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In part 1 of this Exclusive Interview, Dr. Jeffrey Mechanick talks with Diabetes in Control Publisher Steve Freed during the AACE 2018 convention in Boston, MA about the concept of trans-cultural endocrinology and why it is essential to understand how differences in culture can impact diabetes care.
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: This is Steve Freed and we are here for the American Association of Clinical Endocrinologists (AACE) 2018. We have a special guest with us, Dr. Jeffrey Mechanick, who is Clinical Professor of Medicine and Medical Director of the Kravis Center for Health at Mount Sinai Heart, Division of Endocrinology and Director of Metabolic Support with the Division of Endocrinology, Diabetes and Bone Disease at the Icahn School of Medicine at Mount Sinai in New York City. We are really glad to have you here and I understand you’re doing a presentation. Can you tell us the title of that presentation?
Mechanick: We are going to be speaking on transcultural endocrinology, and actually, this is going to be, not necessarily a first ever for AACE, because we have had some other transculturalization type activities at annual meetings in the past, but what is going to be different this time is that it is going to be a summary of activities that we did this past December 2017 for a program of Diabetes Care Across America. We went to three different cities in the U.S. and spoke about the different ways diabetes care can be fashioned based on different cultures and ethnicities.
Freed: That’s interesting. I know in the medical communities such as AMA and AACE, some of you guys come up with terminology that nobody knows what you’re talking about. So, can we start off by you telling us what ‘transcultural endocrinology’ is?
Mechanick: (Laughs) Right. So, we know what endocrinology is – it’s the study of hormones and the endocrine glands. The word ‘transcultural’ you could argue is a little bit of a made-up word but what it really describes is the process of taking evidence-based recommendations for a very specific medical problem, in this case, diabetes care, from a source population, a source culture with a certain distribution of races and ethnicities, and then, making it portable for a target population with perhaps a different culture, and within that culture, a different distribution of ethnicities and races. The problem is, is we didn’t really recognize this as having a significant impact on optimizing or providing diabetes care. However, now, we know that this is probably true. A lot of times, the realization of what we are doing for populations of patients is not quite what we would have liked with particular structured lifestyle changes, particular pharmacotherapy, even procedures like bariatric surgery because we’ve miscalculated the differences between the two cultures (the source culture for the recommendations and the target culture where we’re applying it). So, transcultural means going from one culture to another culture in the context of evidence-based recommendations.
Freed: Can you give us an example?
Mechanick: Sure. So, let’s say diabetes care – nutrition – how much carbohydrates should be in a healthy eating pattern for somebody with diabetes – it could be 55 percent. If you wanted low-carb it could be in a zone, it could be 40 percent. But, if you go to India where the staple is polished rice or glutinous rice, it might be as high as 60,70, or 80 percent. And in fact, the transculturalizaed recommendations are going to be between 60 and 70 percent rather than, 55/50 or there abouts percentage in a North American population, for instance. Furthermore, if you want to cut back on the glycemic index of that particular staple, what do you replace white rice with? Well, there are some concerns about the eating patterns that have gone from generation to generation as part of the culture. And also, socioeconomics – white rice is cheaper. Can average families afford the brown rice? Can they afford quinoa? Can they afford barley? Is it available in the food chain? What types of oils are going to be healthy as part of a cardiometabolic risk mitigation strategy – oils that are going to have more monounsaturated fatty acid, oils that in a polyphenol content in a diet that mimics the evidence-based Mediterranean-type diet. How do you export those recommendations that adopt Mediterranean diet eating patterns to areas of the world not accustomed to a Mediterranean eating pattern like India or Southeast Asia?