Diabetes & BP: Managing Dual Dangers

Soham Patel, MD, FACE, DipABLM

Doing well, Dr. Marbas. Thank you for having me on this summit and sharing my views.

Laurie Marbas, MD, MBA

Absolutely. I just wanted to say that Dr. Patel, we like to do the summit the way we should introduce it. But anyway, because every time I’ve ever had a conversation with you, I feel like I walk away with a little bit of an encyclopedia of knowledge. Because it’s just so easy for you to pull things out and understand. I’d like to get started with just the basic question of how hypertension and diabetes relate to each other. Is there any underlying physiological connection between the two? Because it seems they seem to travel in pairs.

Soham Patel, MD, FACE, DipABLM

There is a very common pathophysiological link between the two. Is there something called insulin resistance? If you think about it, insulin resistance is the initial process that can lead to high blood pressure. However, if insulin resistance is not strategically identified and addressed as the root cause, the treatment for high blood pressure can often lead to higher sugars. That’s one aspect. But not addressing the insulin resistance eventually can also lead to the manifestation of pre-diabetes and then type 2 diabetes, so let me unpack that a little bit. 

Let’s start with insulin resistance. In simple words, your body not responding to insulin as it normally should is insulin resistance. What it is: insulin is a hormone that is produced by an organ called the pancreas. We have a very powerful level in the abdomen called the pancreas, which produces a bunch of different hormones and enzymes that play a role in our normal health and maintenance. Many people may know that insulin is something that deals with carbohydrate metabolism, but more importantly, insulin is an anabolic hormone, meaning we need insulin to be able to convert food into body composition. In that same aspect, insulin is required for the metabolism of not only carbohydrates but also fat and protein metabolism. Essentially, if your body doesn’t produce insulin, which would happen in the case of someone with type 1 diabetes, and if you don’t get insulin, you go into a state of acidosis called ketoacidosis, or diabetic ketoacidosis. Then, if that is not addressed with insulin and other treatments, that is a very high rate of fatality and a very high risk of dying because your body cannot maintain its normal functioning without insulin. Insulin is that important. 

But when your body ends up in a state where it’s producing more and more insulin but it is not working what it should be doing, that leads to insulin resistance. Let me bring it down further to a breakdown. Imagine a deposition of fat in cells that are not designed to store fat. We have a special type of tissue in our body called adipose tissue that is designed to store fat. But when you start seeing the deposition of fat into cells and tissues that are not designed to store fat, the insulin receptor that sits on the surface of those cells starts not working properly. When there is a buildup of fat in your liver cells, which is a very important organ for metabolizing food and also detoxifying, the insulin receptor that sits on the surface of the cell doesn’t respond to insulin as it normally should. Insulin binds to the surface of the receptor on the top of the cell. But all the chemical reactions that should happen inside this cell do not happen because, essentially, what the cells, the receptor, are signaling is that there is enough energy stored in the form of fat inside the cell. There is no need for insulin to do what it’s supposed to do. 

One of the key functions of insulin is to allow glucose, or sugar, to enter the cell and be utilized for energy generation by a very powerful system called the mitochondria inside your cell. Think of mitochondria as your powerhouse of the cell, and the fuel for that powerhouse is glucose. However, the glucose entry is regulated by insulin. And so if the insulin receptor doesn’t function because it is getting signals of increased energy stores in the cell because of that higher fat deposition, it doesn’t allow the glucose to come in. Glucose stays high outside in the bloodstream, which is recognized by your pancreas. The pancreas produces more insulin in response to that; initially, with more insulin, the receptor responds, and it starts allowing the glucose to come in. But again, the same process happens as we have higher storage of fat in the cell, and glucose keeps getting converted into fat because the energy stores of the cell are higher. The cell machinery is perceiving a lack of need for energy expenditure. It just keeps converting the fat—sorry, the glucose—into the fat. You keep worsening the fat deposition. 

The insulin receptor keeps getting more and more resistant to the effects of insulin. Now you reach a stage where your body is producing the maximum amount of insulin that it can. We are at capacity, but we are still not getting the effect that should be happening inside the cell. We are talking about the liver. Now, the liver is important because 50% of the insulin that your body produces is taken up by the liver, and 30% or so is taken up by the muscle cells throughout the body. Then the remaining tissues require the rest of the insulin. But because of this increased fat buildup in the liver cells, it reaches a point where the liver says, Okay, I cannot keep things to myself anymore. I need to share the misery, so to speak. The liver starts releasing fat molecules into the bloodstream in the form of something called triglycerides, and those triglycerides travel through the bloodstream and start depositing into other cell lines. Now you have a fat buildup happening in your muscle cells, which are the second most common place for insulin to work harder because of the buildup of the fat, and then they don’t respond to insulin as they normally should. Now you go from liver insulin resistance to muscle insulin resistance. 

The third place where this hormone also starts ending up is inside the beta cells that produce insulin inside the pancreas. You have two sides, the liver and the muscle, with various buildups of fat, and they are not responding to insulin, and the sugar stays high in the bloodstream. On the second side, you have the beta cells of the pancreas, which are the only cells that can produce insulin also, start building fat inside them. Studies done by Dr. Roy Taylor in the UK have shown that when there is a buildup of two grams of fat in the beta cells in the pancreas, the beta cells’ ability to produce insulin goes down. If you lose those two grams of fat in the beta cells of the pancreas, the ability to produce insulin can come back up. You have a double-whammy going on. It’s called the double hypothesis of insulin resistance. On one end, your liver muscle is not responding as it normally should. On the other hand, your pancreas’ ability to produce insulin is also going down. and this is a process that I described; this process is not something that happens in a short window. This is something that builds up over years and decades. Identifying insulin resistance early on can help us prevent the buildup of diseases that can start with hypertension and then go into high cholesterol, prediabetes, and type 2 diabetes. We can essentially avoid the whole gamut of those metabolic pathways.

Laurie Marbas, MD, MBA

Well, again, I think we could have done an entire college lecture on just what you mentioned. There’s so much here. With insulin resistance being more of the root cause, are there other things that we should also look at that can cause hypertension that maybe are less looked at?

Soham Patel, MD, FACE, DipABLM

Yes. Uric acid is a metabolite of DNA breakdown in the body. High uric acid levels can also lead to hypertension. When anybody is having issues with high blood pressure, their workup should also include checking their serum uric acid levels. Now, many times you may not have uric acid levels that are high enough to cause something called gout, where you have these inflamed joints. Your big two or your knee joint gets big and inflamed and painful because of the uric acid getting crystallized inside the joints because that happens when it’s very high. But when your uric acid levels are running borderline high but not high enough to cause gout attacks, if you don’t check for that, you’re not going to identify that. Then that’s another last opportunity to address the root cause. 

Something I mentioned briefly earlier in my explanation of insulin resistance is that when you’re diagnosed with high blood pressure, many times you’re put on water pills, as we commonly call them, or more specifically, hydrochlorothiazide or your tablet on those types of medications. They make you feel hydrated and help you lower your blood pressure. But also, a very strong side effect of those medications is that they can raise your uric acid levels, and they can also raise your blood sugar and cholesterol levels. if you, again, don’t address the root cause of insulin resistance, which is why you may be having high blood pressure or high uric acid levels, which may be leading to that. You may end up with more issues, which may then be diagnosed as high cholesterol or pre-diabetes, and you will need more medications. But you still keep getting worse and worse. 

Going back to uric acid, high fructose corn syrup, which is so prevalent in processed foods as a sugar alternative, is equally bad as refined sugar. High fructose corn syrup inside the body unfortunately gets broken down into high uric acid. If you’re consuming a lot of processed foods that have high fructose corn syrup or a lot of fruit juices, those have fructose. But again, in refined form, you’re getting fructose without the fiber from the fruit. Eating fruits is healthy in their natural form, in their dead form. But if you get it in there in fruit juice form, even if you’re freshly squeezed yourself, not the packaged stuff from the store, it doesn’t have any fiber left. That fructose, concentrated in the form of fructose, can turn into a uric acid pathway and also lead to high blood pressure. Understanding and recognizing that uric acid also plays a very key role in checking for that would be important.

Laurie Marbas, MD, MBA

I think that’s an amazing tidbit for people. I’ll be adding that to my list of things to be looking for. Well, okay. I guess the one thing since we talked about the uric acid and the resistance and we’re talking about is the root cause. How do you counsel patients to begin fighting this and reversing it? What is your message there?

Soham Patel, MD, FACE, DipABLM

The first step is to check a few labs to determine whether or not you are insulin-resistant. And those are not; they’re very widely available now. They can be checked across the globe. There was a time when these labs were considered special labs, but now they’re accessible. checking a basic chemistry panel where you have your glucose, sodium, potassium, kidney function in the form of creatine, and your panel of liver enzymes and liver function, and then checking for fasting insulin level along with that. once you have your fasting glucose and your fasting, and when I say fasting, it means at least 10 hours of fasting, preferably 12, but at least 10 hours of fasting overnight. If you have your fasting glucose, then you have your fasting insulin. There is a calculator called Homam Iyer. It’s a calculator. It’s an equation that, again, you can Google; you can easily plug in the insulin and the glucose values in it, and it will give you a spot on the number. If that value is less than two, you’re not insulin resistant, but if the value is higher than two, then you’re definitely insulin resistant. That’s number one. 

Number two also tracks this fasting insulin level. Even if you don’t do the calculation of the Homam Iyer, you can gauge the level of insulin resistance just from the fasting insulin. Ideal fasting insulin should be less than five, and now I think I should specify what the unit is. I believe the unit is a micro-unit pyramidal. Dr. Marbas, you can probably verify that, but because different countries may have different unit systems, in the unit system that we use in the U.S., it should be less than five and the fasting glucose should be in the 70 to 80. This is when your fasting glucose starts going into the 90s and low hundreds, and your insulin level starts going into the 10, 15, 20, 30, 40 range. You’re getting into insulin-resistant territory. 

Let me give an example. Many times, I check this routinely, so I’ll see all the time where someone has a fasting glucose of 95. It’s less than 100. It’s not technically normal, but it’s getting closer to the 100 mark. Their fasting insulin would be 15, 20, or 25. If you don’t check the insulin and you only look at the glucose, Oh, it’s 95; it’s less than 100 looks okay. You check that hemoglobin A1C which is a three-month sugar average number, and that A1C is 5.4. At face value, you would think, Okay, that’s normal, things are fine, but you’re missing out on building insulin resistance because ideally, the optimal A1C should be closer to five. 5.4 means it’s starting to creep up towards the high normal range. Your glucose is also creeping up at midnight, and if you did not check that insulin, which would be 15, 20, or 25, you would completely miss building insulin resistance, and that would be a lost opportunity. The first and most important step is to identify insulin resistance early on. Then you can start working on making corrective steps to prevent things from happening. 

One of the other things is the lab aspect of early detection. Another telltale sign that anybody can see and pick up but is not fully recognized is acanthosis. Acanthosis is where the skin tends to grow because, again, as I said, insulin is an anabolic hormone. When the insulin level runs high, it stimulates the growth of many tissues in your body. This gives your skin cells, and it also stimulates something called the melanocytes, which are the cells that create the pigmentation in our skin, to have more melanin. You have thicker skin patches and a darker skin tone. You will see the elbows getting darker, and you will see the back of the neck getting darker. But something very specific for the Hispanic population and also the population from the Indian subcontinent is the blackening of the side of the face. In the temple area, you will see blackening of that area or blackening on the forehead. That is something that anybody can pick up just by looking. But I can tell you how many times no one has even recognized that until I’m seeing the person and I can say that they’re insulin resistant. When we checked the lab, that insulin level came back to be 20, 30, 40, or 50, which is very high. These physical signs and the lab—are two key things to pick up early on because it takes many years for things to progress. If we can identify this, we can hope.

Laurie Marbas, MD, MBA

Wow. Yeah, absolutely. The units were NICU per mil.

Soham Patel, MD, FACE, DipABLM

Yes. Micro International Unit.

Laurie Marbas, MD, MBA

Absolutely. Now that you’ve discovered someone, let’s say that they have insulin resistance, and they’re, okay, doctor, now what do I do? What do you recommend, and how do they get started?

Soham Patel, MD, FACE, DipABLM

Four things play a key role in our whole health, but specifically insulin resistance, nutrition, sleep quality, stress management of day-to-day stressors, chronic maladaptive stress, and not the good type of stress. We need things to do in life. that keeps us going. Then, when we feel that we are underwater all the time, that’s the chronic stress I’m talking about, and then activity. I’m saying activity because you could do things for 5 minutes or 10 minutes that can still have a big impact without darkening the skin, half an hour or an hour in the gym. Nutrition, sleep, stress management, and activity. Those four things can very quickly change your body’s insulin resistance, making it worse or better, depending on what you’re doing with those four things.

Laurie Marbas, MD, MBA

Perfect. What type of diet do you recommend?

Soham Patel, MD, FACE, DipABLM

Again, there is so much information out there that there is a lot of confusion. This is what some experts say. It’s quite challenging for people to pick up and tease out what’s good and what’s not good. But if you look at all the different types of evidence, there are five different types of evidence, you have epidemiological studies. You have studies done in terms of bench-reducer lab research. You have randomized controlled trials; you have meta-analyses and systematic reviews of a bunch of different studies put together. Then you have population studies, which look at how much and what’s the impact of different behaviors in different populations over years and decades. When you look at all those five different types of evidence, it’s the common theme that comes out: is the plan the predominant way of eating? And what that means is that focusing on whole, intact plant foods is 90–95% of your food. You could go all the way to 100%. If that’s what works for you, it is completely sustainable. But if you feel now it’s not fully sustainable for you to be 100% whole plant-based, you could still eat 90%–95% whole plant foods. And you could still get a huge impact because the key thing that we need to do to lower insulin resistance is to also consider the mechanisms. 

The mechanism by which that works inside the body is to eat foods high in fiber and nutrients, meaning vitamins, minerals, and phytonutrients. When you eat foods like vegetables, beans, lentils, whole grains, and fresh fruits, you eat fresh seasonal foods, not juices as we mentioned earlier, you get the fiber, the minerals and vitamins, and all the nutrients you need. That allows your body to slowly break down the glucose and the sugars and get a steady supply of that into the bloodstream, which requires a very minimal amount of insulin for the body to break it down, metabolize, and do what it needs to do. You still produce the insulin that you’re producing in the body, but you’re allowing the body to channel that insulin production in a very steady manner. The example that I give is: imagine you’re working at a bank, let’s say, and the teller is addressing the clients. One by one, they’re standing in a line; there are five people in the line, and the teller can address them one by one. But imagine if 50 people show up at the bank at the same time, and they’re trying to come at the teller from all sides. The teller is going to be overwhelmed.   

Same thing. If the glucose is being broken down and steadily coming to the liver, the liver can very easily handle it. But if it gets bombarded with all that in one go, so when you consume ultra-processed foods or you eat foods that are very high in fat and you combine that with something high in sugar, you get a double whammy. You get the high fat and the high sugar all at once, and your liver gets easy oil. When you eat foods high in fiber and nutrients, you’re able to feel full. You can get a very steady release of the nutrients that the liver can easily handle without getting over. 

The second part of the food aspect, which is very important, is to not only eat the foods but also eat them at the time. What that means is that if you eat even the foods, but if you eat them later at night, foods consumed after 7 p.m., especially once the sun is down, are going to be more likely to be deposited as fat rather than expended as energy. People do intermittent fasting, and again, it’s a whole different conversation by itself. But the one-liner is that intermittent fasting is great, but do you want to make sure your feeding window is in the middle of the day? You don’t want to do a 16-hour fast or an eight-hour feeding window, but those eight-hour feeding windows start at 2 p.m. and go on till 10 p.m. Your feeding window should start maybe at 10 noon and stop at seven or eight. Nothing past eight. that you have 2 hours to 3 hours of no food in your stomach at this time before you go to sleep. When you go to sleep at 10:30 and your food is completely digested, the liver can very easily go through the detoxification cycles that it needs to do and help your body detox. Because if you eat something late at night and go to bed, your liver cannot do the detoxification, and it builds up toxins. That’s the importance of eating at the time. 

The second important aspect is sleep, and I’ve seen it many times with my patients where, even if they eat the best and are very active in their day-to-day lives if their sleep quality is not optimized and they won’t see the benefit, their sugar still runs high, and it creates more frustration because they’re putting in efforts to eat and be active but they’re not seeing the results. The reason is that sleep is where our body restores different functions. It also helps balance the hormones. One of the key functions of sleep is to lower insulin levels and cortisol levels in the first half of the day. When you don’t get proper sleep, your insulin and cortisol levels stay high through the night, and your sugars run high. coming up, and I’m sure, Dr. Marbas, you heard that from patients. I check my sugar at night before going to bed. It’s 100, and I’m not eating anything. And when I wake up, my sugar is 140 or 160. That’s because their sleep is not optimized, and you’re having high insulin-cortisol levels through the night. 

Another key thing to keep in mind with sleep is the quality of sleep, and the time of onset of sleep is more important than the quantity of sleep. What if you sleep 6 hours of solid, deep sleep starting at 10 to 10:30 p.m., or 11 p.m. is better than sleeping 8 hours of sleep past midnight. Quality at the time of onset, meaning you’re going to bed before 11 is going to be better compared to sleeping more. But going to bed after 11 or midnight. That’s important because you could sleep longer hours, but if you don’t get the quality and the time window of sleep, you will not see the metabolic benefit you’re looking for.

Laurie Marbas, MD, MBA

Exercise, I think.

Soham Patel, MD, FACE, DipABLM

Yes. Exercise. I said activity rather than exercise because, let’s say you have a very busy schedule. You can spend 30 minutes going to the gym. Start by doing 5 minutes of brisk walking after your dinner. That 5 minutes of brisk walking next week can become 10 minutes of brisk walking, and then next week, 15 minutes of brisk walking. Eventually, by five or six weeks, you can get to maybe 25 to 30 minutes of brisk walking after dinner. What it will do is help your muscles more, so get more sensitized to insulin so you’re able to metabolize the food better, and you will have better sleep at night. And that could be an activity that you can sustain daily. Another thing that I would also suggest is that rather than what some people tend to say, I go for a walk for an hour in the morning or 45 minutes in the morning. That’s great. You get fresh sunlight, which is good for your circadian rhythm. It’s important to get sunlight exposure in the morning. But if you are scrunching for time and you’re trying to maximize the impact of exercise activity, if you break those 45 minutes or an hour into 10 to 15, 20, or 30-minute blocks of activity after lunch and after supper, you will get better results in helping lower your sugars and improve your insulin resistance. if you can do a workout, whether it’s some sports you play or going to the gym and doing aerobic and weight combination, not just aerobic or weights, but a combination. Go for it. But if you can’t do that, start with five to 10 minutes of brisk walking or biking. Another thing I always suggest is that, let’s say the weather is bad, it’s too hot outside, or it’s too cold or raining. Whatever the situation is, get a stationary bike and put it in your living room. When you finish your dinner and are sitting down to watch some TV shows, get on your bike, watch TV, and do 15 to 20 minutes of stationary biking, You get the entertainment and the exercise all in one, and you can do it all the year without any external weather factors hindering you. These simple steps, but things that can add to your health and lower insulin resistance.

Laurie Marbas, MD, MBA

I think that’s fabulous. I’m going to pause for just a moment and thank everyone for joining us today. And I hope you found this conversation very educational. I picked out some nuggets already. And if you’re a summer purchaser, stay here because we’re about to dove even deeper into this awesome discussion. And if you’re there, click on the button below or to the side and get access to the rest of our conversation. If you’re watching this, thank you for being a valuable member of our community. And I have a few more questions for you, Dr. Patel, in particular. I know you’ve had some stories that I recall about stress in patients and blood sugar, and stress, we know, affects blood pressure. What do you recommend for patients who are struggling with stress that’s affecting them? There is some resistance there—diabetes, hypertension. What do you suggest?

Soham Patel, MD, FACE, DipABLM

The example that I would start with is a true patient, a person who had a very challenging home situation with a special needs child, was the primary caregiver for the child, and was also diabetic, and the patient told me that, My sugars go wild very easily. If I’m stressed about something, my sugar can easily go up 100 or 200 points. This is from many years ago. I had similar experiences after that because I was trying to pay attention now, but this was the first patient that I learned from. We checked blood sugars in the clinic. When the patient checked in and was triaged, it was about 110. Then the patient is talking about this. We checked the sugars again in 10 minutes after the patient was talking about this. And the sugar had gone up 150 points, just as the person was talking about the child and all this stress and all of that. stress depending, again, on the person’s situation. If you’re in a very stressful situation, your body’s pumping all these stress hormones, and those stress hormones are making your liver crank out more sugar. It’s a very, very strong response that you can get. 

How do we, again, depending on where we are on the spectrum of stress, maybe some moderate or very high, how do we work on improving that step by step? One of the simple steps that can help you is creating this routine of deep breathing, pranayama, which is part of your yogic traditions. Yoga traditions involve controlling your breathing. There’s again a whole different conversation and topic, but something as simple as deep breathing, which you do multiple times throughout the day, allows your body to break from that fight or flight cycle that you’re in all the time because of whatever stressful situation you’re going through and allows your parasympathetic nervous system to get stronger. We have this sympathetic nervous system, which is a flight, fight, or flight, and then we have the parasympathetic nervous system, which is how to just calm down and feel relaxed and at peace. when you do deep breathing multiple times throughout the day, just one minute at a time. We do it as a routine. It breaks from that fight or flight response and brings in that calming response in the body. It helps your blood pressure, your blood sugars, everything, and your heart rate to stabilize. 

Again, there are many different ways to do deep breathing. Something that I suggest that is very easy to do is the 214 technique. 2 seconds to breathe in, 1 second to hold, and 4 seconds to breathe out. The breath out should be longer than the breath in. That’s what will trigger your parasympathetic nervous system. What I suggest is that when you wake up in the morning before you get out of bed, do a minute or two of deep breathing. In the middle of the morning, you’re busy doing what are you doing? Do a couple of minutes of deep breathing in the morning, a couple of minutes of deep breathing in the afternoon, a couple of minutes of pretty good dinner time, a couple of minutes of deep breathing at bedtime, and a couple of minutes of deep breathing. And again, there is no limit. I’m just giving you a couple of minutes because that’s the minimum you’ll have to do to see the effect. But you could do longer periods of deep breathing if you wanted to. But then, repeated bouts of deep breathing are what will create that system throughout the day, which can help you because when you do deep breathing, no matter what you may be thinking or doing, it will force you to get your attention back in the present moment. You will be, and there is no choice that you make. 

When you do deep breathing, you will be forced to gather and focus on your breath, which then allows you to break from that cycle of whatever thoughts or situation you’re going through. And so something as simple as that can help to start something else that can also help is keeping 528 Hertz music running in the background. 528 Hertz that particular frequency again helps to go to your parasympathetic nervous system. There’s a lot of work that has been done in terms of music—special frequencies of music that can stimulate different tissues and have an impact. NASA has also done a lot of work on specific frequencies that can impact the body. 528 Hertz is one such frequency that has been shown to improve your parasympathetic tone. Having that in the background can also allow your body to feel more at peace. Even if the world is going crazy around you, the music frequency will give a different input to the body and allow the body to feel more centered and not scattered.

Laurie Marbas, MD, MBA

Oh. Cool.

Soham Patel, MD, FACE, DipABLM

Then there are more advanced things in meditation practices: yoga, tai chi, qigong, all those different systems. Again, they’re all different, complete systems, but anything that appeals to you that you can do as a daily or weekly routine, starting, is great. And then something else that I would suggest is, let’s say you can or don’t have time to do any of that just for one hour in your whole week and go for a walk in some wooded area. Whether it’s as simple as walking barefoot in the grass or going to a park or a state park that has trees and some water and just spending an hour there. In Japan, I think they talk about this as nature therapy. This is just two hours of nature therapy every week. Something as simple as that can also help you address the stress. If you do it consistently.

Laurie Marbas, MD, MBA

Now, I think that all of that makes complete sense and is such a simple investment in your health. But we also were speaking earlier before we started our conversation about visceral fat versus subcutaneous fat in particular ethnicities, some of whom are at higher risk. Can we talk a little bit about that in light of what you mentioned earlier? Because I think it’s an important message that people may not be aware of.

Soham Patel, MD, FACE, DipABLM

Sure. Based on different ethnicities, the deposition of fat in the body is different. What that means is we have two types of fat. We have the fact that we find it under the skin, which we call subcutaneous fat, which is found throughout the body. Then we have something called visceral fat, which is the fat that is deposited around the abdomen, around our organs, in the abdomen. The fact that it is deposited around the abdomen, organs, and visceral fat is metabolically very bad, and there are ethnic differences in different types of populations on how much preference you have for those fat deposits. If you take Hispanic populations, if you take people from the Indian subcontinent or even a broadly Asian population, there is a preponderance to have visceral fat deposition compared to, let’s say, a Caucasian or African-American ethnicity. You will see fat deposition throughout the body. 

There will be subcutaneous fat and visceral fat deposition in a more similar manner versus the other Hispanic, Asian, and Indian subcontinent populations. You will see a readiness for visceral fat. You have the same BMI (body mass index) as a Caucasian person versus a person from the Indian subcontinent. A person from the Indian subcontinent has a higher risk of metabolic disease because the deposition is primarily happening around the abdomen. The BMI cutoff for the Asian population is 23 for a healthy BMI and not 25, which is common for other populations. Understanding the difference in visceral fat deposition and being able to create a lifestyle routine where you cannot allow that visceral fat to be deposited, because as soon as you start seeing that depositing, your risk of metabolic disease, high blood pressure, high cholesterol, prediabetes, type 2 diabetes, heart disease, and cancer starts going up as that happens.

Laurie Marbas, MD, MBA

That’s perfect and then it goes back to the four things you were speaking about earlier and combating some resistance. Well, this is fantastic. Is there any final word you want to share with anyone? I think this has been very helpful.

Soham Patel, MD, FACE, DipABLM

I will summarize. The first thing I said was to identify the root causes so we can address them directly and not let your health keep getting worse over time. identifying insulin resistance, one, the signs on the face and the skin, and then the lab work we talked about. Secondly, also assess for uric acid elevations if you’re dealing with high blood pressure and then focus on the corrective steps of nutrition, sleep, stress management, and activity. Again, it’s not about perfection. I want everybody to understand and remember this. It’s about progress over perfection. Don’t get overwhelmed with perfection. It’s about progress. Identify where you are. Be very honest about what you are doing. Those four aspects of nutrition, sleep, stress management, and good activity, and then set your goals for where you want to go, break down that goal into maybe ten steps, and then start focusing on just the first step in each of those. Then, as you achieve the first step, go on to the second step, and that way, it will be easier for you to start progressing and improving your health and not feel overwhelmed. Because if you get overwhelmed or if you focus on perfection, you will not achieve the goal you’re looking for. And you just keep going around in circles, and your health gets affected in the process.

Laurie Marbas, MD, MBA

A perfect summary is that you have to start your first thousand-mile journey with the first step. Small steps will make a huge impact. By the time you get to your 1,000-mile destination, you’re done. That was incredible. It didn’t happen overnight. It was done step by step. That’s fantastic. Thank you again, Dr. Patel, for spending time with us today.

Soham Patel, MD, FACE, DipABLM

Thank you.