This November, let’s delve deeper into the intricate link between type 2 Diabetes Mellitus and men’s intimate health
November is designated as Men’s Health Awareness Month and Sunway Medical Centre Velocity (SMCV) in Kuala Lumpur, Malaysia has taken the initiative to shed light on a pressing health concern that affects men at a higher rate than women – Diabetes. According to the Centers for Disease Control and Prevention (CDC)[1], men are more likely to receive a diagnosis of diabetes than women. World Diabetes Day on 14 November is an opportune time to delve into the intricate link between Type 2 Diabetes Mellitus and men’s health, with a specific focus on how diabetes can contribute to Erectile Dysfunction (ED), impacting men’s overall well-being.
Men and Diabetes: A Closer Look
This increased susceptibility of diabetes among men can be attributed to several key factors, including hormonal differences and body fat distribution. Hormonally, females have a more favourable effect on insulin sensitivity, with research suggesting that estrogen plays a role in enhancing it[2]. Sunway Medical Centre Velocity (SMCV) Consultant Endocrinologist and Internal Medicine Physician, Dr. Kim Piow Lim explains.
Testosterone enhances glucose-stimulated insulin secretion and reduces inflammation, leading to improved beta cell health. However, research has shown that lower testosterone levels in men are associated with a greater risk of Type 2 Diabetes[3].Another contributing factor is body fat distribution. Men often carry excess weight around their abdomen, a pattern known as central obesity. Visceral fat distribution is associated with a higher risk of insulin resistance, metabolic syndrome and Type 2 Diabetes.Low testosterone level in men can increase visceral fat leading to increased risk of Type 2 Diabetes compared to women.
Dr. Kim Piow Lim, Consultant Endocrinologist and Internal Medicine Physician
ED and Diabetes: an unspoken challenge
While the management of blood sugar is a central concern in diabetes care, it is crucial to recognise that diabetes is not limited to its physical manifestations. It can have far-reaching effects on a man’s overall well-being and quality of life, with one such consequence being Erectile Dysfunction (ED). Sunway Medical Centre Velocity (SMCV) Consultant Urologist, Dr Cheng Hood Goh highlights the connection.
After the age of 40, 10% of men develop ED, and as age increases, so does the risk[4]. With the presence of diabetes in men, the risk of developing ED increases 3.5 times compared to non-diabetic patients.
Getting an erection involves increased blood flow in arteries and reduced blood flow out of veins. Diabetes disrupts this process due to neuropathy, decreased nitric oxide (NO) levels, and increased prothrombin factor, causing reduced blood flow and blood vessel clotting.
Diabetes can lead to ED through two primary mechanisms: vascular damage and nerve damage.
Vessel diseases, dysfunction, and the accumulation of advanced glycation end products result from hyperglycemia. This impairs the relaxation of the vascular smooth muscle of the penis and ultimately leading to ED.
Besides the physical impact, the emotional consequences of ED are often underestimated. It can strain intimate relationships leading to communication issues and emotional distance between partners.
For many men, their sense of masculinity and self-esteem is closely tied to their sexual performance, and this is why ED can have a profound impact on self-confidence and self-worth.
However, this should not deter men from seeking professional help before their condition progresses into a severe form.
21% of male patients with ED experience severe dysfunction. Beyond its impact on the quality of life, ED can also lead to psychological challenges, such as the development of severe depression disorders. Thus, he strongly highlights the importance of early medical attention.
Dr Cheng Hood Goh, Consultant Urologist
The Role of Nutrition
Effective diabetes management involves nutrition. To support this, Sunway Medical Centre Velocity (SMCV) introduces the Better Days Recipe Booklet. It features delicious yet healthy and diabetes-friendly recipes that focus on controlling the “3 Highs”: High Blood Sugar, High Blood Pressure, and High Cholesterol. These recipes help manage diabetes and contribute to overall well-being by stabilising blood sugar levels and potentially positively affecting ED.
Dr Lim strongly agrees the critical role that nutrition plays in managing diabetes and overall health. He recommends a well-balanced diet that is low in carbohydrates, sugars, and trans fats while being rich in protein, fiber, and essential nutrients. “This diet should include plenty of fruits, vegetables, and lean proteins. It is also advisable to reduce the consumption of processed foods and high glycemic index (GI) items like white bread, instant noodles, processed meats, and sugary or salty snacks.”
However, maintaining a healthy diet doesn’t mean sacrificing taste or variety. There are numerous healthy and fresh options available in the market, such as green leafy vegetables, whole grains, fatty fish, legumes, nuts, and fruits, providing ample room for dietary preferences and customisation.
Type 2 Diabetes could be put into remission, says opthalmologist Dr. James Muecke AM. Almost as soon as he was named Australian of the Year 2020, Dr. Muecke started advocating for the implementation of a tax on sugary drinks in an effort to save more eyes. Dr. Muecke speaks to AsiaFitnessToday.com about his proposed change to Australia’s dietary guidelines, he expresses why there’s a need for government to impose a sugar tax and talks about his work in raising awareness about diabetes – a lifestyle disease that could lead to the loss of sight.
Dr. James Muecke with his team in Vietnam. Photo credit: Sight For All foundation
He began his career in Kenya, then returned to South Australia to become an eye surgeon and blindness prevention pioneer, starting both Vision Myanmar at the South Australian Institute of Ophthalmology in 2000, and Sight For All, an organisation which uses Australian and New Zealand eye specialists to train overseas doctors, a social impact organisation “aiming to create a world where everyone can see”.
Has sugar blinded our reasoning?
A few months ago, we featured a story about a patient of Dr. Muecke’s who woke up one morning Blinded by Sugar. Neil Hansel is sadly a victim of the debilitating disease which has not only taken his eyesight, but also his limbs.
In his address at the National Press Club in Canberra last year, Dr. James Muecke gave an immensely moving account about having had to remove a patient’s eye. He wanted to be an eye surgeon to give the gift of sight and not to take it away from someone, especially when someone has been needlessly blinded by an avoidable, man-made Type 2 Diabetes he said.
Sugar toxicity can be solved
Humans were for the first time in history “overfed and undernourished” with sugar and refined carbohydrates, he affirmed. We met with Dr. Muecke in person at a studio in Sydney this March 2021, one square year after the Australian border closures and he summed up our conversation to this, “When the mother is pregnant with the baby and if she’s consuming a diet high in sugar, that sugar crosses the placental barrier to the foetus but insulin doesn’t cross, so you’re already metabolically priming the child for health problems in the future. So gestational diabetes is a big big problem so people should be aware of that, that it be picked up early in pregnancy and wind right back on your consumption of sugar and refined carbohydrates,”.
Dr. Muecke spoke to us at length about a strategy he came up with, which he calls the 5As of sugar toxicity.
Addiction
Alleviation
Accessibility
Addition
Advertising
It’s so hard to kick the habit. If you’ve ever tried to detox from sugar, it’s quite an unpleasant process. And even if you’re able to succesfully do it, everywhere you go, all the foods you eat, you’re just bombarded with sugar, so it makes it very difficult. So having a tax on sugary drinks, we know that it’s been shown to reduce purchase and consumption in 17 countries with Mexico being one of them.
Let’s say in Australia, we put a 20% levy on sugary drinks, that would raise about A$600million which could then be used to fund health awareness initiatives and about 77% of Australians agree with this in principle,” added Muecke, giving light into his call for a sugar tax.
Back home in Adelaide, Dr. Muecke continues his advocacy work in awareness building and has called for a crackdown on sugar in drinks and processed foods, also a change in Australia’s dietary guidelines.
He spoke about how diabetes, one of leading causes of blindness among Australian adults could be sent into remission. Diabetes is a metabolic disease, caused by the over-consumption of sugar, refined carbohydrates and ultra-processed foods which are cheap and accessible. He mentioned the dangers of seed oils, and that we should be aware of the types of oils we’re consuming daily.
Australia’s dietary guidelines was last updated in 2013 and in a Facebook post, Muecke suggests a certain biasness that 80% of the recommended foods were plant-based. He came up with this proposed diamond (see diagram below), shifting sugar and heavily processed & grain fed meats to the opposite tips of the healthy eating diamond.
A 7News report quoted Dr. Muecke saying, there were three successful ways to place type-two diabetes in remission – low calorie diets, low carbohydrate diets or bariatric surgery. Of these, he said the low-carbohydrate diet was the easiest solution.
AsiaFitnessToday.com also attended a webinar in November 2020, organised by the Australian Society of Opthalmologists. In that webinar, Dr. Muecke shared an imagery about glucose metabolism likening it to a packed train at peak hour. When too much glucose is ingested, insulin level rises and tries to push glucose into the blood stream, but it’s rejected. It’s then stored as glycogen instead in the liver, giving rise to fatty liver. Fructose – when taken up by the liver, almost a third of it is converted to fat so fructose is far more toxic than glucose!
Dynamic duo
Dr. James Muecke was awarded a Member of the Order of Australia in 2012, then in 2015 he was EY’s Social Entrepreneur of the Year for Australia, and in 2019 received a Distinguished Alumni Award from the University of Adelaide. It was the year of the Covid-19 pandemic, that Dr. Muecke was named Australian of the Year for 2020 and appropriately so, considering he is not going to be silent anymore and will be carrying the torch to highlight the fact that non-communicable lifestyle diseases like diabetes can be put into remission, and one of the ways to achieve that is to intervene with awareness first, followed by a change in lifestyle and importantly, diet. Partnering Dr. Muecke in advocacy and stewardship of the non-profit work is spouse Mena Muecke OAM, who also plays a vital role in the marketing and publicity of Sight For All and is a co-founder of the Vision 1000 social investment initiative. She was awarded a Medal of the Order of Australia in 2018. The Mueckes run private consultancy, www.Medthink.com.au.
In this 7th episode of Season 1 of The Kurang Manis (Sugar, Less) Podcast, we also speak with Dr YokeLi Ling, based in Kuala Lumpur who is passionately advocating Sleep and Airway Centric Dentistry and Oral Myofunctional Therapy. Dr. Ling shares more details in the 8th episode of the podcast (click here) with co-hosts Nikki Yeo and Jasmine Low.
Mia Palencia
Our tradition continues where we introduce music from this region and we’ve chosen a song titled SUPERMAN by Tassie-based Mia Palencia who launched her career in Malaysia at the age of 14 as the other half of Sabahan jazz duo Double Take. The song reflects the advocacy work that’s being undertaken by Dr. James Muecke AM – Australia’s SUPERMAN. Mia composed, produced and performed the opening night theme song for the Southeast Asian Games 2017, and continues her PhD research in Songwriting at the Conservatorium of Music, University of Tasmania and released her 7th album with her Australian jazz quartet, In Good Company. Visit www.miapalencia.com.
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Now streaming – Dr. James Muecke AM, Australian of the Year 2020 wants to put diabetes in remission. Listen to the podcast on AsiaFitnessToday.com or wherever you get your podcast: “The Kurang Manis (Sugar, Less) Podcast”
Now streaming – Dr. James Muecke AM, Australian of the Year 2020 wants to put diabetes in remission. Listen to the podcast on AsiaFitnessToday.com or wherever you get your podcast: “The Kurang Manis (Sugar, Less) Podcast”
Now streaming – Dr. James Muecke AM, Australian of the Year 2020 wants to put diabetes in remission. Listen to the podcast on AsiaFitnessToday.com or wherever you get your podcast: “The Kurang Manis (Sugar, Less) Podcast”
The Novel Coronavirus nCoV or COVID-19 has been one of the most widespread diseases so far. With a death rate of 1.52 million people, many believe that this pandemic is the greatest challenge in history. But there is a bigger and far more dangerous disease that has been in our lives for longer.
Photo via Pexels Alex Green
What are NCDs?
Non-communicable diseases (NCDs), such as heart disease, stroke, cancer, respiratory diseases and diabetes, are the leading causes of death in the world. They contribute to 71% of global deaths each year. This invisible pandemic causes more death and suffering than COVID-19, year after year.
NCDs kill approximately 41 million people every year. This is more than the population of Malaysia and Singapore put together! Unfortunately, many people remain unaware of this pandemic that has been wreaking havoc for quite a while now.
NCDs are diseases which are non-infectious, meaning that they cannot spread from one person to another. They tend to last for a long duration and occur as a result of a combination of:
Genetic – Certain diseases such as diabetes, asthma and cancer are genetic, meaning that they can be inherited from parents or ancestors. (We will investigate how certain interventions have shown positive effects in disease management in another feature article later – Ed.)
Physiological Factors – These are factors that are related to a person’s body and can be influenced by genes, lifestyle and other factors. For instance, obesity and high blood pressure are physiological factors.
Environmental Factors – These include factors such as access to clean water, air pollution, sanitation and poverty.
Behavioural Factors – These are factors that are related to an individual’s actions and lifestyle such as smoking, drinking too much alcohol and lack of physical activity. These can be reduced through changes in lifestyle.
Cardiovascular diseases (e.g. heart attacks and stroke)
Cancer (lung, breast, skin and the like)
Chronic respiratory diseases such as asthma
Diabetes
An indiscriminating disease
Just like COVID-19, NCDs do not discriminate but the most vulnerable are those living in developing countries. Poverty is closely linked with NCDs and increases the risk of death and disability from NCDs.
Each year, WHO reports that 15 million people between the ages of 30 and 69 years die from an NCD, and over 85% of these “premature” deaths occur in developing countries. The Kaiser Family Foundation (KFF), a leading voice and repository for facts and information on U.S. health-care issues shared in a post published on 29 Jan 2019, “The U.S. Government and Global Non-Communicable Disease Efforts” that chronic diseases in developing countries are not given the importance and attention it deserves (Ed.)
According to WHO (2018), NCDs account for:-
26.6% of all deaths in Taiwan,
63% of all deaths in India,
68% of all deaths in the Philippines,
73% of all deaths in Indonesia,
74% of all deaths in Malaysia, Singapore and Thailand,
More than 80% of all deaths in Fiji, and
89% of all deaths in China.
The rate of deaths caused by NCDS are extremely high in Western countries with NCDS accounting for: –
74% of all deaths in Brazil,
89% of all deaths in the United Kingdom, and
91% of all deaths in Australia and Italy.
It has been predicted that by 2030, the global average NCD deaths from the total number of deaths would be 75.26%. That’s a whopping two-thirds of total fatality.
Ann Keeling, Chair NCD Alliance and IDF CEO stated “90 million avoidable deaths from NCDs will occur worldwide within the next decade if nothing is done. We’re angry and we want action!”
The risk factors that increase the chances of NCDs include the person’s lifestyle and environment.
This includes age, gender, genetics, exposure to pollution, lack of physical activity, smoking tobacco and drinking too much alcohol.
The rise of NCDs poses devastating health consequences for individuals, families and communities, and threatens to overwhelm health systems. However, most NCDs are considered preventable because they are caused by modifiable risk factors. Having an healthy and active lifestyle such as regular physical activity and nutritious food reduces the likelihood of getting NCDs.
Countries and other stakeholders have to support a holistic approach to health, which promotes good health and healthy behaviours, prevention of NCDs and accounts for the early detection, diagnosis, management, and treatment of NCDs.
This article has been researched, compiled and written by the team at Asia Fitness Today; Sneha Ramesh – Intern, Monash University (Sunway campus), Syuhada Adam – Editorial consultant, Nikki Yeo & Jasmine Low – Director/Producer.
Asia Fitness Today has embarked on MISSION 2030 — to halve NCD rates in the Asia Pacific region by 2030. If we could ask if you could please share this article on social media or with someone you know and care about so we can perpetuate this ripples of awareness in the community. It begins with a whisper, a drop in the ocean and slowly, change can happen. It begins with us. Learn more: www.move8.org.
References:
World Health Organization. (2015, October 5). NCDs, poverty and development. https://www.who.int/global-coordination-mechanism/poverty-and-development/en/
Benham, B. (2018, April 5). Poverty Increases Risk of Non-Communicable Diseases in Lower Income Co. Johns Hopkins Bloomberg School of Public Health. https://www.jhsph.edu/news/news-releases/2018/poverty-increases-risk-of-non-communicable-diseases-in-lower-income-countries.html
World Health Organisation. (2019, June 12). Noncommunicable diseases. https://www.who.int/health-topics/noncommunicable-diseases#tab=tab_1
World Health Organisation. (n.d.). World Health Organization – Eastern Mediterranean Region. http://www.emro.who.int/noncommunicable-diseases/causes/index.html
“Blinded By Sugar” tells the story of Neil Hansell, a man who woke one morning blind in both eyes due to neglect of his diabetes. In this confronting 20-minute keynote presentation, Dr Muecke discusses why type 2 diabetes is a growing worldwide epidemic and explores a number of strategies to curb the toxic impact of sugar on our health.
Source: James Muecke’s YouTube Channel
An in-depth interview
We’ve been researching the work by ophthalmologist Dr. James Muecke earlier this year, having come across an article about his Australian of the Year 2020 award presented by the PM Scott Morrison. Dr. Muecke made headlines recently following his speech at the National Press Club on 1st December 2020. In that memorable speech, he speaks about a possible sugar tax as a solution to reducing the alarming rate of millions Australians presenting type 2 diabetes or are pre-diabetic. Rachel Clun of the Sydney Morning Herald summarises it well here.
AFTNN will be conducting a special interview with Dr. Muecke in the coming months and we really look forward to bringing his message to more people in the Asia Pacific region – home to two-thirds of the world’s population, sharing his ideas and proposed solutions on curbing the disease.
