What type of patients do you see at ODHIR?
The majority of consultations concern diabetes, despite the fact that more than half of our population is overweight or obese.
At present, patient management is often focused on medication, without optimizing diet or adapted physical activity. These aspects are discussed at conferences, but nutritional optimization is often lacking due to a lack of mastery of scientific knowledge. I meet patients with a multitude of treatments (at least two to three drugs for diabetes, and as many for hypertension and high cholesterol), with no improvement in their ODHIR monitoring parameters, and no personalized prescription for their diet!
In your opinion, does the change in diet really help to reduce the number of cases of diabetes?
Hippocrates said, “Let your food be your best medicine”.
As Professor Philippe Froguel emphasized, it’s important to eat well. Unfortunately, some international teams have imported protocols without evaluating what exists in Mauritius and without correcting dietary errors. It would be beneficial to review our eating habits and adopt healthier preparations. Without science and studies on food preparation methods, we won’t progress! Rice is the most widely consumed food in Mauritius and the IOC region. Yet nobody really knows how best to cook it, or what quality of rice to choose. I observed no significant difference between white rice, brown rice, rice cooked in a rice-cooker or microwave, or rice “poured” using CGM (continuous glucose monitoring). Hot, cooled and reheated rice do not have the same impact on glycemic load. Mixing other foods, such as legumes (dried grains) and other carbohydrate sources, can be useful for optimizing glycemic load without the patient feeling constrained.
We tend to substitute bread for other carbohydrate sources, but whether white or wholemeal, the glycemic load of breads remains high. The lack of serious studies on cooking and food preparation methods makes dietary advice uncertain. We are going to undertake a study of these preparation methods and publish a book for health professionals and the general public. This goes far beyond our borders.
We have launched observational studies on diet and its effects on health parameters, seeking to optimize meals based on scientific data rather than on preconceived ideas about what is good or bad for health! I’m amazed to find that fads have a major influence on the way we eat, which leads me to call it the “my little finger told me so syndrome”. Everyone claims to know a lot of things, but without any real scientific basis or truth. I’m also surprised to see people spending a lot of money on all kinds of products, from seeds to astronaut-worthy drinks! We need to rationalize and provide references for health professionals, so that we can offer meals that are better suited to our Indian Ocean Commission (IOC) region. All this must be based on science and innovation.
We’re witnessing a trivialization of food intake. The speed at which people eat in Mauritius is impressive – it’s like high-speed trains! The satiety signal takes at least 30 minutes. As a result, patients eat too fast, stop at fullness and consume around 30% more calories than they need.
Changes in the composition of our meals, the popularity of fast food and ready-made meals, while tasty, are not at all in line with dietary recommendations. They have taken the place of festive or exceptional meals. These dietary changes can disrupt our microbiota. Studies are underway in Mauritius and La Réunion to analyze the intestinal flora of diabetics and obese people.
What about physical activity?
The first challenge for our patients is to combat a sedentary lifestyle. Rather than watching television slumped in an armchair, it would be better to sit in a chair. We recommend limiting screen time to less than 2 hours a day, and not eating or snacking when you’re not concentrating on eating.
When it comes to physical activity, patients tend to don shorts, T-shirts and sneakers. There’s no assessment of their physical capabilities, and they often embark on inappropriate programs, sometimes even with coaches. This represents a danger, especially if the patient has not had a health check-up including biological and radiological analyses. I’ve never seen so many cases of fatty liver in my career as in Mauritius! In such cases, it’s essential to join in with the proposed activity and ensure careful follow-up, to achieve satisfactory results. On the other hand, for people in good health, regular physical activity is essential to prevent metabolic diseases. A minimum of 4400 steps a day, three times a week, evenly distributed, is recommended. Other activities, such as swimming or cycling, burn more calories at a comparable intensity. It’s even possible to exercise without buying any equipment, by improvising with everyday objects such as broomsticks or plastic bottles filled with sand instead of dumbbells. The key is to remain creative without hurting yourself or worsening your physical condition.
Tell us about the “Research” branch, soon to be up and running?
The research will begin once the necessary authorizations and legal compliances have been obtained (CPP, Data Protection Act, etc.). The aim is to put the knowledge acquired into practice for the benefit of the populations of the IOC zone. Drawing on our past experience in various territories in the south-west Indian Ocean, we will be collaborating with other teams to consider different approaches depending on the components of the Mauritian population. We will need to draw further inspiration from studies carried out on populations similar to our own, such as those in Singapore, Asia and India.
What are the two genes identified by Professor Froguel in the Mauritian population? How does this discovery open the door to future cutting-edge diagnostics?
Professor Philippe Froguel has revealed the identification of two genes, and a third has been isolated. As far as diagnoses are concerned, one of the gene mutations leads to kidney disease – the first time this has been described anywhere in the world! In this context, despite his diabetes, the patient did not develop kidney failure. We take preventive action and seek to maintain a good balance in his disease. He is regularly monitored by a nephrologist to prevent any deterioration in his renal function. Of course, his diet will be carefully monitored for sodium and glucose intake. He will be monitored by my nutrition department.
The second gene appears to be responsible for sudden cardiac arrest, due to a potassium channel anomaly. This gene has already been identified in this type of pathology. It is important to avoid certain high-risk drugs that could aggravate the patient’s condition; a list has been provided. Tests are currently underway to assess the risk of serious cardiac complications, and to consider more appropriate drug treatment, or even the installation of a defibrillator.
The third gene affects a protein that appears to be linked to breast cancer in women and prostate cancer in men. The patient carrying this mutation is followed by oncogenetic specialists according to a precise protocol. Actress Angelina Jolie carries a genetic mutation linked to breast cancer, and chose to undergo a preventive mastectomy. It would appear that this identified gene is just as worrying as the one carried by the actress.
These discoveries lay the foundations for precision medicine. They pave the way for a 4P approach to medicine: precise, personalized, preventive and predictive. As far as kidney disease is concerned, this certainly represents a breakthrough in taking care of patients long before their kidneys deteriorate. As for the gene linked to breast cancer, preventive ablations can be envisaged, before the severe form of the disease develops. In our case, the patient is in her thirties and several women in her family have been affected.
In practical terms, how can diabetes-related complications be prevented?
Complications associated with ODHIR diseases are well known, but we don’t always know when and in whom they will occur. Genomic diagnosis will enable us to tackle the problem from the outset and better target the risks involved, enabling us to actively prevent and reinforce specific follow-up. In La Réunion, we have developed projects and trained our staff to offer the best possible care, particularly with regard to the prevention of blindness and amputations.
In Mauritius, around 700 amputations are carried out each year, affecting some 525 people, while in La Réunion we amputate an average of 170 patients a year, and that already seems a lot to us… To give up would be tantamount to saying that the value of feet would not be the same depending on the sister island concerned… All this foot damage is avoidable, provided we can diagnose and assess patients correctly. However, the current process is repetitive, and follow-up parameters are not always the best for assessing the risk of injury. It will be necessary to conduct studies and propose solutions that are better adapted to our populations (COI), as the inhabitants of our islands are not all the same as Americans and Europeans.
How can early detection be encouraged? How do you go about it?
When it comes to ODHIR diseases, there is often a family context, and people suffer from them over several generations! This context plays a crucial role in understanding the risks involved. DNA is extracted from saliva samples and analyzed by high-throughput sequencing. We use a collection of genes already known in the field of these diseases, and look for any mutations. This allows us to establish a diagnosis and any complications. This procedure requires a doctor’s prescription and the consent of the patient or his/her legal guardian.
In conclusion…
Let’s face it, metabolic diseases like ODHIR are difficult to treat. It’s vital to do everything possible to prevent them from occurring in the first place! Mauritians are in the top three worldwide for diabetes, after Saudi Arabia and the Emirates! We must (and we will) change our approach to these disabling diseases, which are costly, affect a younger population (in their thirties) and affect life expectancy and quality of life.