Dr. Jeffrey Mechanick talks with Diabetes in Control Publisher Steve Freed at the 2016 AACE Meeting. In part 2 of this Exclusive Interview, Dr. Mechanick emphasizes the importance of the doctor/patient discussion about proper nutrition and lifestyle and what is required for an effective discussion.
Dr. Jeffrey Mechanick, MD, FACP, FACE, FNLA is the Clinical Professor of Medicine and Director of Metabolic Support in the Division of Endocrinology, Diabetes and Bone Disease at the Icahn School of Medicine at Mount Sinai, NY. Dr. Mechanick was chosen president of the American College of Endocrinology (ACE) in May 2016, an office he will hold for one year. His current research interests are in nutrition and metabolic support, lifestyle and obesity medicine, and network analysis of complex systems.
Transcript of this video segment:
Steve Freed: You mentioned two important things: metabolism and nutrition. They play a major role when it comes to type 2 diabetes, but obviously type 1, but more so type 2. So what are some of the things you do? How much time do you have with the patient?
Dr. Mechanick: So this actually brings up a good point, because what you’re alluding to is the fact that rarely do physicians engage in a constructive and even comprehensive discussion of nutrition and lifestyle in the very constrained amount of time for a routine patient encounter. That’s really the nature of the question. The answer is that first because of a lack of formal training in nutrition and lifestyle medicine, we’re ill-prepared. The point though, and the point of the talk is that with better education and training, particularly in a formal nature, we can do it. It absolutely can be done. If you go around the world, there are a lot of endocrinologists who have far less time per patient encounter than what we have here in the States. But the fact is that within a 15-minute encounter you can at least begin the discussion. What are the components of an effective discussion about lifestyle medicine and nutrition? In order to go into that, if I may, let me just break it down into some of the parts. So first, lifestyle medicine is not only nutrition but really healthy eating patterns. It also includes physical activity, but not just rigorous exercise, aerobic exercise, but strength training, maybe even some relaxation techniques and stretching and other forms of physical activity incidental physical activity. It can be done during ordinary daily activities. Lifestyle medicine also includes proper sleep hygiene, which extends beyond just the requisite 7 hours of sleep duration, but the quality of sleep, the way in which you go to sleep. The way in which you sleep uninterrupted, you go through all the normal cycles and the next day you are refreshed, you’re not sleepy, you don’t take very long naps and have sleep inertia the next day, but to have healthy amounts of sleep, we’re all aware of the emerging research connecting proper sleep with our metabolism, with cortisol and with glucose intolerance. There really are a lot of important integrative physiologic connections among sleep and insulin, diabetes, obesity, stress, etc. Another component of lifestyle medicine is behavioral medicine and stress reduction. It also includes tobacco cessation, alcohol moderation and the avoidance of any kind of substance abuse. So these are all things that although we’ve heard of them, we really have not been exposed to formal training, so that’s what we used as a framework for the talk, but then we focused more on the nutrition. In order to go into the nutrition we discussed patient centered care, motivational interviewing, where you’re really having a conversation with the patient. If the patient needs to lose weight, which those effects get amplified in terms of having salutary effects on lipids and blood pressure and insulin resistance and well-being. Small amounts of weight loss can have huge effects and larger amounts of weight loss can almost eradicate a lot of the pathology that we see and traumatically reduce the amount of pharmacotherapy that we require. But how do engage that conversation. It’s not about lecturing. It’s not about sitting up on high and talking down to a patient, but rather involving the patient, letting the answer come from the patient. Hearing what the patient is able to do, what they’re not able to do. A lot of times the solution, the patient will offer rather than the doctor instructing the patient to do this or that. So we moved from that into some basic dietetics and then into what I would consider to be a modern approach to nutrition, where we would define nutrition, not simply about the food we eat but the interaction of these eating patterns, these healthy eating patterns or unhealthy eating patterns with our own metabolism. We actually even discussed doing all of this on a molecular scale, so called molecular nutrition where we have networks of molecules in the foods we eat in aggregate, interacting in a complex fashion, but a fashion that we can understand with the networks of molecules in our metabolon. With that, we were able to draw some conclusions and conclude this very brief 40-minute talk with 4 hours’ worth of information.
To view other segments in this video series:
Part 1: Nutrition and Lifestyle