really hoping that people who don't have diabetes listen to this episode and can get some helpful knowledge that might improve their quality of life and reduce the chances of them getting diabetes, and I'm also hoping that people who have diabetes can listen to this episode and have some real, actionable lifestyle changes that might help them be healthier.
Speaker 1:You know what diabetes reminds me of culturally. What's that the way that a lot of Americans talk about alcohol, they'll make jokes about how much they drink or how completely dependent they are on it, and it's just seeped into society so much. And that is what it reminds me of with diabetes, which're just like oh yeah, everybody's got that, it's not that big a deal.
Speaker 2:People treat it like it's inevitable.
Speaker 1:Yeah.
Speaker 2:Yeah, no, I agree with you and I'm not diabetic, but I sure have a weakness for eating food to excess. I have to admit it's easy for me to eat too much food even though I know I shouldn't be, so it's something I have to be on the watch for all the time. Let's talk about definitions, criteria, that sort of thing. So I'm just going to define diabetes in broad terms and, nicole, you do your thing. You feel free to interrupt me anytime if I need to make it a little less doctor talk.
Speaker 1:With pleasure.
Speaker 2:So diabetes is a chronic condition and it has to do with how your body is able to regulate the concentration of sugar in your blood. We're going to talk about things like insulin, which is the main hormone in your body that helps you reduce blood sugar, and glucose, which is a form of sugar that you find in your blood most commonly when you eat food. You absorb that food, it breaks down into its components and glucose is the main source of energy that your body uses. But it has to get into your bloodstream. It has to get to all the cells in your body to be used by different organs and muscle tissue and all sorts of things. That glucose is needed to help keep your cells up and running. So that hormone that we use is called insulin. That's released by your pancreas, which is another organ that's in your abdomen, and the insulin is what helps take that glucose from your bloodstream and put it into cells. Are you with me so far?
Speaker 1:Yeah, but I want to point a clarification first. So when you eat something, you're talking about literally anything like a bite of celery. You're talking about rice, you're talking about bread, you're talking about donuts.
Speaker 2:Anything that's carbohydrate-rich rice, donuts, bread, sugary things is going to have a higher concentration of glucose type foods. When those foods are broken down into their constituent parts, you're going to have higher glucose than, say, if you eat a stick of celery. So you're going to have much, much less insulin secreted when you eat a stick of celery versus a box of donuts. Okay, but then let's talk about healthy quote, healthy comparison. So if I want to eat an apple, that would release a lot of glucose, of sugar that I'm not going to get into. But there's fructose and dextrose and glucose and sucrose. These all are different types of sugar. But for this discussion let's just say anything that is sugary or carbohydrate, which is made up of polymers of sugar, are going to increase insulin in your body polymers of sugar are going to increase insulin in your body.
Speaker 1:Yeah, I guess you're just coming from a. Well, obviously people know this standpoint, whereas I'm coming from a. I pulled a bunch of people randomly in a Costco to ask them what the primary five ingredients of ice cream was.
Speaker 2:Did you really do that?
Speaker 1:Yes, I really did with my friend Sterling. We had a bet going on and a surprising majority of those people did not even list sugar as a primary ingredient in ice cream. That's why I'm trying to break this down a little bit more, make it clear that there is that the way we think of fruit doesn't mean that fruit's a bad guy, but we just need to recognize how fruit is adapted into our system and taken in. As well as oatmeal, healthy oats, things like that, Oats rice versus donut, those things are all carbohydrates, sugar-based, right, but they react differently in our body. Is that fair to say?
Speaker 2:I think that's fair to say, and I think that's a great point, that maybe when most people think of the word sugar, they literally think table sugar, just like that white grainy stuff when we think sugar where it can come in lots of other forms. I think we should revisit that, but I think it's a great point. But we'll go back to the definition and we can revisit exactly what you're talking about. So I'm sure you've heard of type 1 and type 2 diabetes. Can you give me just a brief difference between the two?
Speaker 1:Type 1 is something you're generally born with or developed very early in life, where your body is not capable of producing its own hormone, insulin that's right. And I think that was like one of our first episodes, kind of proud of myself for remembering that. Are you proud of me?
Speaker 2:I'm proud of you. Oh, thank you Always.
Speaker 1:Thank you, and type 2 diabetes is generally something you develop later in life and it's because you have. Your body has been wrecked by either genetics or combination of genetics and your food choices, or just your food choices.
Speaker 2:That's a pretty good summary and we're not going to talk about type 1 diabetes a whole lot for this episode. But I just wanted to differentiate, since most people are aware there's two types. It used to be child onset and adult onset, but now it's. But now children are getting type 2 diabetes too, so you can't really use that name anymore. So type 1 diabetes is generally autoimmune related or some sort of genetic deficiency where your pancreas cannot create usually no insulin or very little. So you got that right.
Speaker 2:So, no matter what you do, you can't fix that. Typically, where type 2 diabetes, your body's able to produce insulin, but the insulin's not doing what it's supposed to do because you developed a resistance to insulin's effects, meaning your body puts out insulin saying, hey, our blood glucose levels are too high, we need to bring them down. You start secreting lots of insulin from the pancreas but for whatever reason it's a complex host of different chemical pathways and factors that influence this. Your body is not responding and so it requires more and more insulin to get the job done. And that is how you would quickly summarize type 2 diabetes, which is going to be the main topic of discussion today.
Speaker 1:And I also want to point out that you don't necessarily have to be obviously overweight in order to be susceptible to type 2 diabetes. It's like sleep apnea, which we talked about in our sleep episode. You don't necessarily have to be an overweight person to have sleep apnea. There are other factors at play. You might be somebody who doesn't look like you're overweight, but perhaps your body is not very conditioned physically and so you're still susceptible to it.
Speaker 2:Certainly true. I think a lot of people think of diabetics as only being obese, and obesity is often associated with diabetes. But you're absolutely right you can be relatively thin and have diabetes still. So there's a couple of criteria we look at when defining when you're diabetic versus pre-diabetic or what we'd call quote unquote normal blood sugar. So probably the most common test is called the fasting blood glucose test, meaning you don't eat for eight hours, you eat nothing at all and then you draw your blood and see how much glucose you have in your blood. By the American medical standard, if you're under 100 on a fasting blood glucose, that would be considered normal.
Speaker 1:And you can't just like cheat on that test, right? It's not like I can just not eat a donut the day before and then while fasting and then the day after I get my blood results back, go back to eating donuts.
Speaker 2:No, you can't really cheat on it. The only way you could cheat on this test is if you actually inject insulin into your blood to lower your blood glucose. Because even if you don't eat, the whole point of the test is if you haven't eaten for eight to 10 hours, your blood glucose should be pretty normal.
Speaker 2:But if it's remaining elevated, that means something's not working and shouldn't remain elevated for that long a time without eating. So the only way to cheat that test is to literally inject insulin to artificially lower it, which is very dangerous. Do not recommend it. If you inject insulin on your own without supervision, you could kill yourself literally. If you drop your blood sugar too low, you can die. So don't do that. Pre-diabetes would be between 100 and 125, meaning you're starting to show signs that your insulin is not working correctly, but you haven't gone into diabetic range. Now, depending on what medical association you talk with, this number varies, and then diabetes is usually a blood glucose that's over 125.
Speaker 1:Once you are diagnosed with diabetes type 2, don't you have to start measuring your blood glucose multiple times a day?
Speaker 2:Depends on the severity and guidelines have changed a lot even since I was in medical school. The way we treat diabetes and our guidelines and criteria have changed. It can be dependent on who you talk to, whether they're old school or more, on the new measures and new criteria, how they would define it. One of the other common lab tests that we see in diabetes is called the hemoglobin A1c. Have you ever heard of that?
Speaker 1:I have. I think I've had that test run on me multiple times.
Speaker 2:Right and just real quickly. Hemoglobin A1c basically measures if you're having chronically elevated blood glucose levels, looking at different. If you're having chronically elevated blood glucose levels, you're looking at how much of your hemoglobin, which is a protein in your blood is glycated, meaning literally the sugar is starting to stick to it because you're having sugar in your blood for so long. And if you have chronically elevated blood glucose, that number starts to go up. So it's really a percentage. Normal would be anything under 5.7%. Pre-diabetes is 5.7 to 6.4 and above 6.5 would be diabetic.
Speaker 2:And this is probably the number one test that we look at diabetes with to see how well your blood sugar is controlled. Generally we're shooting for below a seven in people who are diabetic and I look at this number a lot in my practice because, as we talked about before, infection risks go way, way up when you're diabetic. So if you're talking to an orthopedic surgeon and wanting your knee or hip or shoulder replaced and you have a high hemoglobin A1c, we're really concerned that you'll have an infection with surgery. So we sometimes will not operate if you have a hemoglobin A1c above 8%, which is my cut off, because the risks of surgery are so significant that you're going to be worse off after surgery than before if you get an infection.
Speaker 1:I bet that's really frustrating to those patients and maybe they feel a little singled out.
Speaker 2:It sure is, and I feel for them. I really do, and it's really a horrible situation to be put in because they're suffering and they're hurting and they want care. But you, as the surgeon, know that if they get an infection they're going to be a hundred times worse off than they are even now sitting in your office asking for a joint replacement.
Speaker 1:Yeah, it seems like a really, really thin line between making decisions to help a person and knowing that if you make this decision to operate on them, that will inevitably end up hurting them more and I have to tell them no, I know that this is going to make you worse and you shouldn't have this surgery.
Speaker 2:And the other troublesome part is that there's a good chance they'll go to another surgeon who will operate on them. So I have to do my very best to try to educate people on why I'm saying no to them, and not just to be dogmatic and say nope, not doing it. Just try to help them understand why I'm making that decision.
Speaker 1:I remember meeting a guy in my CrossFit gym years ago who had an issue getting his life insurance policy renewed because he was very overweight and so until his blood levels and things dropped, his life insurance said we're not going to renew your policy, You're going to have to check back in with us for another three to six months. And that guy started training so hard. He was really going for it because he knew how important it was for him and his family that he had good life insurance coverage. I thought that was interesting because I didn't realize that they would preclude people with type 2 diabetes from getting what they need.
Speaker 2:I would wager, I guess, that they would probably cut you off at a certain A1C level, because the risks of heart attack go significantly up, as does your A1C level. Most places will give you medical insurance, no matter what it's, just the premium goes up as your diseases go up.
Speaker 1:Gotcha.
Speaker 2:Okay, let's take a quick break from diabetes for everybody's favorite segment of the show, and that's Fractured Facts. Nicole, as always, I'm going to do my very best to stump you, but I usually fail. Do you know what the longest nerve in the body is?
Speaker 1:I have no idea. I'm going to guess it stretches along the back.
Speaker 2:Not a bad guess, like the polyvagal nerve.
Speaker 1:I couldn't even name all the nerves, but that one I know is pretty important.
Speaker 2:Can you name some nerves? The ulnar nerve yeah, that's a good one. The is pretty important.
Speaker 1:Can you name some nerves, the?
Speaker 2:ulnar nerve. Yeah, that's a good one.
Speaker 1:The medial nerve. Median nerve, median nerve.
Speaker 2:Now, you got it. I don't know what the polyvagal nerve is, but I do know the vagus nerve. That's a pretty long one.
Speaker 1:Maybe it's the polyvagal theory, and I'm like mashing those together.
Speaker 2:Is that a psych term? Yeah, yeah, yeah, Okay. Is that like a vasovagal response to trauma? Sure, Okay. Well, we're getting off topic a little bit. The longest nerve in the human body is the sciatic nerve. Have you ever heard of that nerve?
Speaker 1:I've heard of that nerve because I've heard many friends of mine have struggled with that nerve, with their back pain.
Speaker 2:Yeah, that's probably where most people have heard the term sciatic nerve is when people refer to sciatica, meaning sciatic nerve related pain. If you want to get really technical, the sciatic nerve starts as one nerve and then splits off into two nerves, and then one of those nerves splits off again. You might argue that it's not one nerve. For the sake of trivia, I'm going to go sciatic nerve if we count the whole thing, being a nerve without the branches, so it starts off in your low back and then it goes down the back of your leg and then, when people talk about one leg well, you have two sciatic nerves, so you have one in each leg.
Speaker 2:So that branches off from either side of your lumbar spine and becomes a sciatic nerve. So you have two of them. So, basically, it starts off from your spine and goes all the way to your toes. It makes it the longest and actually the thickest nerve in the human body too. It's actually almost as thick as a human thumb at certain parts.
Speaker 1:That's a pretty fat nerve.
Speaker 2:Probably where most people hear about the sciatic nerve is when that nerve gets compressed and causes that radiating pain down the back of the leg that most people refer to as sciatica.
Speaker 1:Yeah, I've heard that can be pretty debilitating.
Speaker 2:People can find it very, very painful and causes a lot of inability to walk, work or do any kind of lifting. Just like pretty much any peripheral nerve, it's made up of a number of nerve roots that come off the spine. In this case the nerves are L4, l5, s1, and S2. Those are little nerve roots that come off of the spine. They're numbered, related to which vertebral level they come from.
Speaker 1:Okay, give us a good general. Is this? You're talking mid-back, low-back.
Speaker 2:We're talking pretty much the lowest part of the back as it meets your pelvis. When the sciatic nerve splits into two, it's called the tibial nerve and common perineal nerve and some people call that the fibular nerve, but us old school people call it the perineal nerve, not to be confused with the perineum, which is a different part of the anatomy.
Speaker 1:Yeah, yeah, that just gets confusing.
Speaker 2:Maybe that's why people started calling it the fibular nerve instead. I think I've actually had med students get perineal and perineum confused.
Speaker 1:Yeah, I mean, they're med students for one. So what do they really know? No, just kidding.
Speaker 2:Probably a lot more than you do.
Speaker 1:Yeah, probably.
Speaker 2:One of the things that often can cause static nerve irritation is called piriformis syndrome. The piriformis is a small muscle around your hip and it's deep to your gluteus muscle, which there are a few of, which makes up your buttocks, so gluteus maximus. Gluteus maximus, gluteus medius and gluteus minimus are the three glute muscles, but most people just think of the glute max.
Speaker 1:I think my older brother used to call me gluteus maximus as a joke.
Speaker 2:It sounds like a good gladiator name, right it?
Speaker 1:does. Yeah, let's pitch that idea.
Speaker 2:You can often see athletes having compression injuries of the sciatic nerve from either repetitive motion or poor positioning and poor posture in certain conditions. A lot of times cyclists get it from compression and you often see runners getting chronic irritation of their piriformis as well. That can cause inflammation and compression of the sciatic nerve, causing that radiating pain.
Speaker 1:I've also heard about it in people who I don't particularly think are very athletic. So how is a person who doesn't do a lot of high intensity sports like that? How would they get it?
Speaker 2:More often than not it's not from piriformis syndrome. It's more often going to be from compression directly at the nerve roots coming out of the spine, and that can be from a herniated disc. Think of a disc as like a little cushioning between the vertebral bones of the spine and they push into the spine and pinch the nerves. So that's something called radiculopathy, meaning a nerve root's being pinched and that's causing the radiating pain.
Speaker 1:That sounds like a Harry Potter thing.
Speaker 2:Like Spelliarmus or something.
Speaker 1:Ridiculous.
Speaker 2:Yeah, this came before Harry Potter. I guess it's all Latin in its roots, though, so it's probably what Rowling modeled her spell names after. Probably the most common thing that I see is spine-related. In my clinic I'm seeing people who have either herniated disc or what we call degenerative disc disease, where they may have some bone spurs pushing on the nerve roots as they come out. So that's by far the most common time I see it. I bet a lot of physical therapists or athletic trainers will see more of the piriformis syndrome.
Speaker 1:I follow a fair amount of physical therapists on Instagram and see their reels on how you can help fix your piriformis syndrome, and so, of course, they're often selling or promoting certain tools as well that will dig into the front part of your hip to release it. I do have a question about herniated discs, though, like how does that happen to the average person?
Speaker 2:That's a great question. There's acute trauma. Someone bends over and picks something up really heavy and that causes the disc to spurt out almost like a jelly donut. I know it's kind of evocative imagery, but it pushes the disc out and pushing on the nerves. So you can have that. Other people that just happens. You could sneeze or cough too hard and cause that pressure. Ultimately, I think you're more susceptible to have it if you have a weak core and weak back muscles and generally aren't that conditioned, but it can happen to professional athletes too. Physical therapy is still going to be the number one thing that you should try to treat this, whether it's piriformis syndrome, a herniated disc or even degenerative disc disease with bone spurs in your back. I would certainly encourage people to attempt non-surgical interventions and only save that for a last resort.
Speaker 1:Really, when it comes to back surgeries right, because those are incredibly invasive and they don't necessarily have the best outcomes. It depends.
Speaker 2:I find that with people who have one herniated disc at a single level of the spine actually can do very well with what we call a discectomy, where the disc is either fully or partially removed. I don't do that surgery myself, but when it's something like that I see people do fairly well. If we're talking about more invasive decompressions and fusions, then you're starting to look at people who have more bad outcomes. I don't want to speak out of turn, because everyone is unique in their own situation and there are people who can really benefit from surgery, but in most instances I do try to treat my patients without surgery, especially in this setting I to treat my patients without surgery.
Speaker 1:Especially in this setting, I feel like, as a lay person, surgery is always seen as the oh okay, this is something I'm going to need someday, Whereas you really turned my mind around thinking about it as surgery should be a last resort. It is not something that you want to have done because there are complications.
Speaker 2:I'm around surgeries all the time constantly and we all do our very best to make everything perfect. And even when surgery goes perfectly from your standpoint, you leave the operating room and say that was a textbook case of perfect surgery People still have complications. And even if the patient's responsible and healthy and doing everything right, people still have complications. It's just a fact of nature that there is a percentage of people who are going to have a bad outcome, even if everything is done perfectly. So I don't think surgery is something that should be taken lightly.
Speaker 2:In orthopedics, a lot of times the stuff we're dealing with is not life-threatening, so a lot of our surgery is quote-unquote, elective. Although we're talking about debilitating problems that we're addressing, we have the luxury of trying to treat people without surgery at the get-go, although it's sometimes that people do require surgery, where, when you're talking about someone who falls and breaks their hip or shatters a bone and it becomes an open fracture where the bone is exposed, our hand becomes forced those situations where you have to have surgery. There's really not an option. But we are fortunate that a lot of the conditions we deal with are not emergencies, where general surgery or vascular surgeons or neurosurgeons are often forced to operate because it's a life-threatening condition. The only other thing I wanted to mention about the sciatic nerve was the term foot drop. Have you ever heard of this? No, so foot drop refers to when you cannot bring your toes and ankle up. Your foot just droops down.
Speaker 1:I'm testing it out right now.
Speaker 2:Do you have foot drop?
Speaker 1:No, I'm good Okay.
Speaker 2:A branch of the nerve is compressed, and the nerve can become compressed or damaged, either by trauma. Sometimes it's man-caused in surgery, what we call an iatrogenic injury. That can cause you to not bring up your toes and ankle, which may seem unimportant. But imagine trying to walk and your foot is drooping. You have to lift your leg way higher to be able to walk and then that foot just slaps down as you bring it down. You have no control of it.
Speaker 2:So you sit on a toilet for too long and you get up and then your foot's completely numb and you can't feel it. Yeah, that's your sciatic nerve being compressed, because that's the sciatic nerve. I'm really glad you brought that up, because that never happens to me. Some of us don't sit on our phone on the toilet all day. Tell us more.
Speaker 1:There's such judgment in your eyes when you're a young person and you're trying to get away from chores or other responsibilities and the only sacred place in your home is the bathroom. Sometimes you just end up sitting there for a long time.
Speaker 2:Yeah, are you a toilet texter?
Speaker 1:I'm not going to confirm or deny if I'm a toilet texter, but let's just say that there were many books that were read while on the toilet and, seen as I get sucked into things, I might have spent too much time there while on the toilet and seeing as I get sucked into things, I might have spent too much time there.
Speaker 2:So are you telling me that there's more than one occasion where you've stood up from the toilet and your leg has?
Speaker 1:gone to sleep? Oh for sure. Yeah, see, I think that there's a percentage of people in this world. They're either toilet people or not toilet people, so there's people who just do their business and immediately get up and then there's people like me who just sit on the toilet and that's their throne.
Speaker 2:Well, I don't know about you, but I'd like to not be labeled as a toilet person. I'm not going to embrace that label. But no, I can't say that I've been on the toilet for so long that my leg's gone to sleep. But that is actually the static nerve being compressed. So that's a perfect real world example. Now, obviously, a short-term compression you recover very quickly. But imagine long-term compression can actually cause permanent damage. And if you have permanent damage to the nerve, you may be unable to lift that foot up at all and the way you walk is severely altered. And eventually, if your foot stays drooped like that, it becomes stuck. You develop a contracture where you can't bring that toe up.
Speaker 1:Sort of like frozen toe.
Speaker 2:Yes, but it's a little bit different than frozen shoulder.
Speaker 2:It's not exactly the same thing. This is more like the muscle becomes atrophied and the other muscle overpowers and then it just becomes stuck. And if the nerve doesn't recover with whatever various surgeries or therapies, we sometimes have to do something called a tendon transfer, where we go and reroute your tendons so that you can use different muscles to bring your toe and ankle up. I think we're at a huge advantage of all the different medical interventions that we have that can treat these problems now. The way I see it, if you had a serious injury to a nerve or a bone back in the day, you had no hope of recovering because you couldn't get up and feed yourself or defend yourself. So it's really miraculous what we can do now to restore function to people. Even if that nerve doesn't work. We're able to reroute your muscles and tendons so that you have a functional limb. I think that's absolutely incredible.
Speaker 1:It is yeah.
Speaker 2:So do you know what else makes you susceptible to nerve injury?
Speaker 1:Outside of toilets.
Speaker 2:Outside of toilets. What I'm looking for is diabetes. Let's go ahead and get back to our talk on diabetes. Let's talk about some of the stats over the last 20 years for diabetes, because this really was quite shocking to me.
Speaker 1:This is going to be sad.
Speaker 2:It's going to be a little sad, but this is something that, even though I knew diabetes was such a problem and that it's always growing, the numbers are pretty staggering. So if you look back at 1980, you're looking at 108 million people worldwide with a diabetes diagnosis, where in 2021 we hit 537 million. We're projected to reach 643 million by 2030.
Speaker 1:So basically, wall-e is going to come true.
Speaker 2:The movie WALL-E. I've actually never watched that, but it does seem that way, doesn't it?
Speaker 1:I know what we're doing this weekend.
Speaker 2:It was estimated in 2021 that diabetes-related health care costs were nearly $1 trillion worldwide, and that's a 316% increase over a 15-year period in cost.
Speaker 1:So I know the big question on everybody's mind is why? Why is this happening? I know there are a lot of people with a lot of varied opinions and some of them may seem like conspiracy theories, so I don't really want to get into anything that's going to cause a lot of distress, but I would wager to think that our food choices are definitely among the top things that we are doing. I think food is probably 80% of the battle, but I know other people are saying it's not just what we decide to consume, it's also how the food is grown and prepared, and that could be causing a lot of issues as well, and that is not as much in our control.
Speaker 2:We're going to talk about some of the things that promote diabetes and things that can prevent diabetes. In this episode, people really get into this whole. Gmo foods are to blame, or for whatever reason. The wheat in the United States is inferior to the wheat in Italy and the wheat in Italy doesn't make you fat or diabetic, but the wheat here does.
Speaker 1:I mean, we've been to Italy, though they were not necessarily slim people.
Speaker 2:And I gained eight pounds when I was in Italy for a week.
Speaker 2:Because it was delicious, so it made me fat. So I don't know if I buy into that. I can't dismiss it, I can't affirm it, so I'm not going to get into that too much, because I can't go in either direction. So back to the stats. This is for the United States, not worldwide. In 2000, 5.5% of the population was diagnosed with diabetes. In 2020, it's around 13%. And then it's estimated that up to 38% of adults have prediabetes. That's pretty staggering 38% of adults in the United States have prediabetes.
Speaker 1:I kind of want to compare that to our earlier podcast on mental health. It seems like the numbers for things like depression and anxiety have skyrocketed, and still has diabetes. So I mean, is that? What is it that you always say? Correlation doesn't equal causation.
Speaker 2:Sure, I think. Just in general, we're all becoming unhealthier. The question is does one cause the other or are all of these things caused by something else? I think it's probably the latter. I think there's something causing all of these things to go up together. I think diabetes can definitely cause depression. I think you can be anxious about your diabetes, but I don't know that diabetes itself causes anxiety and depression. I think there's something else going on. The annual cost of diabetes in the US is increased from $132 billion in 2002 to $327 billion in 2017, and the numbers are just going up. So those are just the most recent numbers I had. I imagine it's significantly higher in 2024.
Speaker 1:That's kind of interesting, but just the idea that, as a physician in a private practice, you get a certain amount of reimbursements for stuff like Medicare, right, and the government has to provide health care for patients who are on Medicare and the majority of those patients, as it sounds like from our stats they are diabetic or they're prone to all of these metabolic syndromes. And so what the government seems to be doing is saying, okay, you have to treat them, we know you have to treat them, but we're not going to reimburse you very much for it, and the insurance companies are not reimbursing you as much for it, and so I feel like the only way that this is going to ever get resolved for physicians and their practices is that they stop treating patients with these kinds of diseases, or if the health insurance agencies are going to stop covering people. Doctors literally cannot survive anymore by treating patients with diseases that are, in a lot of ways, preventable, and patients cannot survive anymore with pain out of pocket.
Speaker 2:You're describing probably one of the biggest dilemmas to face the American medical structure You're talking about. The chronic diseases are going up. People are living longer despite that, so we're having a large increase in the number of aging population than we ever have. So from my perspective, more and more people are needing joint replacements, but they're sicker and sicker.
Speaker 1:Right and then they get the infections if you do the joint replacement.
Speaker 2:Correct. There's more and more people that are getting their medical care from Medicare, which theoretically has a limited amount of money to pay for things. So the cost of care is getting more and people are getting sicker and sicker. So the question is where does it all end? Who's left holding the bag when the music stops? I don't have an answer. I don't think anyone does and I have no intention of getting political on this podcast. But you're asking the trillion dollar question is what do we do about that? And no one has an answer.
Speaker 1:Yeah, it's a little overwhelming for me to think about, and so the only way that I can think about it is OK, I got to do my personal due diligence to attempt to get my health in order so that I'm not one of those 38 percent of people who needs that massive medical care, not when it's preventable. Anybody could get into a car accident or something and need life-saving care. It's not their fault necessarily, and I'm not saying that diabetes is the fault of everyone who has it. But there are things that we can do that would help us from crashing our own health care system.
Speaker 2:I think you've crushed it. That's perfect. That's exactly how I would have chosen to segue, and you beat me to it.
Speaker 1:Oh, me not always doing that.
Speaker 2:Yeah, you're always doing that. No, it's great. You have to think to yourself. It's ownership, self-ownership. I would choose to tell you, whether you're a Republican or a Democrat or a Libertarian or whatever. You got to take this into your own hands. You got to take it seriously because eventually, the house of cards is going to fall and the medical system might not be there to save you or help you, and you have to take care of this yourself.
Speaker 1:It's sort of like don't rely on FEMA to come in. If you are capable of having several gallons of water stored in your house in an emergency, fema can't get to you for three days before you die of dehydration. Hopefully you've got that three gallons of water per person per day.
Speaker 2:There's a lot of the sort of things on the rise like with Peter Atiyah's podcast or Andrew Huberman's podcast to people who are like trying to listen to these health experts who are giving them a lot of details and data and information to try to change their lives for the better, and so that's encouraging to me somewhat that people are taking it seriously. I'm hoping that the wellness blueprint is another piece of that puzzle that may be helping people to change their lives so that they can not have to be in these horrible situations.
Speaker 1:Let me just say something else, caleb, because I don't want anyone to think I'm coming from a place of judgment, because I personally have dealt with prediabetes several times. In fact, I have been overweight several times in my life and several years ago my doctor had a very frank discussion with me and said hey, you got to turn this around because you're pre-diabetic. This is getting dangerous for you, and I was mid-20s at the time, and so I did. I cleaned up my diet and I started joining CrossFit and all of my levels got fantastic. I dropped a bunch of weight, was eating pretty healthy, did great. And then life happened, covid happened. We moved literally three times for your job. It's my fault.
Speaker 2:Yeah, it's definitely your fault, yeah.
Speaker 1:Yeah, and my numbers started climbing again, and so it was again this year, a different doctor, because I'm now in a different state. My doctor came in and started a bristle in that way and I was like, listen, doc, I know I'm overweight, I'm working on it. I hired a coach. I hired a coach Trey Turner from Turtle Muscle and I said, hey, man, I need you to help me because I do better if I have that kind of outside discipline, outside force helping me lose weight. I've learned in my life that I can't have my husband be the person to tell me hey, you shouldn't eat that.
Speaker 2:Call me crazy, but yeah, conflict of interest, I guess yeah.
Speaker 1:Yeah, yeah. It brings out too much of my teen girl insecurity. I want you to look at me and go whoa, not look at me and be like why are you eating that pizza?
Speaker 2:In my experience at least, can't be your husband or wife who tells you to clean up your diet and is the one policing things. But the point is that Nicole's actually been able to see in her life that lifestyle modification changes do reverse pre-diabetes.
Speaker 1:They do and they're not easy. It's not easy but it gets easier when you work on it. Especially if you have a community of people who are in it with you, who are helping you, it gets easier. So please know I'm not coming from a place of judgment. I want to be your cheerleader and I want to encourage you and I want to say, hey, if I can do it, you can do it too, Because my very favorite thing is to sit on a couch and snuggle my cats and eat popcorn and watch TV. It's a real force of discipline for me to meal prep and or go to hot yoga three or four times a week and get my strength training workouts in.
Speaker 2:But the important thing is you've taken ownership of it. By the way, I'm pretty sure one of your cats is diabetic too. I think snuggling on the couch may not be good for him either. Just FYI that he's not actually diabetic, he's just a real chonk.
Speaker 1:Yeah, he's on a diet. We're working on it.
Speaker 2:So let's talk about some of the risk factors for diabetes. I think we really touched on most of it. Being obese is a high risk factor for diabetes. Being physically inactive is another one. Excessive eating I know this may sound like a no-brainer, but really eating more calories than you need, than what your body's expending, is a big risk factor.
Speaker 1:Yes, I would also say. It creeps up on you, though, because you go to a restaurant, you don't know how many calories are on that plate. Is you go to a restaurant, you don't know how many calories are on that plate the average American restaurant the calories are super overwhelming because they're adding in so much oil. They're adding in a lot of excess carbs. You're drinking a soda, maybe, or a lemonade, and so it's a lot of calories, but we don't know that when we're eating it. That, to us, is just a normal meal.
Speaker 2:You're getting into what has caused diabetes, in my opinion.
Speaker 1:Yeah, what's that?
Speaker 2:The North American culture, or at least whatever system you want to call it, how we eat our food, how we prepare our food has created a hyper-dense food, hyper-caloric foods. If you look at the nutrition facts that are on a meal, now you can go to a restaurant and have a meal that has 1,500 calories.
Speaker 1:That's supposed to be your caloric intake for the entire day.
Speaker 2:Well, me personally. I eat closer to 3000 calories, but that's pretty high.
Speaker 2:Okay, Dr Big guy, so that would be half my calories in one meal. Let's just stick to the United States. So the American food culture has created these. Hyper palatable meaning they're super tasty. Hyper dense meaning you're getting way more calories than you think and you're getting them all at once, and then you're doing that three, four times a day, so you're getting way more calories than you need in a sitting. They're super, super palatable, so they taste fantastic and it's always making you crave more. That, I think, is the key to why we're overweight and have diabetes.
Speaker 1:I did not understand how much I was overeating until I got on my meal plan with my coach and I was like man if I were just left to my own devices, I would have eaten five handfuls of nuts without even thinking about it.
Speaker 2:What's one of the things I always told you about diet and how do you first start? When you want to change your diet, what's the first thing you do? Food journal.
Speaker 1:Yeah, that's what I tell everybody.
Speaker 2:If you say okay, I don't know where to start Food journal. You write down every single thing you eat for a week, and I'm talking even a little snack, even if it's a peanut butter and crackers at the hospital, which is common for us doctors and other medical workers. You write it down and you write down the calories and you will be shocked at how much you ate and how many calories you consumed, because it's really easy to get away from you because you just don't think about it and it adds up real quick. Even as much as like having a coffee and you put a bunch of milk or creamer in it. All of these things eating a salad but you have ranch dressing on it. It all adds up so quick. I don't think it's a bad idea for people to get A1C screening and fasting blood glucose screening, probably once a year, just to keep an eye on it. Personally, I think a lot of people do, actually if they have a primary care doctor and that's a big if.
Speaker 1:Oh really, I know it's been harder to find primary care doctors, at least like where I've lived in the last couple years.
Speaker 2:Well, it's really just a lot of young people just don't go.
Speaker 1:Who can find the time right between the crazy, hectic schedules of work and juggling children and their respective schedules? But guys like, if we don't take this seriously, not only are we all going to end up in an early grave or in an early position where we are not capable of taking care of ourselves, but we're going to pass it along to future generations of our children too.
Speaker 2:And, on that note, here's some reasons why you should take it seriously and should get screened and should take preventative steps. Here's some things that you can look forward to if you develop diabetes High risk of heart attack, which is probably the number one killer of people with diabetes, heart attack. High risk of stroke. High blood pressure. Peripheral artery disease, meaning you don't get good blood flow to your hands and feet, which could lead to amputation. Kidney disease, which could lead to needing dialysis. Eye disease, which could lead to blindness. Peripheral neuropathy or autonomic neuropathy. Peripheral meaning the sensory nerves on your feet and hands and outside of your body. Autonomic meaning gastric emptying problems, where your stomach doesn't empty anymore, your bowels don't move correctly, sometimes even erectile dysfunction. The list goes on and on. Frequent infections, liver disease, mental health disorders and, believe it or not, increased risks of cancer with chronically elevated blood sugar.
Speaker 1:So the one thing that you said on that list that sounds scariest to, I would say, the average person in our age range would probably be erectile dysfunction.
Speaker 2:Believe it or not. Sometimes that's one of the biggest things that gets men to come in and really have their quote-unquote turn to Jesus moment is they can't function sexually anymore. So they're like, okay, I got to turn this around.
Speaker 1:I would say that that long list is nothing that I, as a lay person, hadn't heard before. But because I'm relatively young and I haven't had any of these things affect me yet, I'm not quite as concerned about it. I think, oh, that's a long way off this cancer, and I just don't have time to deal with this. But maybe you can describe for us a composite of different patients that you've seen or you've had over your years as a doctor, and what is life like for them actually when they deal with a severe case of type 2 diabetes? What is their daily functioning like? What's their pain level like? How often are they having to go to the doctor? What kind of time does it take for dialysis to be necessary if your kidneys aren't functioning, et cetera, et cetera.
Speaker 2:I'm going to use some extreme cases, so I just want to make that clear. There's plenty of people who are living with diabetes, who manage their diabetes with medication and or lifestyle modifications. So let's not be too alarmist. But I am trying to make this call for action. So we're going to go for extreme examples here. I've had a lot of patients who've had chronic ulcers on their toes because they can't feel anything, so they don't know the ulcers are developing.
Speaker 2:So an ulcer is what Just think the skin's broken down and it's oozing. Let's just say that for simplicity. There's no skin coverage on their toe and so there's an open wound.
Speaker 1:Okay.
Speaker 2:They can't feel it, so they don't even know it's developing. So they can't change the position of their toes or their shoes so that they don't develop it. Their blood flow is poor so it can't heal. Then it becomes infected. They will often have to go to a doctor up to twice a week to have the wounds cleaned and inspected, and then they might start to end up having their toes cut off and then eventually ankle up to the knee, sometimes even up to the hip, have their leg amputated because the infection can't be controlled. And then you might have people who have to have a professional cut their toenails because they can't do it themselves, because they can't feel, and they're at a high risk for cutting themselves and then getting an infection. If you're on dialysis, you're talking about maybe going to a center where your blood is filtered up to three times a week and if you don't, you die.
Speaker 1:But how long does that take, the blood filtering process?
Speaker 2:I think it's a few hours.
Speaker 1:Okay, in a clinic, several hours a week, while your blood is being taken out of your body, processed through this machine and then reentered back into your body as like clean, purified.
Speaker 2:Essentially yeah.
Speaker 1:That's a lot of time.
Speaker 2:Oh yeah.
Speaker 1:Like how do you even work when you deal with something like that?
Speaker 2:I mean, if you're on dialysis, it's the next to impossible, unless you work from home.
Speaker 1:Is that generally people who are above retirement age, or are you seeing this in people?
Speaker 2:Well, now I'm seeing it more in younger people. I mean, it used to be unheard of unless you had some sort of genetic kidney disease or some injury to your kidney or viral or cancer to be on dialysis at a young age. But there's obviously exceptions. There's going to be people who tell me like, oh, I know someone who's young on dialysis, but I'm actually seeing people who have kidney disease now from diabetes in the age of 30. And the fact of the matter is they're probably not going to live past the age of 40 when they're in that stage.
Speaker 1:Yeah, that's scary.
Speaker 2:But this podcast is about taking charge and making your life better, not scaring the living daylights out of you.
Speaker 1:Well, sure, but I just you know, you list a long litany of things that can go wrong, but that doesn't really translate into anything to people like me, because I don't know what it looks like to live with chronic kidney disease. You do.
Speaker 2:You see it every day. I see the horrors of diabetes every single day, and so it's easy for me to visualize and think, wow, I don't want that to happen to me.
Speaker 1:So that's why I'm trying to paint a picture here.
Speaker 2:Yeah, you paint a very beautiful, dark, horrible picture. Thanks babe, let's talk about some lifestyle modifications. All right, I think everyone knows weight loss. That's a big one. The question is, how do you do it? I think the best way to lose weight is actually to modify your diet. It's not exercise, although obviously I recommend that you exercise to augment your weight loss but watching your diet and monitoring how many calories you eat is by far the best way to produce weight.
Speaker 1:My coach told me that diet is 80% of what it is. It'll help me achieve my goals.
Speaker 2:Absolutely, there's no question. Now there's lots of tools out there to find out what your caloric needs are. You can try to calculate what we call your basal metabolic rate, meaning the amount of calories your body needs just to survive without doing exercise or really any activity, and there's calculators on. You can do your best to calculate this. I'm not going to be able to tell you how to magically do it, but you can get an idea what your caloric requirements are and then try to shoot for below that.
Speaker 2:Increasing muscle mass actually increases insulin sensitivity. Insulin sensitivity is something that we want. We want your body to respond to insulin, so doing some weight training and strength training is actually beneficial for diabetes, in addition to cardiovascular exercise that you might think of as classic exercising for weight loss. People have had success losing weight and going into remission on their diabetes with all sorts of diets. A lot of people take the low-carb approach because it's easier to manage your blood sugar, so I would encourage that, but people can. Even as long as you're eating your carbohydrates in a reasonable way, you can do it on any sort of low-calorie diet.
Speaker 1:I would also say that a lot of health insurance plans these days provide you with free access to a dietician or a nutritionist or, like a nurse, I've had nurses call me out of the blue and say hey, I'm here to help you on your health journey. I come as part of the package of your health insurance Because, guess what? These health insurance companies are invested. They want to make sure that you actually have the tools you need to get healthier, so they don't got to pay for you.
Speaker 2:Yeah, because they're paying billions and dollars of diabetes-related health care now.
Speaker 1:I know I'm in a privileged position where I was able to hire a personal coach, but if you don't have that opportunity, know that there are opportunities where you can find dietitians and nutritionists who don't cost you anything and they're going to be able to help you, as well as the myriad resources for free on the internet.
Speaker 2:Like us, but we're just one piece of the puzzle you have to take ownership and figure it out with the tools that you're provided, or you have to go find those tools, but, like Nicole said, a lot of them are free. You just have to know where to look and have the wherewithal to do it. So we've talked about lifestyle modification. If you go back on our sleep episode and inflammation episode, you can see a lot more of this sort of thing. But healthy sleep, healthy diet, regular exercise are all really important things. One that I really like to do is something I call the postprandial walk. Nicole, do you know about this?
Speaker 1:Oh, I know You've told me. No one normal knows what that means.
Speaker 2:Right, of course, I didn't invent this term. Postprandial just means after eating. A lot of studies have shown that if you actually get up and walk for 15 minutes after a meal, you significantly reduce your blood glucose concentrations and increase insulin sensitivity, and so this is something that I would highly encourage people to do is, after every meal, get up and walk.
Speaker 1:That's going to be harder to do in the winter.
Speaker 2:Yeah, it is. But even if you're in an office building, you get up and walk up and down the stairs of your office building or around the floor. It doesn't have to be outside. Just getting some walking around is beneficial and can be really helpful, especially if you're diabetic.
Speaker 1:And it's free.
Speaker 2:So we have to talk about one thing, since it's the biggest buzz about diabetes. What is it?
Speaker 1:Ozempic, ozempic, aha.
Speaker 2:There's a lot of varied opinions Now. The generic name is semaglutide, but ozempic is probably what people are most familiar with. There's a lot of opinions about this. It's weird. There's people who love Ozempic. There's people who hate Ozempic. There's this weird. Oh, it's a cheat. If you take Ozempic, you're not really doing the work, which is bizarre to me. If you're using it to augment your healthy crusade to get better and treat your diabetes, it should be treated like any other medication. It's good for you if it can help you treat uncontrolled diabetes. Now, if you look at it as a way around having to do everything else, like exercise and diet, then I think that's probably unhealthy for you to look at. But like any medicine, it's a tool and it has multiple effects. Nicole, what do you know about Ozambic?
Speaker 1:I know that it's been popularized by middle-aged and younger women who are struggling to lose weight and they're not necessarily trying or not having a lot of success, let's just say, with their dietary and fitness regimes. And so they've turned to Ozempic, which a lot of people said you don't actually need it because you're not diabetic, and so now that's driving up the cost for people who are diabetic.
Speaker 2:Yeah, you see all these sensational headlines about Ozempic, about Hollywood stars taking Ozempic to lose that 10 pounds, and I don't particularly think that's a good thing. I don't think it's good to take medicines just for recreational purposes when you don't have an actual health problem. But we're talking about, in a pragmatic sense of someone who struggled with diabetes for years and has had poor outcomes, that I think it's a great tool. So that's all I'll say on that matter.
Speaker 2:But it helps suppress glucagon secretion, which is a hormone that actually increases your blood glucose. It helps stimulate your body to increase insulin secretion, but only in the setting of glucose, meaning it's not just secreting insulin all the time, which can lead to hypoglycemia, which in the past there's been some problems with diabetes treatments that drop your blood sugar dangerously low. So that's the advantage here. And there's a some problems with diabetes treatments that drop your blood sugar dangerously low. So that's the advantage here. And there's a couple other effects it delays gastric emptying, meaning your stomach stays full longer, and it gives you that feeling of satiety, meaning you're not hungry all the time. So it actually makes you eat less and eat less frequently, and it also acts on the brain, which just makes you feel more full.
Speaker 1:You know, what also has personally helped me with satiety is drinking a whole lot of water, just drinking tons and tons of water. My goal is to always drink a gallon a day.
Speaker 2:That's a lot of water. Yeah, I would wager to guess most people don't get that much but you're absolutely right.
Speaker 2:If you're feeling that hungry feeling and you fill your stomach with water a lot of times, it'll go away. A lot of times we're dehydrated. We don't even realize it. That's very common. So I don't want people to think that Ozempic is the answer for everything and it's the miracle drug. I think it's something you should certainly discuss with your primary care doctor or someone who's managing your diabetes and see if it'd be a good option for you.
Speaker 2:In my own personal philosophy, I try not to take any medication unless lifestyle modification has failed. So take that how you will, but if you're not having any results or success with lifestyle modification, it may be an option for you. If you're diabetic, I don't recommend taking it if you're not diabetic. Let's talk just briefly on diet.
Speaker 2:I think some of the pitfalls are things that we see where you have processed food that are filled with fats and processed sugar that wouldn't normally be in natural foods in such high concentrations. So we talked about that hyper palatable food that's densely packed with calories that wouldn't really be found in nature, and that's probably one of the biggest shortfalls. In terms of physical and activity, a sedentary lifestyle reduces insulin sensitivity, which can cause your blood sugar to spike. That's a whole host of reasons where our hobbies are more involving playing video games and watching TV instead of going out and playing outside, and also our jobs in general are more sedentary than they used to be. Chronic stress we talked about that in some of our previous episodes can also raise blood sugar and increase your risk of diabetes as well, and sleep deprivation, another topic that we've have talked quite a bit about can also increase your insulin resistance, and it also is promoting in weight gain and worsening your diabetes.
Speaker 1:It makes it sound like we're really not very fun people, because we're like, yeah, you should sleep and you should make sure that you eat well and drink enough water and do all this stuff and we're like fun killers.
Speaker 2:I've been accused of that many times and I don't deny it at all.
Speaker 1:On paper it's like oh, he's a doctor, he's a surgeon, he likes to travel, but if you meet me in person, I'm really quite dull. You're not dull. But here's the thing though Somehow in our society, things have gotten really warped in that if you are advocating for a healthy lifestyle, your scene is really boring.
Speaker 1:The choices on the weekends to stay up until 3 am and drink until you're blackout drunk or whatever that's seen as the cool, fun thing to do, whereas maybe some of us would prefer to go to bed by 10 or 11 and get eight hours of sleep.
Speaker 2:Hey, I'd prefer to go to bed at nine if my wife would let me.
Speaker 1:Yeah, that's hard.
Speaker 2:I was talking about the podcast in the operating room the other day while I was doing a surgery and there was a nurse I hadn't met before and someone mentioned oh, dr Davis has a podcast. And she said, what's it about? And I said, oh, it's about wellness management and health and illness prevention. And she said so, basically about having a boring life. I said yeah, that sums it up, Thank you.
Speaker 1:Yeah, but how can we change that?
Speaker 2:One episode at a time, baby One episode at a time.
Speaker 1:Yeah, I don't know. I'm like I am fun, I promise.
Speaker 2:We need somebody more flashy and fun to represent it. I don't know if it's going to be me.
Speaker 1:I'm trying Okay.
Speaker 2:So if you do have diabetes already and you're looking to reverse it, there are a number of things that you can do to reverse your diabetes, Although it's not going to be an easy road. The biggest clinical thing that you can change is your weight. A combination of diet, exercise, lifestyle modifications and medication can be a good way to reverse diabetes. Increasing your physical activity both cardiovascular exercise and strength training, I think, is the key, and understanding what it is that you're eating and how it affects your blood glucose can be very helpful. There are trials and scientific papers that have shown that people who underwent low-calorie diets consistently for long periods of time were able to successfully reverse their diabetes. Bariatric surgery has also shown that you can reverse diabetes. Things like a stomach stapling or a gastric sleeve, although this lasts for several years, often has a recurrence, unfortunately, over time. Nicole, do you have any closing thoughts?
Speaker 1:Oh, just a general form of encouragement. I know this might have been a little doom and gloom or made you feel overwhelmed, but really we're here as a nonjudgmental source of facts, and I personally have dealt with some of this, and so I just want to be your cheerleader and say you've got this. There's no better time than the now, than the present, for you to make positive changes that will not only positively affect you, but it will affect those around you as they notice. It will increase your energy levels, your ability to do everyday things in your life, and it's going to encourage your children if you have any as well, for them to have a healthier lifestyle.
Speaker 2:And I would close by just summarizing some of the things we talked about If you're diabetic, if you're not diabetic, I'd encourage you to get at least once yearly blood screening to understand where you are in this spectrum. I'd encourage you to really understand what you're eating. Look at your calories, look at the foods that you eat and have an understanding of the trends that you follow. Appreciate what is actually going into your body. Focus on sleep and not staying up too late and partying and drinking and having lots of sugary snacks. I'm guilty of a late night snack sometimes too, so I understand. Focus on getting up and walking after meals to help lower your blood sugar and get a mix of cardiovascular and strength training exercise to help boost your insulin sensitivity really, this all starts in your mind.
Speaker 1:You've got to start speaking encouragement to yourself and stop thinking of this as an unnecessary or annoying chore, and that's the first step.
Speaker 2:Man. That was a really great talk on diabetes. We had a lot of really interesting topics. I hope that we gave some really good information for people that they can take into their daily lives and change. And I hope that we gave some really good information for people that they can take into their daily lives and change, and I hope that people really take this seriously, even if they don't have diabetes or prediabetes, and take screening seriously and take preventative measures, since we're seeing how prevalent it is in our country. This is the first episode of the Wellness Blueprint and I hope there's many more to come. And, nicole, I really appreciate you being part of the show again and I hope you'll join me next week.
Speaker 1:Yeah, absolutely, can.
Speaker 2:I still call you Dr Big Guy now you can call me whatever you want. So take all this information and let this be a wellness blueprint for your life. And remember be humble, be happy, be healthy and we'll see you next week.
