Diabetic Dialogue – Professor Jason Gill

Welcome to Diabetic Dialogue. I'm Sandra Ewers and we are keeping the conversation going about diabetes. We are fighting the war on diabetes. Do you know approximately 415 million people have diabetes worldwide? This is said to be estimated at 1 in 11 of the adult population. Wow. So today I would like to welcome Professor Jason Gill to the show. Jason is a professor of cardiometabolic health at the University of Glasgow. Professor Gill also took part in ITV's Fast 6 diabetes show aired in June, and we'd like to hear about the show and the work that Professor Gill does. Thank you, Jason, and welcome to the show. Hello, Sandra. I'm delighted to be here. Thank you very much. And we're very privileged to have you here. But what we really want to know, we want to know more about you. So firstly, can you tell our listeners what is cardiometabolic health? So cardiometabolic health is really the sort of interplay between cardiovascular disease and metabolic disease. So metabolic disease is things like obesity and diabetes, cardiovascular diseases, diseases of the heart and circulatory system. So being obese and having diabetes actually influences your risk of cardiovascular disease. There's quite a lot of overlap between those two conditions. Most my work is really the interface of those conditions and trying to work out best how to understand more about these diseases and who develops them, how to prevent them better and also how they work. That's very interesting. It's obviously something that we all can relate to as the general public. So what made you to decide to study in this field? Was there a link to your family history? I know that my daughter's been doing a bit of research for me and I know that both your parents developed diabetes. Correct. So was there any link to you studying. So both my parents do have type 2 diabetes. I don't think it sort of explicitly came to the forefront of my mind when I was deciding what to do, but maybe it had a role in the back of my mind, because as you know that if you have a family history of diabetes, your own risk of diabetes is substantially elevated. And if you have two parents with diabetes, type 2 diabetes, like I do, my. My risk of developing type 2 diabetes at some point in my life is about 90%, so it's quite high. And I guess that sort of knowledge in the back of my head might have subconsciously influenced what I do, but I'm basically interested in trying to improve public health. And we know that obesity and diabetes, type 2 diabetes, are really important public health problems going forward. So I want to be In a field where I think I can do the most good, and I think this is a field where there is potential to do lots of good and improve a lot of people's lives. And it's certainly needed as well. And I'm also in that predicament, and I don't want to say predicament, but both my parents too have type 2 diabetes, and my sisters, and obviously I also have it as well. So it was perhaps inevitable that I was going to get it. So thank you for telling us that. But tell us about the Fast Fix Diabetes show. So were you the inspiration behind this or was it Professor Roy Taylor? Were you working alongside him in developing this? Yeah. So the work that was behind the Fast Fixed clinic was a study called the Direct Study, that Roy Taylor from Newcastle and colleagues in Glasgow as well, Professor Mike Lean and Professor Navid Satar led. And what they showed was that if you can take people who have diabetes and you give them a low calorie liquid diet for between 12 and 20 weeks, and then you bring on board a dietitian, we have a dietitian on board all the time. But help them reintroduce food in a way that keeps the weight off. What you find is just under half of people, so 46% of people who underwent that approach had their diabetes in remission at one year. So what that means is there are people started off with glucose levels in the diabetic range, and by the end of that year, their glucose levels or their HbA1C levels, which is a marker of their long term glucose regulation, were not in the diabetic range. And in people that lost at least 15 kg, 86% of people had their HbA1Cs not in the diabetic range. So what this suggested was, with this very, very low calorie diet approach, well, not very, very, very low, but this very low calorie diet approach, you could put your diabetes into remission. And this was a little bit different from what a number of other studies that had done previously. Because what often happens is you ask people to lose a bit of weight and to increase their levels of physical activity, but the goals tend to be much more modest than this. And what this suggested is if you have sort of very aggressive goals and you try and get people to lose a substantial amount of weight, you can potentially roll the clock back. Right, I see. So what we wanted to do in the Fast Fix clinic is because this gets published in high profile scientific journals, like it was published in the Lancet, which is one of the biggest medical journals in the world. A lot of people in the population don't see that. The idea with a program like the Fast Fix is we could potentially get this message out to a much more wider range of the population than you can get with the scientific literature. So it increases the potential impact of this work by sharing it with a much, much wider audience. And a large number of people watched the program, believe it was 2.6 million watched the program on the first night and 2.3 million on the second night. So that's getting to numbers of people with this message that is relevant to a number of people that we can't get from just putting the work in scientific journals. So as a result of this, obviously you know what the results were. But let's. For example, I went to my GP last year, I was diagnosed with type 2 diabetes. I had a very high HbA1C, obviously, which is my average over three months, my blood sugar average, and I was sent away given Metformin. I'm not complaining because I feel great and I've lost loads of weight, I've lost nearly two stone. But are gps thinking that perhaps they could advise you to maybe go on that diet and support you? So the direct trial is still ongoing. They've had one year results and the trial is going to continue going and hopefully they'll get data out to four years. They'll keep following the people up for a long time to see whether the diabetes stays in remission. Right. And once that trial is completed, there will be a reasonable amount of evidence to say, well, look, this does or it doesn't work long term. And once that evidence is in place, then a case can be made that this is something or not that might be possible to introduce as a sort of a frontline primary treatment for management of diabetes. We're not quite at that stage yet, so it's not at the point where we can say, yes, we definitely need to introduce this approach in the NHS because we don't have long enough data to support that. But what we do show is that when people do undergo these diets, they appear to be safe if you do them with the agreement of your diabetes management team, so your GP or your diabetes specialist. So we think that it's safe on those conditions and we know that it is effective in about half of all cases. So there is enough evidence that people want to go on these types of diets they can do. At the moment, there isn't enough evidence to say that this is what we should do for the nhs, but that might be coming over the next few years. And once we get to that point, we can make that judgment more definitively. I do appreciate that because I also heard, and this is, you know, because they're sort of saying that you have to lose a certain amount of your body weight. If you are diagnosed with type 2, then you would have to have lost a certain amount of your body weight to sort of get it into remission. Is that correct? So the evidence showed that the more weight people lost is the more likely they were to get their diabetes into remission. So people lost different amounts of weight when they went on this program. Some people lost huge amounts of weight and some people lost less weight. And the evidence was the more weight you lost, the more likely you were to put your diabetes into remission. So people had lost at least 15 kg, which is just over 2 stone, had an 86% chance, so nearly a 9 in 10 chance of putting their diabetes into remission. And people that lost less weight, a smaller proportion of them, put their diabetes into remission overall, taking everyone in the group, irrespective of how much weight they lost. About 46% of people put their diabetes into remission. So the key thing here is there's nothing special or magic about the diet. It's the weight loss that's important. And so if you can lose more weight, you're more likely to put your diabetes into remission. And just to put a bit of background perspective on this, the reason this study was done in the first place was from evidence in bariatric surgery. So what studies showed that when you have people who have bariatric surgery, so this is the sort of stomach stapling type operations that people undergo when they're very big, is what you find is those types of surgeries, when people lose substantial amounts of weight, 20, 30 kg, generally was very effective at putting diabetes into remission. And we've got this problem in that we can't put everybody on weight loss surgery, we can't give everyone bariatric surgery and probably wouldn't want to give everyone bariatric surgery. So what the purpose of this was to say, well, look, if we can get weight loss close to those sorts of levels through diet, are we going to get the same benefit? And the evidence from direct suggests that, yes, we are, yes, we do get the same benefits and it is possible to put diabetes into remission. So may I ask you what would happen if the person is not overweight? Because I know that in terms of diabetes type 2, I understand it works from the fat around your middle. So if you were just a slim person, would it be on medication that you would be the medication or you would obviously the lifestyle change? Is that what's going to make you go into remission? Because obviously you wouldn't have any weight to lose? A very interesting question. So in short, we don't know. So losing weight will be the problem if being too heavy. Losing weight will be the solution if being too heavy was the problem in the first place. And there are a number of different reasons why certain people develop diabetes. Some people develop diabetes at low body weights for slightly other reasons. We called a bunch of different conditions type 2 diabetes. But there's evidence that genetically this is, there's a multitude of different conditions underpinning this. And if people have one of the slightly more unusual forms of diabetes which might look like type 2 diabetes, this approach may not work. So we simply don't know whether someone is a normal body weight and they do this, whether they would get a benefit or not. We simply haven't done those studies yet. Right. I appreciate that. What we're going to do, Professor Gill, was Jason, we're going to take a short break, a five minute break and we're going to just come back and have a chat with you again because it's interesting what you're saying. So if you do want to, if you do have any questions, you can tweet us. WomenFromRadioSTN WRS Women's Radio Station. Voice of Women Worldwide. Sarah's Universal Soul Show. What does your soul or spirituality mean? Mean to you? Welcome to future Classical Woman Awards with me, Stefania Passamonte on women's radio station. Welcome back. I'm Russ Cain. You're listening to in conversation with on women's radio Station. I'm Angie. 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Supporting women is our passion. We're currently welcoming donations to help towards our running costs to keep this important initiative alive. To donate, simply head to our website. Every little will help. Welcome back to Diabetic Dialogue. I'm Sandra Ewers and I'm keeping the conversation going about diabetes. We are fighting the war on diabetes and we have been lucky enough to be joined by Professor Jason Gill and Jason is professor of Cardiometabolic Health at the University of Glasgow. Welcome back, Jason. Hi, Sandra. Right, I just want to ask you something because I've been reading up on your, well, looking at your presentations of about 2014 and I know that you did one about ethnicity, environment and health and I did find that extremely interesting. So can you tell me what your findings have been regarding this? Yeah. So we do lots of work trying to understand ethnicity and diabetes risk. So if we look at places like the uk, what you find is people of South Asian ethnic origin. So people who originate from India, Pakistan, Sri Lanka or Bangladesh have about a three to four times higher risk of developing type 2 diabetes compared to people who are white European. And people who are black or Afro Caribbean have about double the risk compared to a white European of developing diabetes. And also South Asians develop diabetes about 10 years younger in life. So on average, a white European will develop diabetes at 58 years old. If you take the population in the UK and it's about 48 in South Asians, there's about 46 in South Asians, 48 in Afro Caribbean. So people are developing diabetes much younger and also at lower body weights. We've shown using data from a very large population study called UK Biobank, that people develop diabetes at much, much lower body weight, much lower body mass indices if they are South Asian or Afro Caribbean compared to if they are white European. So a South Asian person with a BMI of 22, which is really very thin, is actually at similar risk of developing diabetes as a white European with a BMI of 30. And for people who are of black ethnicity, it's about a BMI of 26. It's comparable to a BMI of 30. So people are developing diabetes at much, much lower body weights and much earlier in life in black and South Asian ethnic groups. And we're trying to understand a little bit more about why is that actually the case. Right, so the other thing I noticed as well was that you said about black people and if black people and white people and southern Asian people were living in a rural area, that they would have obviously a very slim chance of if they were living in perhaps, I don't know, I think you'd even said Africa. In a rural area in Africa, they would have a very slim chance of getting diabetes. So is that because of the diet? What is the reason for that? What seems to be happening is that when you move to the westernized obesogenic environment that we've got here, the ability to sort of buffer the adverse effect of this lifestyle seems to be lower in certain ethnic groups. For example, we just did a study which I think is a very interesting study, which we called Glas Vegas, which is the highlight of my research career, stands for Glasgow Visceral and Ectopic Fat with Weight Gain in South Asians. So what we did is we got some young, thin European men and young, thin South Asian men, as they were, body mass index 22, age about 22. We basically got them to gain about five kilograms in body weight over six weeks. And we measured them before and after. And what we found is that if you are a young, thin, white European man and you gain 5kg in weight, essentially nothing bad happens. Your body can absorb that sort of 5 kilogram weight gain and you don't become metabolically less healthy in an appreciable way. Whereas if you're South Asian, that very same weight gain actually has a very big effect on your level of insulin sensitivity, which is the level that insulin, the way that insulin regulates your blood sugar levels. Your insulin sensitivity got about 39% worse if you're South Asian with that and very small weight gain. So South Asians appear to be less able to absorb the consequences of putting on too much weight. We don't know exactly what's happening with Afro Caribbean in that respect, but there are metabolic differences between these ethnic groups which seem to explain differences in diabetes risk. The other thing with South Asians that we've shown is there seems to be differences in the way their muscle works and particularly the way that South Asians muscle is able to burn fat. So South Asians muscles seem to be less good at burning fat than European muscles on average. And we, we've shown that that seems to be linked to this level of insulin resistance as well. And we've just got some research grant for the Medical Research Council to try and investigate in quite a lot more detail about which aspects of what's going on in muscle. So is it the small blood vessels in muscle? Is it the mitochondria, which is the powerhouse in the cells that differ? Is it how close the mitochondria are to fat droplets in the cells? So we're trying to understand in quite a lot more detail about what actually is going on in the body, which means that some ethnic groups are at higher risk of diabetes and other groups. That is really interesting. And you know what's so weird? I'm so glad I listened in science at school, because I actually know about mitochondria. That's so interesting. May I ask you something? Because in terms of the fact that you did that fast fix show and you're also doing research, do you think that this is going to, well, this over the years, if you find that the results continue to be fabulous, you know, like it's positive, is that going to sort of take money away? Is that going to save the NHS money? Because I know that they're spending millions, even billions, treating diabetes. Prevent diabetes. It will save money. So diabetes at the moment is responsible for about 1 in 9 pounds spent in the NHS. And actually worldwide, 1 in 9 healthcare dollars is spent on type spent on diabetes. So that is huge. And the NHS is stretched. And what we need to do really is we need to prevent people from developing diseases because the treatment costs are so high. So if we can get back to preventing people from developing diseases rather than trying to treat them in the first place, we're going to make everybody healthier, we're going to save the NHS money, we're going to increase productivity because if you think about diseases like diabetes, they occur to people in the prime of their, of their working life. And if they, if they're not able to work as effectively because they've got these conditions, it's going to cost the economy money. So I think there's lots of savings that can be put in place. If we can work out strategies to effectively prevent people getting diabetes and other chronic conditions like cardiovascular disease. Heart disease as well, if we can prevent them from happening in the first place, we'll definitely save the country money. So can you be honest with me? Why is this happening? Because I'm even hearing that children, that they're saying that children, young children are now getting type 2 diabetes. So, so why is this happening? Is it just that we've got lazier, sedentary lifestyle? I think it is. I don't think it is. I think a lot of people say, well, it's personal responsibility and it's, well, people are just getting fatter because they're lazy and greedy. And I don't think that's the case. What we've had is a very, very big environmental shift. And there is really good evidence that the environment we live in has a profound effect on what we eat and our body weight. They've been really, really neat, very carefully controlled studies that show, for example, if you present somebody with bigger portions of food, they eat more food and they continue to eat more food day on day, on day, on day, if you give them bigger portions of food every single day. So that's what's happening. So one of the things that's happening is portion sizes have got bigger. We know that energy density, so the number of calories in every gram of food is increasing. And we know that that is a mechanism by which people eat more. So if people eat, have presented with two different types of food, one has more calories per gram and the other one doesn't, they will eat more calories. And the one that has more calories per gram, people do it and everybody does it. So the fact that we are presented with a food environment which is making us make it easier for people to eat more, is making the whole population eat more. Now, within that population, there are people who are better able to control their weight and less able to control their weight. What's happening is as a whole population, we are shifting to becoming fatter. Now, within that population, it affects people, some people more than others. And we know there's. For example, we think that a lot of the genetic differences in body weight are probably related to differences in regulation of appetite. So people often say that people who are overweight are lazy. But what the evidence is suggesting is if somebody who has genes which predispose them to obesity eats until they feel full, they actually eat more food than the person who doesn't have so many genes which are predisposing them to obesity. So they're eating for the same level of fullness, but it's more food there. So some people, we'll eat more. And what we can do is we can. It's not inevitable. These genes would only make a few kilograms maximum difference in body weight. If you take. People have not very many of these genes versus lots of these genes. It's not there's a single sort of obesity gene. What we've. What the evidence has shown so far is there's 97 different genes which have been identified and everybody has one copy of one. Everyone might have a type which makes you slightly less heavy or slightly more heavy. And what you can do is add up all the different genes that you have and work out the effect of each genes. And basically everybody can have an obesity sort of risk score. And what you find is if you have people with a higher obesity risk score, they tend to be a bit heavier than people who have a lower obesity risk score. But what we know is when you have people with a high obesity risk score, it's the things that you are in control of, such as what you eat. So whether you're consuming fizzy drinks and how physically active you are and even how much sleep you have seems to have a much bigger influence on your body weight. So in people who are genetically predisposed to diabetes, environment has a much, much bigger effect. It's even more important for those people to be much more careful about their environment. Make sure they try and eat carefully, make sure that they are physically active and also new data showing that make sure they get enough sleep at night. That's some very interesting information there. And we really want to thank you for all the, all the information that you've given us and obviously listeners out there, you know, if you do think you have got diabetes, then obviously don't forget to go and see your GP or a health professional. Professor Gill, Jason, I'd like to thank you for taking the time to come to this show today on women's radio station. Thank you very much, it was very interesting. It's been a true pleasure. Sandra, thank you very much. You are very welcome. Bye bye. Thank you for listening to diabetic dialogue. And I'm Sandra Ewers if you have any questions, you can email us@presenterswomensradiostation.com or in turn, you can tweet us @womensradiostn. Thank you very much for listening. Welcome to Women's Radio Station, the voice of women worldwide. Hungry? 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