Your Brain On... Diabetes

Ayesha Sherzai (0:00)

When we see statistics saying that one in nine adults are living with diabetes, it can be easy to forget that behind those enormous numbers, there are hundreds of millions of individuals with entirely unique relationships with this condition. Different causes, different ways of managing it, and even for those living without diabetes, different perceptions of the disease. When there's that much variance, confusion can arise, and from that confusion comes feelings of shame, guilt and uncertainty. So in this episode, we'll review how diabetes impacts your brain and the body, how it can be prevented, managed, and in some cases even reversed, and we'll challenge some of the long-held myths about food, genetics and chronic illness. We'll share our own experience with discussing diabetes in our clinics with our patients, and hear from three incredible guests who have treated thousands of patients, conducted groundbreaking research, and are laying the foundation for the future of diabetes treatment. Brenda Davis, a registered dietician and global authority on nutrition, who has helped thousands of people reverse type 2 diabetes through diet and lifestyle. Dr. Michelle Mcmacken, executive director of Nutrition and Lifestyle Medicine for New York City Health Hospitals, working at the front line of diabetes care with compassion and science. And our colleague Dr. Theodore Friedman, a leading endocrinologist addressing the complex brain-based roots of obesity and diabetes, and advocating for compassionate, stigma-free treatment. This is Your Brain On Diabetes.

Dean, glad to be here to talk about diabetes. Usually, a disease impacts one part of the body, but diabetes is one of those conditions that impacts each and every cell in your body.

Dean Sherzai (1:58)

It is. And it affects every system, every cell in the body, and it affects every age group, every gender, every race, and every way you can imagine. And on top of that, the way they manifest is just so multifarious and so devastating. I remember for myself, one of my first experiences was a patient, an older patient that came in. This was my first week in a general practice clinic. You know, in third year, you're all excited, you're going from book work to clinical work. And the first patient I remember was a diabetic patient that had both legs amputated below the knee. And I was wondering why, and realized that it was a consequence of diabetes. The neuropathy that happens, and then the infections that happen, to the extent that the vascular pathology leads to the need for amputation. Throughout that year, I saw patients with visual losses secondary to diabetes, which is the most common reason for loss of vision. And then I saw people with kidney failure. Again, one of the most common reasons for kidney failure. And then I saw a case in the ICU of diabetic ketoacidosis, where the diabetes had gotten so bad that this young lady had developed ketoacidosis and she had become comatose. And she was in the ICU and we had to treat the ketoacidosis, where the person is full of glucose, but the body thinks it's starving. So it starts breaking down fat in the ketone bodies. The body becomes acidic and the consequences are multifarious.

Ayesha Sherzai (3:29)

I mean, it can be fatal if it's not treated right away. We all see diabetes in our clinics. I had a discussion with a friend of mine and she was saying that at this day and age, if you are in health care, you have to understand how to manage diabetes. It's not just reserved for an endocrinologist or a specialist because we see so many of these situations, unfortunately, in our clinic and hospital setting. Just to give some numbers for our lovely audience who are listening, there are 537 million adults worldwide, those between the ages of 20 to 79, who are living with diabetes. That's about 10.5 to 11% of the global adult population. That's a very, very big number. And because of the trends of the lifestyle and the dietary patterns that we see, they are suggesting that by 2045, the number is projected to reach 783 million, with more than 80% of the burden falling on the low and the middle income class. That's just terrifying.

Dean Sherzai (4:34)

There was a time that Type 2 Diabetes was rare. Type 2 Diabetes is now the dominant diabetes. And it has to do with lifestyle and environment and things of that nature. So the numbers are changing dramatically, not just because of some genetic proclivities. It has to do with our relationship with the world around us.

Ayesha Sherzai (4:52)

In the United States, there are 37 million adults, about 11.3% of the population who have been diagnosed with diabetes. There is about 8.5 million of them who don't even know it. They're undiagnosed. So that's just diabetes. Prediabetes, which is a condition where you don't have stark abnormalities in your glucose, but they still are causing some damage to your body. By definition, it's not diabetes. There's about 97.6 million adults, or about 38% of the population living with prediabetes. And based on CDC's number, they conducted some surveys and research in 2021 Only 19% of that population is actually aware that they have prediabetes.