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Jeffrey Mechanick Part 4, Trans-Cultural Drivers in Type 2 Diabetes

In part 4 of this Exclusive Interview, Dr. Jeffrey Mechanick talks with Diabetes in Control Publisher Steve Freed during the AACE 2018 convention in Boston, MA about trans-cultural drivers in type 2 diabetes, such as different eating patterns in different cultures.

Dr. Jeffrey Mechanick, MD, FACE, FACR, FACN, ECNU 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.


Transcript of this video segment:

Freed: What is the focus on the transcultural drivers in Type 2 diabetes?

Mechanick: Well, there are many transcultural drivers in Type 2 diabetes. Let’s go through some of the main ones. Nutrition would be one, and I would prefer that to be viewed as eating patterns. So, there is no good or bad food; it’s really the eating pattern that determines our risk for various chronic diseases. Those eating patterns change from one culture to another. It’s very important to understand that. It’s not even the food that are on the table – it’s also the timing of eating – we’re learning a lot about the chronobiology of obesity care and diabetes care; consuming most of the food earlier in the day, not eating so much right before you go to sleep, not night grazing. So, a lot of that finds its roots in cultural dictates. So, nutrition is one. Number two would be physical activity. There are many parts of the world where it is sort of ingrained in the culture not to sweat in public. There are many parts of the world where it is so hot that people do not want to go outside or as in the Islamic faith, [are required] to be covered. These things make it more difficult to go outside and exercise in the warmer climates. A lot of those cultural dictates find their way when we look at our American population in this diverse mosaic of an American population. So, as a physician you have to be prepared to discuss this. The sarcopenia – talking about progressive resistance training to build-up muscle mass, to add protein supplements perhaps to supplement a vegan diet or a vegetarian diet that you might find in an Asian-Indian family or an Asian-Indian culture for instance here. The socioeconomics, the belief system, the attitudes toward doctors and relating to doctors, dieticians, and the paramedical, and attitudes toward stress – a lot of populations come in from other countries where there is a huge amount of stress. There is actually an allostatic stress model for diabetes where you’re revving up all of that stress and the cortical input to the limbic system, counterregulatory hormones, cortisol, adrenaline, and however you cobble together all of the pieces of this, but stress is a huge factor and being able to come up with nonpharmacologic, nonsurgical ways to manage stress – that’s lifestyle medicine. So, meditation, various forms of dances, various forms of other physical activities are all part of the ways that we can transculturalize lifestyle medicine in order to better manage chronic disease such as diabetes.

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