Alcoholic Fatty Liver

i think that type two diabetes isan absolute catastrophe worldwide. this is probably the "greatest health catastrophe" of the century. our food environment is setting us up to fail. as a problem that, we, as society are grappling with and particularly for childrencoming through. we are just not doing it with any sense of urgency whatsoever. 40 years ago, type two diabeteswas almost unheard of. today, almost a quarter of a million new zealander's live with it and that is not including theone hundred thousand more

that have it and do not know it. yet, type two diabetes is entirely preventable. we are all supposed to have controlover what we put in our mouths. so, what has happenedto us so quickly? brian kairua loved his jobas a youth social worker, but last year, type two diabetesforced him into early retirement. now that i am at endstage renal failure, you cannot help but want to kick yourself for not listening to the professionalsand being too stubborn.

pretty much devastated my bodybecause of all the poor choices i made. five years ago, brian wasgiven ten years to live. you do not think about diabeteswhen you first get it. i seldom went to doctors appointmentsthat i was supposed to go to. i never took any medication. i am less than half of the guy that i use to be now that i'm in a wheelchair. and now i have lots of regrets. five weeks ago, i was admitted into hospital

because i had a hypoglycemic episode. i just about "went" for good. you get lots of bugs whenyou are on dialysis. so i had a bug in my blood and that bug had settled intothis infection in my hip. and as a consequence i could not walk anymore. they got that under controland it came right. then unfortunately, and they looked at one of my toes and they said, "that toeneeds to go."

i heard that when you have poor diabetes you can have amputations but i did not think that my toe was that bad. i said, "nah its all good mate it will come right." it is an "out of it" diseasebecause it seems like people do not take too seriously. i did not even know what diabeteswas when he was diagnosed. type two diabetes will cut ten years off your life, number one cause of amputationbeyond car accidents, number one cause of preventable blindness,

number one cause of impotence in men, number one cause of kidney failure,dementia, doubles your risk, doubles your risk of heart disease. this is not a benign disease. so, how do people gettype two diabetes? years of high blood sugar or glucosestops insulin from doing its job. and insulin is the magical hormone that allows the body to turnglucose into energy. we get most of our glucosefrom carbohydrates,

especially sugar. and we are consuming well abovethe recommended limits. the reality is we only needabout a teaspoon of sugar to maintain our blood sugar at the right level, the rest gets stored inour muscles and liver. but the problem is becausewe eat too much of it, it goes to the liver and itgets converted into fat. there is a complex wayin which being fat, particularly the fat you cannot see,the fat in your liver,

the fat inside your tummy, andthe fat in your muscles, means that insulin doesnot work properly. and it is that that ultimatelyleads to type two diabetes. the epidemic of type two diabetes threatens to overwhelm thenew zealand health system. so diabetes new zealand is out in the community to help diagnose it before it is too late. (man) better to heed the warning now than later eh? (lady) that's right, very good.

people think because its in the family they do not have to doanything about it. they think, oh ok, my family has got it, i will leave it at that. and, if i get diabetes i will get it. they do not understand that there are stages, and there are steps that they can take to lower their risk ofdeveloping diabetes. i know it is a pretty severe condition that most maori and pacific people suffer with.

it is something that we can prevent,i know that much about it. ropata adams-walker is worried that his unhealthy diet has put him on the road to diabetes. how is your day going? pretty good. i was walking past and thought i had better come and see what this is all about, and see what my chances are. this simple blood test will reveal if further testing is needed.

while ropata's blood sugar levelsdon't make him diabetic yet, he is overweight and has high blood pressure. he has been told to see a gp. i feel sorry for my family membersthat are suffering with diabetes. it's something i would like to prevent, tobe able to be around for my children. i have hit 30, so i have to dosomething now or never. this is my antibiotic setup tableand all of this here is purely to combat the infection in my hip. first i started losing my vision,

then the sensation in my lower legs, and then in my feet. now i have kidney failure andthat is where i am at the moment. this is something i have to do four times a day. and this it is going directly into my artery, and rushing down into my hip, i hope. high levels of sugar in the blood, or sugary blood going roundand round the system damages the blood vessels, both very small blood vessels like in the eyes, the kidneys, and the feet.

as well as medium size arteriesin the heart and in the brain, because these arteries, it's like rust is to pipes sugary blood tends to cause little blockages in the small blood vessels and also hemorrhages. then in medium blood vesselsin the heart and the brain can also have blockages leadingto heart attacks and strokes. ropata has come to his gp for a more accurate picture of his diabetes risk. (ropata) i fit the criteria of a diabetic.

it's not uncommon to be diabetic without knowing that you are. if anything there is a fearof not knowing whether i am or not. i know it's a silent killeramongst our people. your reading is 8.6 what does that mean? readings should be between 5 and 7. a finger prick test showshis blood sugar is high. now he will be sent to a lab

for a more accurate readingof his glucose tolerance. about five years ago i had a scare of becoming diabetic. so i took the precautions of joining a membership at the gym to help try and fight back. (doctor) are you workingat the moment? nah, i think that contributes a lot towards the stress as well. you make a few lifestyle changesthen there are barriers that stop you, to allow you to get backout in the workforce. hence that overwhelming feeling of stress.

one door opens and beforeyou even get a foot in the door it gets slammed straightin your face. on a daily basis we see lotsof patients with similar problems. stress has become a verycommon problem, and it's one of the riskfactors for diabetes as well. you have got a family history, your weight is in the obese range,and you have a stressful life. all of this puts you at a higherrisk of getting diabetes. what stress tends to do it causes secretion of stress hormones,

and those stress hormonescortisol and adrenaline can actually help createglucose in the body. stress and guilt are the common things that drive obesity. guilt about being fat because no onereally wants to be fat or obese. feeling it is their fault. and stress because you sleep badlybecause your cortisol levels shoot up and that drives your blood sugarsup and then you get insanely hungry. and what you want is comforting carbs. you want chocolate and all those lovely foods,

which the food manufactures have carefully created to satisfy those urges. brian's parents had diabetes,but raising four children on his own meant that he had little timeto think about his own health. now his kids are adults, it's his mokopuna he wants to be healthy for. at the very beginning dad just did not care. he use to run around the bush,hunting, all sorts of things, and now he is stuck in a wheelchair. so... i stopped caring when he did, i guess.

and now he cares a lot but it's too late. there were those days when doctorstold him to eat salads... but what is the point now?is it too far gone. i don't care he can eat whatever he wants. i know he is scared. yeah. he has lost so much weight. he has always been tough. he has always tried to be "the man."

but these last couple of years,he is actually breaking down. it's sad that he's not takenthe necessary precautions, earlier to prevent something like this from happening. we always had bread and butter, you had to stretch it out becauseyou had four hungry kids. we were only allowed threehot chips per sandwich. $10 worth of hot chipsthat's a lot of sandwiches. i cannot remember a single time we had vegetables when we were young. a lot of fish and chips.

it was simple diet back in those days, potatoes, mince and bread. and always a bottle ofcoke or sprite in the fridge. that was about it, meat, bread, salt... meant, bread, salt, butter... ...meat, bread, salt. i'll grab the grandchildren, feedthem all that terrible stuff that you can get diabetes from... duh....

but they are kids, they are young, and you think why not? but it is really cool that they love their pappa, and they know theirpappa loves them. i let her have a little glassof fizzy drink sometimes, not all of the time becauseif i get caught... i get a hiding from my "mrs". the progression of diabetes complications is by no means inevitable. and it is very closely linked to the level of control that people that people have with theirblood sugar levels.

i don't think people are to blame. it's a complex interaction betweenthe biology, society, the food and nutrition system we have, and the environment we live in. our world has changed andour biology has not changed. we are mismatched to the modern world. while there is a tendency to think that even in adults it's all about voluntary choice in behaviour. it is not as simple as that.

there's a lot of biological drivers that are set up early in life, which are hard for people to change. ropata has six childrenand one on the way. looking after his own healthis not a high priority. because i have got young ones,they are the motivation. it's confusing, not knowinghow to diet properly, and especially when you liveon a set budget. i have got four children withmy partner now, and two to two previousrelationships.

with the stressors of life you tend to forget about dieting, and you want to go backto your comfort foods. $1 pie, and you can get two piesat the cost of a fancy lettuce. when you weigh up those optionsto someone who's on a budget who doesn't have much money,and has a lot of people to feed, which would be the cheaper of the two? it's hard to break free of the cyclewhen it becomes a normality. they explain to you to drink waterto help you feel full, but an hour later maori boys are hungry.

so you get a bite to eat, a quick burger,that will last a good hour or so. (narrator) diabetes does tend to run in families but that might not be entirely genetics. the biggest factor is families all have similar diets and lifestyles. (brian) my dad died of renal failure, his younger brother also had diabetes. my mum has diabetes, and my youngestsister is also a type two diabetic. i like my steak blood-red just about running around a paddock. they've put a massive bbq on,and lots of salads.

normally i can't see the salad because i have really bad eyesight, so i will probably justeat meat and bread. i think a lot about my own kidsand i hope they are bright enough... because i have made a big stuffup of it, that they don't do. he has always cared abouteveryone else before himself. my kids don't drink fizzies, i limittheir lollies, and sugar intakes. i say, "do you want to end up like granddad?" "do you want to endup with no teeth?" i've put my kids through so much this year.

i was in icu for ten days. it was the biggest shock of my life. i never thought i would end upin somewhere like there. i nearly "went" a couple of times when i was in there. i had to have three operationswhile i was in there. i was sedated heavily. and on an artificial ventilator. when i came too, all my children, and my family, my brothers, my sisters, my mum, were allaround my bed.

my daughter in laws, theywere all there. you don't realize how much lovecan fit in one room, until you see it in their faces. i had tubes down my throat and i couldn't talk. but i could see their loveand i could feel it. i tried to tell them that i was sorryfor making them all worry. (narrator) the diabetes epidemicshould be avoidable. but we are surrounded by foodthat makes us fat. we need action on a population level,

but individuals can make changesto their own diet. nutritionist caryn zinn, is on a mission to show that healthy eating can be affordable. i believe you have beento the doctor today? yes. i am boarder line and haven'tyet been diagnosed. what sort of foods doyou normally eat? we eat a lot of packagedand processed foods. noodles.

we try not to but when you'reworking with a budget, we are limited on the options. ok, carbohydrates, eating lotsof breads, lots of cereals, lots of cereals, and lots of muesli barsactually make you hungry. if we eat a diet that is very high in carbohydrate, your blood sugar will need to control that, and your hormone insulin will be secreted to help control your blood sugar. so instead of getting highs and lows,

like we do throughout the daywith lots of carbohydrate, the way forward is reducing the amount of carbohydrate that you eat and improving the quality of carbohydrate. eating carbs from wholeunprocessed foods, vegetables, fruit, milk, and yoghurt,and legumes, like lentils and chickpeas, whichare a cheaper source of protein. those carbohydrates are goodquality carbohydrates. eating whole unprocessed foodsis how we should all eat. but it will be particularly beneficial for you

because it will keep youinsulin levels down, which is what you want for your diabetes. we are going to attempt to make homemade burgers, with garlic in it and mix it together with the mince. one of the more difficult thingsabout diagnosing diabetes is that you can go to the doctor and have your blood sugar measured, and the blood sugar could be normal. but your hormone insulin could beraised throughout the day. so while your blood sugar is reallyimportant to look at for diagnosis,

it's your insulin which is just as important, but the doesn't happen at themoment with diagnosis. so that's another reason that youkeep your insulin levels down. one of the simplest message is to have a full fridge and an empty pantry, because it means you have lots offresh ingredients in your fridge. you can lots of frozen vegetables in your freezer. and apart from having spices and that in your pantry, if it's empty it means there's nota lot of packaged stuff in there. (ropata) so, that's a good thing?

yeah, that's a good thing definitely. this way of eating is not abouteating a lot of meat or protein. do you know what happens to proteinif you eat too much of it? (ropata) does it go in with your stored fat? interestingly, it gets turned into sugar. (ropata) to be honest, i would normally have two patties on one burger. and how many burgers? (ropata) two and a half. that's a lot of protein.

(ropata) when you're brought up starving... you want to eat as much as you can. see these all look like little cupsand what you can do is put in... some red onion, tomato, a bit of beetroot and then mayonnaise. so, you can then coverit with the other side. and here's your burger! (ropata) (laughs) thank you so much. mmm, it's actually better than a mcdonald's one. (caryn) oh that's good to hear.

(ropata) i've learnt that healthy food can taste nice and that it's very easy to cook. people eat poor quality foodbecause it's there. if it wasn't there they would not be eating it. in my older days of being a dietician, i would look at people who were overweight and think it was their fault, and think they were lazy, undisciplined,and had poor food choices. now i believe quite differently about it. i think the environment is setting us up to fail.

and also the physiology is driving as to eat. sugar is addictive. so when you eat a lot of sugar, and a lot of fast-food, that drives to you eat more. so, it's not the fault of the individual, it's the fault of what's happeningto the physiology, as a result of eating this poor quality food, which is cheap and everywhere. (bassy music)

(narrator) for 16 hours a week, brian is connected to a dialysis machine. he's been doing this for five years. when i am on the machine,you get really cold as the blood leaves your body,your core temperature drops. i am in a lot of pain at the momentbecause of my feet. if my feet weren't such a problem,i would be a lot more relaxed. this has become a part of my life now. it's weird thinking your life dependson this machine

and how well it keeps you clean of all the toxins. this is me, this is my realsystem right there. we have three shifts, morning,afternoon, and evening shift. life length on dialysis is four to five years. but the evidence of our patientsis five to ten years. i believe this indicatesof our better service. it's causing a massive impacton our economy in terms of the healthcare costsand loss of productivity. and it's been very hard to find a figure on that

but it's in the order ofthree hundred million in direct costs to the publichealthcare system. it's going to be a long term trend and i think we're going to see thenumber of people with diabetes, coming through the hospital doors only increasing. (narrator) the results are back from ropata's blood glucose test. i've come in for my test results, and if the worst comes to worst with diabetes, i know that i am on the right track,

that i have started my journeyto healthy living. (doctor) i've looked at your resultsand the good news is that you don't have any diabetes at this stage. but i did see some changesin the liver test. (narrator) ropata has fatty liver, which can be caused byinsulin resistance. and is often associated withtype two diabetes. fat in the liver and pancreascan be far more dangerous than more visible fat.

about 20% of people with type two diabetes are not overweight. (ropata) choice. people may well be what we call thinon the outside and fat on the inside. that means they appear relatively slim for their actual body fat in their key organs. what happens is you put on weight,particularly abdominal weight, weight around your gut, visceral fat, then this tips over and starts to fill up the liver and the pancreas. and when these two organsstop "talking to each other"

that's when you have serious problems with insulin levels and therefore you tip overinto type two diabetes. but there is a long build up to it,many years during which maybe you haven't been as activeas you once were, eating badly, you get the development of somethingcalled insulin resistance. and all of these things contribute. but in the end it is about central obesity. (ropata) i've come to realise now i'm in the driver's seat of my own life, and that i have control on the outcome,

which as given me an incentive tostart regular exercise and start dieting. although i look a bit flabby in the mirror, i can see the full potentialthat my body could have. exercise actually is important, because it's not just the effect of exercise on weight, but it's the effect of exercise on the whole glucoses metabolism and being able to get rid ofglucose out of the bloodstream. i go agree that the dominant driverof this increase of weight and obesity that we are seeing in almost all countriesis due to increase in energy intake

rather than reductions in physical activity. (narrator) brian has already had his toe removed, but that hasn't stoppedthe infection in his leg. now doctors want to cuthis right foot off. (brian) the leg didn't look nice,the foot was all mangy looking. the doctor took one look at it and wanted to chop it, take the whole leg. and i was readyto run if they did that. so, doctor bevan said, "it's goingto be along run brian, but we will try our best." so,i was happy for the long run.

it's just a necessary thing of diabetes that your circulation is going to be poor. because the circulation is poor the healing factor is poor. and then you may lose a toe,two toes, four toes, half a foot, and then eventually a foot. they say that once the surgeonsbegin to chop it's pretty hard for themto stop after that. we are not even beginningto see the beginnings, and also we're not going to see the end of this particular disaster. predictions in new zealand are doublingof diabetes within the next twenty years.

already doubled in the last ten years. in the uk, rates of pre-diabeteshave tripled in the last eight years. up from 11% to 36%. this is only the crest of the wave, and when i say crest of the wave,it's the crest of a tsunami. at the bottom of the crest of the tsunami. i think governments are finally going to be forced to act because it's going to bankrupt the health services all around the world. in our next program, christinahas dealt with type two diabetes

for more than a decade. people get quite judgementaland when you're eating at a function or somewhere,then someone says, "should you be eating that?" i get really annoyed. i don't want to be too skinny,because i will look too sick. and brian faces further amputations. desperately trying to keepit under control and trying to hang on to these little tiny limbs i have left.

i'm not on the winning sideof that battle i'm afraid.