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लठ्ठपणा आणि मधुमेह याचा संबंध तसंच समस्या दूर करण्यासाठी ईटीव्ही भारतनं डॉ राकेश कलपाला यांच्याशी संवाद साधला. (#ETVBharatAgainstDiabetes) रम्या के. यांनी घेतलेली त्यांची मुलाखत.
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00:01Today we have with us renowned doctor endoscopy and colonoscopy specialist
00:06Dr. Rakesh Kalpala let us ask him and get more information about diabetes
00:12obesity and the related issues hello sir so first of all we are very glad to
00:18meet you and most of the times we all feel that diabetes is all about sugar
00:23levels but how the gut health is impacting on the diabetes very important
00:29by my so what we think in general about diabetes is diabetes is because of some
00:34problem in the pancreas some problem in insulin production and all but directly
00:39or indirectly gut is related to diabetes why is it happens is because gut the
00:47intestine has got some substances which are released exclusively in the second
00:53part of intestine small intestine which are called GLP and GIP analogs
00:59because the incretins and now in fact if you see the GLP-1 analogs are the drugs
01:05which we use in weight loss and diabetes management so those hormones are
01:10specifically released from the second part of duodenum that is the interest small
01:14intestine and if there is a something called as a leaky gut syndrome where the
01:22duodenum doesn't secrete these hormones properly that leads directly to low-grade
01:29inflammation which leads to diabetes because the endotoxins migrate out and
01:36then these lead to impaired production of these hormones what I talked about and
01:41that will lead to diabetes so gut is direct gut health is directly related to
01:46impact on the diabetes most of the times when we talk something about gut health
01:51the first thing that comes into our mind and the discussion goes through the gut
01:55microbium so how important to have a good gut microbium and what is the key role
02:00that it is playing so gut microbiome in fact if you see you will it's a mind
02:06boggling number of one trillion bacteria are there in our gut and which is
02:11impossible to synthesize so you have good bacteria and bad bacteria when the bad
02:16bacteria dominate good bacteria in the amount that leads to all these
02:20discrepancies for example you have this good bacteria like lactobacillus
02:26bifidobacterium there are some species when these are depleted or decreased in
02:31amount in the gut that leads to imbalance which leads to release of some toxins these
02:39toxins go from the intestine and reach into the blood circulation and that leads
02:45to the disparity of this hormonal balance leading to diabetes obesity insulin
02:52resistance and all the other metabolic diseases what we call so that's the way it's
02:57very important sir in general view there is this thing that people who are obese
03:02they'll most of the time they'll develop diabetes but when we see when it comes to
03:08the Indians the people are very low weight or lean also they are also developing the
03:12diabetes why it is it so yeah it's very valid point in a very nice question in
03:18fact diabetes India is the diabetes capital of the world but not all of us are
03:23obese even if they are obese also most of the obesity is around the trunk area which
03:28is called a centripetal obesity so our body the trunk the upper part is thin legs
03:34are thin but the middle part is wide wide heavy so that is what is called as
03:39there are different types of fat in the body visceral fat then you have the
03:43subcutaneous fat so our visceral fat is basically the fat between the viscera
03:49viscera means organs that is the fat in the liver fat in the pancreas fat between
03:54the intestines so that is all fat distributed so our fat is distributed
04:00around that with centripetal obesity and this visceral fat will lead to release of
04:07this pro-inflammatory cytokines we say that is they produce inflammation they are
04:15pro-inflammatory so they are friendly to inflammation and this increase in
04:19inflammation leads to release of the toxins as I said before into the blood
04:24stream and that leads to these hormonal changes so this visceral fat is a
04:30culprit in fact I always tell my peer group people and all you develop some drug
04:36which directly hits visceral fat unfortunately there is no drug till now so
04:40that is the game changer and that is what the science is now working on to do
04:45something where you can directly hit the visceral fat so as you mentioned about
04:50some drug must have come to come for the visceral fat is there any companies or
04:55the hospitals which are working on it is there any research going on it yeah so
04:59in fact we are one of the pioneers in the world working on the visceral fat so our
05:04concept is there is a entity called metabolic diodynopathy which is a
05:09evolving entity so duodenum is second part of small intestine and there are
05:14some change lot of changes the duodenum is now considered as the second brain of
05:18the body so entire nervous system that is we call it in medical language enteric
05:25nervous system that means gut and brain enteric so entire enteric nervous system
05:31ENS is concentrated in the duodenum so for example you have this neuronal hormones
05:37called serotonin and all you must have heard of so earlier the concept was
05:41serotonin is produced by brain but that is wrong now 85 percent of body
05:46serotonin comes from duodenum so if you try to manipulate the duodenum by doing
05:52some procedures so for example I am working on endoscopic procedure where you
06:00ablate that is you kind of burn the duodenum mucosa so if you do that you
06:05will have a change in increase in your hormonal production then the gut
06:11microbiome changes and even this enteric nervous system serotonin production and
06:15all increase so these are the major research points going on and I am very
06:22confident in the next one to two years we will come up with something which will
06:28address diabetes which will address visceral fat and which will address
06:31obesity so we are already doing on that research so it was what stage the
06:36research is going on and when can we expect for the common people to get
06:40these kind of treatments yeah so it's a little confidential I should not open it
06:44out but because you asked probably I can say it is the phase 3 phase 4
06:48clinical trial we started the recent human trials and as you know like
06:53science is a slow subject so it will take at least another one year for us to
06:59come with positive results and once we have the results positive then we will
07:03make it a market available device so you just mentioned about endoscopy
07:11procedures most of the times for the weight loss when people are OVs they go for
07:16the surgeries so what does the difference between the conventional
07:21surgeries and these endoscopic surgeries yeah so again it's a very valid
07:26question because now with the era of drugs these things are still there but
07:32people want first fast and ready-made therapy so the difference between
07:38endoscopic and surgical bariatric interventions what we call is surgeon
07:42surgery wise they cut or they resect one of the for example if it is sleeve
07:48gastrectomy they call they cut the stomach and make it small size and if it is a
07:53bypass then they bypass and then join the intestine with stomach and all so
07:57what we do in endoscopy is two or three things rather one we decrease the
08:03stomach size by suturing it with endoscopy device which is a daycare
08:08non-surgical no scar or put a intragastric balloon so this is basically to
08:14decrease the appetite so that the person who is binge eater will lose weight
08:19with these things second thing what I I mentioned about just doing in the
08:25duodenum is basically more for diabetes and other metabolic disorders
08:30indirectly it will also give a weight loss sir when it comes to the food habits
08:35and lifestyle changes most of the people times when we met doctors and we discuss
08:40about the diabetes they will say that it is completely the lifestyle changes that
08:44we have to adopt but what are the main reasons that are leading to diabetes and
08:49obesity and how these both are interlinked yeah so there is a term called as
08:54diabetes diabetes and obesity so the main reason for this as you said
09:00lifestyle of course sedentary lifestyle is the big enemy and the foods what we have
09:07now this is a fast fast food what you call zamana as well as fast ready to go ready
09:15to eat ready to go so with our busy lifestyle so whatever comes in hand you
09:20take it and they're all fast I mean easily made ones so ultra processed food if you
09:26ask me or the biggest enemy for the human race in this current world unfortunately
09:32we are hopping on that so the fermented foods the naturally available foods
09:38vegetables fruits they have become a small portion and these have dominated
09:43that and we have to blame ourselves not anybody and the food industry also is
09:49been driven by these things so the main reason for diabetes and obesity is this sedentary
09:58lifestyle with I don't say unhygienic but unhealthy food okay okay so just a few
10:04minutes back we just discussed about the trunk part weight most of the Indians are
10:10developing the belly fat why is it so is there any particular reason to develop
10:15those kind of fat particularly no there are multiple reasons one is genetic of
10:20course the predisposition is one second our body contour is in that way where the
10:27fat accumulates more in the central part of the body third of course lack of
10:31exercise in physical activity so by and large if you ask me it is more of our
10:37body nature because if you see the western population they have more of
10:41subcutaneous fat they are bulky heavy and they have fat distribute from head to
10:47toe equally proportionately but for us we are different our morphology is
10:51different so probably I would attribute it to genetic as well as the
10:54morphological features sir when it comes to the diabetes and gut issues recent
11:02times we are hearing that GERD cases are increasing why is it so what exactly is GERD so I
11:09always say of course GERD basically stands for gastroesophageal reflux disease and I
11:15always tell everywhere wherever I go there is no person on this earth who
11:19never had a GERD GERD that means all of us belch all of us burp all of us will
11:25have heartburn so that happens to anybody who is a human being so that is so
11:29common the reason why this happens is you have the eusophagus the foot pipe the
11:37stomach and there is a junction between the eusophagus and foot pipe called
11:41gastroesophageal junction it's a valve so if the valve is loose or if there is a
11:46high acid production then this that leads to reflux that is a reflux disease but
11:53in terms of the subject what we are talking obesity is one of the main
11:57predisposing factors for GERD GERD we call it GERD because when you are obese
12:03there is a lot of pressure from the external fat onto the stomach and that
12:10in turn leads to pressure on the valve that in turn leads to pressure on the
12:14esophagus that is foot pipe so any person who is having high I mean abnormal body
12:21weight that leads to directly this GERD symptoms and vis-a-vis GERD itself also
12:31say the what happens is people who have GERD they tend to eat a lot because if
12:37they have a little empty stomach the reflex starts coming so they fill the
12:42stomach by eating more more frequently and that when you eat then that will
12:48create a layer in the stomach and this acid won't come up as soon as you
12:53digest and then the food goes down into the intestine again you will get the
12:57reflux again they tend to eat so this is a vicious circle so that is what is.
13:01Generally we all burp as you mentioned we all have some heart burning issue most of
13:07the times at least a week once in a week very common it when it comes to the
13:11burping is it that danger to have such kind of symptoms or when we have to
13:17consult a doctor about this GERD symptoms? Yeah so very nice question in fact
13:21burping and belching is a human tendency it's a it's a physiological process it
13:26is not abnormal but when it happens more number of times that is abnormal so
13:31especially one continuous heartburn where you feel that burning sensation in
13:37the eusophagus and somewhere in the stomach that is one and which happens
13:44chronically and then you have the symptoms persisting. Second if you have
13:49difficulty in swallowing so that means that the food pipe has narrowed down and
13:55third belchings as I told you there is no number that you should have 10 belchings
14:00only that is good and 15 is bad but if they occur frequently and it is
14:05impairing the quality of life and especially in belching or burps what we
14:10have to understand is when what the food we eat comes up in a very sore taste
14:15which will you know give you a tendency of some soreness in the mouth and also that
14:22bitter taste or more of burning sensation. So these are the symptoms which you
14:28have to be very cautious and then if you take a antacid tablet and it doesn't
14:34subside then you have to have a attention to doctor. Why because the symptoms as
14:40such if it is only GERD fine you can take some medications but sometimes if they
14:44are long standing that might lead to cancer of early cancers of the eusophagus or
14:51the stomach so that is the one. Are these GERD diabetes and obesity these three are
14:57interlinked how much impact does that obesity and GERD having on diabetes sir?
15:02Very much. So what happens is obesity as I told you that is the reason for GERD even in
15:09diabetes diabetes is a condition where it directly affects every neuron that is
15:16nerve cell of the body so there is something called as diabetic neuropathy. So
15:21diabetic neuropathy occurs mostly in the lower limbs and they will have the
15:25numbness but diabetic neuropathy also affects the neurons of the other parts
15:32of body. So the whole gastrointestinal tract has also got neurons which we
15:37don't generally discuss. So that neuronal activity decreases if there is
15:44long-standing diabetes in the form of something there is a term called
15:48gastroparesis. What happens is when we when the patient is obese or diabetic or
15:54both when we eat food it usually takes couple of hours to churn itself in the
16:02stomach and then it will go into the intestine. In diabetics or in obesity
16:07people that will stay long instead of churning and then getting out in half an
16:13hour to 90 minutes or something it will stay for 4-5 hours there and when the food
16:19stays there without getting down into the intestine that leads to reflux and that
16:24leads to GRD simple thing and obesity as I told you so these two are main
16:30predisposing factors for GRD. We discussed about the endoscopic bariatric surgeries and
16:37conventional bariatric surgeries but in these recent times when we see people who
16:42are most of the people are consuming some tablets or the powders to lose some
16:47weight. How does those powders and tablets are going to impact the diabetic
16:52people who are obese and when it comes to the normal people also how
16:57dangerous they are or those are very healthy to have. Yeah so see basically these
17:04drugs what are there in the market now are going to decrease I mean they are
17:10helping for decreasing the weight as well as diabetes control but what exactly this
17:14drug is doing is important what happens is when you take this drug that is going
17:20to create that artificial gastroparesis what I told so that will make the food to
17:26stay longer instead of getting into the intestine so that leads to decrease in the
17:33hunger and then you don't feel like eating you eat one meal after few hours then
17:38you get that hunger again because this drug is going to make the food stay for a
17:44longer time so that again leads to GRD so that's a reason why instead of
17:49depending on these drugs you should have a natural way of weight reduction. To have
17:53natural way of weight reduction also some people goes drastic diets and yeah
17:59intermittent fasting and those intermittent fastings or the drastic diet
18:03changes how they impact our gut health and the diabetes. Yeah so intermittent fasting has now become a little
18:10controversial subject earlier it was accepted but now again we only are yeah so we are saying it's not
18:17good for all the first and foremost is as one size doesn't fit to all so no one diet is
18:24common to all
18:25every person they have to have their own diet according to their body mechanisms and these intermittent
18:33fasting is helpful for some people I'm not saying I'm not completely denying it but again some people
18:39intermittent fasting will cause a little more deleterious effects side effects if they are not done
18:45properly then there is a term called circadian rhythm so the circadian rhythm of each person varies and
18:53then you should follow that circadian rhythm for example you should not have a very late night
18:58meal and early meal is good then as soon as you eat you should not lie down you should have
19:05at
19:05least one or two hours sitting standing walking the new concept now is after dinner it can be six
19:12o'clock seven o'clock at least 15 to 20 minutes of walk is mandatory so these are the new
19:18concepts evolving
19:19and as I told you I I I re-emphasize again and again it's individualized it's not same for you
19:26same for me or
19:27same for anybody else
19:29So then as you mentioned it is individualized if one person is diabetic and he's obese then who he must
19:38have to go and
19:39consult and what kind of system he must have developed and adopt so this is again a very practical question
19:47person who is obese and diabetic or only obese only diabetic I always still have a holistic approach so if
19:57you want to visit you visit an endocrinologist they will give you only the medications if you visit a
20:03gastroenterologist they will give you only those gastric related medications and a nutritionist will give
20:09you only the nutrition part so it should be a holistic metabolic clinic concept which has to evolve
20:17everywhere and the person who is obese with diabetes should be seen by all means not only as an individual
20:25tubular vision and if you want to choose the doctor obviously you cannot have everywhere all these team
20:31work in metabolic clinics but ideally in our given time frame of options a good nutritionist and a good
20:43metabolic specialist he can be a he or she can be a diabetologist or endocrinologist or a physician
20:49whoever so these two should be mandatory to have okay so you just mentioned about walking after dinner so but
20:58is
20:59general walking some sometimes when we go through and we discuss with some people some people suggest
21:05that slow walking is good for the reduction of the weight and fats and some people say go for the
21:11fast
21:12brisk walk some says are the weight lifting or something those kind of core workout is good what
21:21exactly is good for the diabetic people and for the people who are having gut issues also so exercise is
21:28a
21:28very key key important factor and now the concept of exercise is evolving into a next level so earlier we
21:36used to say
21:36walking it can be brisk walking normal walking but sometimes brisk walking till you sweat or cycling or running
21:45these things or this cross trainer also is something which commonly people do so those are all aerobic activities
21:52but equally important is strength training so there is a concept which is rapidly evolving now called muscle
21:59metabolism because obesity as you know there is a entity called sarcopenic obesity the person looks obese but if
22:10you see his muscle mass it is totally bad so that is called a sarcopenic obesity where your muscle mass
22:17is very bad very low
22:19but you look very obese so in those people especially when you start these weight loss drugs or you get
22:26these
22:27procedures then they will have a rapid not only loss of weight but loss of muscle mass also and that
22:36leads to
22:36very bad quality of life so strength training is equally important in fact now if you see that standard dictum
22:44of 150
22:45minutes per week walk and all those two days of strength training which includes this weight lifting under the
22:53supervision of a trainer if you can or even otherwise is mandatory because strength training and the aerobic
23:01activities both are important and the muscle metabolism if it is doing good that leads to a positive effect on
23:09your
23:10diabetes control as well as weight loss and obesity also so finally what the message you want to give for
23:17the viewers who really want to adapt a good lifestyle to avoid type 2 diabetes and who want to live
23:24a healthy life so in a
23:27nutshell what we discussed what I would like to put upon is in fact I would add a little more
23:32lifestyle changes
23:34include good healthy food balanced diet more vegetables fruits and fiber diet then less of the carbs and processed
23:49foods and more important is the circadian rhythm what I spoke about sleep is very very important the sleep cycle
23:58is now center point of metabolic control so the better you sleep the better is your metabolism and physical
24:07activity which we already touched upon so it should be a disciplined lifestyle which includes lifestyle
24:14modification food habits under control sleep rhythm under control and a positive frame of mind which is the at the
24:24end
24:24of the day you might be earning millions and trillions or you will be struggling to get some job but
24:32if your
24:33mental health is good your physical health will be good thank you sir thanks thank you so much so this
24:38is
24:39all about how metabolic issues are impacting diabetes and how obesity and endoscopic
24:46procedures are helping to reduce obesity and insulin resistance
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