What is Prediabetes & Type 2 Diabetes, and how your gut microbiome and DNA determines care?


Webinar Summary - Dr. Eillen Schutte, Unique Nutrition Solutions with Ranjan Sinha, CEO - Digbi Health

Webinar Date: 13 Nov 2019

Webinar Link: https://vimeo.com/374201025

 Has your job gotten you stuck to your desk? In our busy lives, there’s often little to no time left for exercise or cooking our own meals. Higher stress levels also mean that we’re all sleeping poorly. 


Add to that- squinting at the laptop, gaining weight steadily, hitting the restroom frequently and needing to hydrate as if you’re stuck in the desert. Chances are, you’re prediabetic.


Prediabetes:

It is a condition where your body is “starving in the middle of plenty.” You couldn’t be farther from actual starvation, but the glucose from the food you consume is just not available to your cells resulting in a starvation-like state on a cellular level. 


This is also known as Insulin resistance. The hormone Insulin is what signals our cells to bring in the goods, i.e. glucose. Therefore, the body’s natural ability to use the glucose, i.e. the fuel, is impaired.


Prediabetes is where your blood sugar is higher than normal, but not high enough that it is diagnosed as diabetes. As a result, this is often not recognized by doctors for the red flag it is, until you actually become diabetic.


Some sobering statistics from the CDC:


    • Around 30.3 million Americans have diabetes, which forms 9.4% of the population
    • A staggering 84.1 million Americans, almost a third of the population, have prediabetes
  • Most do not know it.

  • What if you could know ahead of time if you will develop diabetes ?


    Getting your genome tested can help you take steps to lower your risk of getting full-blown diabetes.


    Nutrigenomics:

    The mapping of the human genome in the last 20 years has been quite enlightening in many ways. Of the 50,000 genes mapped, 145-160 are clinically relevant. 


    Further, Nutrigenomics is the branch of gene studies that deals with :


    1. Those genes that metabolize nutrients from our food
    2. How nutrients impact genes that govern the various biological systems within our body


    How is prediabetes diagnosed?


    Blood glucose level:

    Prediabetes is diagnosed by means of a test where fasting blood glucose is measured, and usually a concentration of 100-125 mg/dL is considered prediabetic. However, these figures are not consistent across the country, so check with your doctor. For instance, in Wisconsin, a result of 135-140 mg/dL is considered prediabetic.

      

    HbA1c: 

    HbA1c looks at your average blood sugar level over a two-month period. 5.6%- 7.0% HbA1c would correspond to about 118 mg/dL. 


    You could be prediabetic if you show these symptoms. Get tested if you experience:


    • Weight gain in the tummy is a sign of developing insulin resistance
    • Fatigue, because your cells are “starving” for glucose/energy
    • Increased thirst
    • Frequent urination
    • Vision loss. This is actually reversible once the blood sugar levels are stabilized.

    Facts about fast food:


    • One in three Americans eats fast food DAILY
    • The average American family spends $1,200 on fast food annually
    • Fast food is full of sugar, saturated fats and chemicals

    So it is not merely a matter of diabetes “running in your family.” Environment and diet are also key factors that have resulted in a 100 million Americans becoming diabetic or prediabetic. 


    Fast food is a recipe for prediabetes as it is filled with saturated and trans fats, refined carbs high in calories, high in sugar, low in fiber.


    Common advice and why it doesn’t always work:


    “Cut carbs,” and “cut out sugar and sweets” are the two main pieces of advice you get from everyone when you are trying to lose weight. It is not enough. Why?


    • It doesn’t take your genomics into account.
    • It is hardly personalized.
    • It doesn’t address individual metabolic imbalances and other stressors in your life. 
    • It doesn’t take into account digestion problems, particularly those that may result from a disrupted gut microbiome (gut bacteria and their ecosystem). 


    Obesity as a risk factor:

    Our diets have changed too fast for our genes to keep up. Fast foods and processed foods have been in the picture since the mid-1950s and contributed to the rise in obesity. Obesity and diabetes are linked. However, it’s not just obesity that is a risk factor for prediabetes: people with normal BMIs are also sometimes diagnosed with prediabetes. 


    So what are the other risk factors?


    Are there “diabetic genes?”


    Could our genes be blamed for diabetes? Could it be certain genes that have failed to evolve to process our current diet? Could we look at someone’s genome and determine their risk profile for diabetes?


    What is happening at a genomic level? Can our genes that metabolize fat and carbohydrate adapt fast enough to the sea changes that have happened in our diet? 


    The answer is no. It would take hundreds of years for genes to adapt to certain changes in our environment.


    There isn’t just one gene for diabetes. Diabetes is a “polygenic disorder” and there are many genes involved. 


     This has to do with three main things:

    • How we metabolize fat
    • How we metabolize carbohydrates
    • How we produce the all-important insulin or thyroid hormones

    Understanding how these genes function helps derive a personalized and targeted approach towards weight loss and diabetes management. 



    Fat metabolism


    Fat intolerance: How well can you take saturated fat, or stored fat and convert it into energy? Some people have a slight genetic variant that affects their body’s ability to generate a compound named L- carnitine, which is necessary to burn fat. It is also instrumental in bringing fat into cells for making energy. It also increases sensitivity to insulin.


    If we can’t produce enough L-carnitine, we need an alternative strategy to enable our bodies to burn fat.


    All fats are not created equal: 


    Saturated fats vs. polyunsaturated fats: here’s a quick guide to help you remember which is which.


    • Saturated fats come from animal products, coconut or palm oils.

    They are solid at room temperature, like butter.


    • Polyunsaturated fats are typically seed oils, like sunflower or nut oil.

    They are liquid at room temperature.


    • An example of monounsaturated fat is olive oil, which is liquid at room temperature, but has just enough saturated fat to make it solidify in the refrigerator.

    Certain individuals are genetically unable to utilize saturated fat. They will have a tendency towards diabetes because they cannot get energy from fat into their cells.  


    How do you address your genes that help metabolize fat? What are the benefits?


    The answer is, you consume the right kind of fat. Eating the right kind of fat lowers the risk for diabetes and prediabetes, and helps with weight management. It also increases energy levels and reduces inflammation. 


    Carbohydrate metabolism:

    Some people are intolerant to carbohydrates and really do not do well on a high-carbohydrate diet. Moreover, they have a tendency towards insulin resistance. This could be because of a lack of insulin in their body to help them maintain your blood sugar. Or their genetics are just not geared towards producing more insulin, as their ancestors did not eat a high carb diet.  


    How do you know which kind of fats or carbohydrates are right for you?

    This is where a genome profile comes in handy. Getting your DNA tested will tell you the right carbs and fats to eat, or to stay off carbs altogether. 


    This will resolve your doubts as to which diet is right for you- whether you should be doing Atkins, or keto, or can stick to the standard American diet but just smaller portions of it. It is a good idea to stay off of high-sugar drinks and high glycemic foods such as white flour or white potatoes in general. But for people with carbohydrate intolerance, it is absolutely crucial that they avoid these foods.


    Microbiome and our metabolism:


    We now know that our microbiome plays a major role not just in effective digestion, but also in:


    • Fat storage
    • Energy and metabolism
    • Oral health
    • Heart health 

    How does diabetes and obesity affect the gut microbiome?


    Diabetes and obesity actually alter the gut microbiome. The more overweight we become, the more our gut microbiome changes, the more we become predisposed to diabetes and prediabetes.


    Can we change our microbiome?


    Yes, we can change our microbiome for the better, but it is key to test our microbiome before we attempt to do so. We can now modulate the composition of our microbiome with prebiotics and/or probiotics. Gut microbiome testing will tell us the composition of our microbiome diversity, and we should be aware of how healthy our “garden” is before we attempt to seed it with the good guys. 


    A healthy microbiome is nourished well with a diet rich in fruits, vegetables and fiber. This is the greatest issue with the popular Ketogenic diet, which is inherently low in these. Stool testing can reveal the changes in the gut microbiome, and the disruption that may have resulted as a result of a ketogenic diet. 


    Fermented foods also help the gut microbiome, as do allium family (onions and garlic) and sulfur-rich vegetables such as broccoli, cauliflower, and bok choy.


    A healthy metabolism depends on good, varied nutrition and a healthy gut. We need vitamins, antioxidants and a combination of the right foods to reduce the risk for prediabetes, diabetes, and weight gain. 


    About Digbi Health:


    Digbi Health has built the first prescription-grade multifactorial diabesity care platform.



    Digbi Health’s program address all aspects of weight loss and diabetes management by personalizing your diet and nutrition plan as per your genomics, metabolic conditions, lifestyle vitals and nutritional deficiencies. 


    This is a very targeted approach, which includes functional nutrition evaluation by a trained nutritionist, and coaching/guidance on getting healthier and fitter. It offers support from cognitive behaviour professionals in making the major lifestyle changes that may be required to achieve a healthy BMI. It also equips you with strategies for permanent solutions, to prevent a relapse into your old habits. This program is covered by Blue Shield of California.


    Q & A


    1. What is prediabetes?

    1. Prediabetes is a condition wherein your body is “starving in the middle of plenty.” You couldn’t be farther from actual starvation, but the  glucose from the food you consume is just not available to your cells; resulting in a starvation-like state on a cellular level. This is also known as Insulin resistance. With prediabetes, your blood sugar is higher than normal range but not high enough to be called diabetes.

    1. How is prediabetes diagnosed?

    1. A simple blood test is performed in which fasting blood glucose is measured, and usually a concentration of 100-125 mg/dL is considered prediabetic. However, these figures are not consistent across the country. For instance, in Wisconsin, a result of 135-140 mg/dL is considered prediabetic.

    The other test is HbA1c that looks at your average blood sugar level over a two-month period. 5.6%- 7.0% HbA1c would correspond to about 118 mg/dL. 


    1. I suddenly gained a lot of tummy fat on a normal diet. Could I be prediabetic?
    1. You could be prediabetic if you show the following symptoms. Get tested if you experience:

    • Weight gain in the tummy is a sign of developing insulin resistance
    • Fatigue, because your cells are “starving” for glucose/energy
    • Increased thirst
    • Frequent urination
    • Vision loss. This is actually reversible once the blood sugar levels are stabilized.


    1. How does diabetes and obesity affect the gut microbiome?
    1. Diabetes and obesity actually alters the gut microbiome. The more overweight we become, the more our gut microbiome changes, the more we become predisposed to diabetes and prediabetes. Fortunately, once you have found out the composition of the gut microbiome through genomics, you can begin a course of pre- and probiotics to restore a healthy gut microbiome.

    1. What is “diabesity?”
    1. It is the term given to the multifactorial disease condition that develops from complex interactions between obesity and diabetes. It arises from the interactions between an at-risk genetic profile, and environmental risk factors such as physical inactivity, less sleep, sedentary lifestyle, excessive caloric intake, the intrauterine environment, socioeconomic status, endocrine disruptors, and the gut microbiome. 

    1. Is diabesity genetic? If I have it, can my children get it?
    1. There is a 40-70% chance of diabesity being passed on to the next generation.

    Author: Ranjan Sinha


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