Diabetologist Prof. Raimund Weitgasser on the causes, prevention, gut health and modern treatment of diabetes
Diabetes mellitus is becoming one of the greatest medical challenges of the 21st century. More than 500 million people worldwide are already living with the metabolic disorder – forecasts predict that the number could rise to around 1.3 billion people by 2050.
The majority of this is type 2 diabetes, which is closely linked to modern lifestyle habits, diet, lack of exercise and obesity. However, additional factors are increasingly becoming the focus of research: chronic inflammation, environmental pollution and changes in the intestinal microbiome.
One of the most renowned diabetologists in Europe has been working on these connections for decades: Medizinalrat Univ.-Prof. Dr. Raimund Weitgasser from Salzburg. The internist and metabolic specialist heads the Competence and Study Center for Diabetes at the MavieMed Privatklinik Wehrle Diakonissen in Salzburg and has been involved in numerous international studies. His research has taken him to the Joslin Diabetes Center at Harvard Medical School in Boston, one of the world’s leading centers for diabetology.
In an interview with ZEOLITH WISSEN, he explains why diabetes is spreading so rapidly worldwide, what role diet, exercise and chronic inflammation play – and why prevention, early diagnosis and a better understanding of metabolism are crucial to counteracting this development.
ZEOLITH WISSEN (ZW): “Professor Weitgasser, diabetes numbers have been rising dramatically worldwide for decades. In your opinion, what are the main causes of this development?”
Prof. Raimund Weitgasser (RW): “The most important cause is actually the change in our lifestyle worldwide. In recent decades, diets have changed dramatically, not just here in Europe, but in many regions of the world. Countries that used to have a more traditional diet with less sugar and less highly processed foods have increasingly adopted a Western diet. This means more sugar, more highly processed products, more fat – and at the same time, people are moving much less on a daily basis. In many regions of the world, we have therefore seen a very sharp rise in diabetes rates over the past 30 to 40 years. This is particularly evident in countries that previously had little contact with this diet, such as parts of Central America, South America and the Pacific islands. Countries on the Arabian Peninsula are also particularly affected. Diabetes has exploded there in a relatively short space of time. Another important factor is the high consumption of sugary drinks, which make up a large proportion of daily sugar consumption in some countries.”
The rapid increase in diabetes worldwide is mainly due to our lifestyle: more highly processed foods, more sugar and at the same time less and less exercise in everyday life.
MR Prim. Prof. Dr. Raimund Weitgasser
ZW: “Before we delve deeper into the subject, we should perhaps first clarify a fundamental question: What actually is diabetes from a medical point of view?”
RW: “Diabetes mellitus is essentially a metabolic disease in which the body can no longer properly regulate sugar metabolism. The central mechanism here is the hormone insulin, which is produced in the pancreas. Insulin normally ensures that sugar can be absorbed from the blood into the body’s cells, where it is used as energy. If this mechanism is disrupted, too much sugar remains in the blood. In type 1 diabetes, the pancreas produces little or no insulin due to an autoimmune process. In the much more common type 2 diabetes, the situation is different: the body reacts less and less well to insulin over time. This is known as insulin resistance. The pancreas initially tries to compensate for this resistance and initially produces more insulin. At some point, however, it can no longer meet this additional demand and the blood sugar rises permanently. This process usually develops slowly over many years.”
ZW: “For a long time, diabetes was mainly seen as a disease of old age. Today, however, we are increasingly seeing type 2 diabetes in much younger people. At the same time, you say that type 1 diabetes doesn’t just occur in children, but can develop at any age. That’s completely new to me. How did this development come about?”
RW: “Type 1 diabetes is an autoimmune disease in which the immune system attacks the insulin-producing cells of the pancreas. It used to be assumed that this disease only occurs in childhood or adolescence. Today we know that this is not true. Type 1 diabetes can develop at any age, including in adults or even in old age. Incidentally, my oldest patient diagnosed with type 1 diabetes was 81 years old. However, we are seeing a different trend with type 2 diabetes, as we are seeing more and more younger people with this form of diabetes. The main reason for this is the changes in our lifestyle – especially in diet and exercise behavior. When people permanently consume too many calories, do little exercise and consume large amounts, including hidden amounts, of sugar from an early age and over many years,
sugar from an early age and for many years, metabolic stress occurs that can ultimately lead to the development of type 2 diabetes.”
The silent disease: Why many people don’t know about their diabetes
ZW: “Many people assume that you notice diabetes immediately – for example through severe thirst or frequent urination. In reality, however, the disease often seems to go undetected for a long time. Why is that?”
RW: “This is mainly due to the fact that type 2 diabetes usually develops very slowly. Blood sugar levels rise gradually over a long period of time, often over several years. The body can get used to these increased levels to a certain extent. This is why the classic symptoms – such as severe thirst, frequent urination, tiredness or an increased susceptibility to infections – often only appear when the blood sugar levels are already significantly elevated. This is also the reason why preventive check-ups play such an important role. In view of the rising prevalence figures, more emphasis should be placed on blood glucose measurements in medicine.”
ZW: “Do you have any idea how many people are actually living with diabetes without knowing it?”
RW: “If you look at the current figures, we assume that around 800,000 people in Austria suffer from diabetes. Of these, around 600,000 people are probably aware of their condition. However, this also means that 150,000 to 200,000 people could possibly have diabetes without having been diagnosed. So once again: screening is more important than ever, especially for younger people under the age of 50.”
Diabetes is basically ageing in fast motion. Many processes that we normally only see in old age take place much faster with permanently elevated blood sugar levels – especially in the blood vessels and organs.
Prof. Raimund Weitgasser
Sugar overload and fatty liver: the drivers of diabetes development
ZW: “Where do these rising, even alarming figures come from? And you recently said in a lecture to colleagues: “Diabetes is ageing in fast motion.” What do you mean by that phrase?”
RW: “Well, that’s a bit drastic, but unfortunately correct. What I mean is that in diabetes, all the processes that we associate with the normal ageing process take place much faster. Permanently elevated blood sugar levels lead to chronic inflammatory processes in the blood vessels and organs. These changes can lead to typical secondary diseases – such as damage to the eyes, kidneys, nerves or large vessels. At the same time, we are now also seeing links with other diseases such as liver problems, depression, cognitive disorders and certain types of cancer in the digestive tract.”
ZW: “Most people today are well aware that too much sugar, in whatever form, is unhealthy. But very few people understand what actually happens in the body when large amounts of sugar are constantly consumed over many years. What happens physiologically in the body?”
RW: “If the body is repeatedly confronted with large amounts of sugar over a long period of time, this creates a permanent metabolic burden. Initially, the body tries to process this sugar as normal, as I mentioned earlier. The pancreas produces insulin so that the sugar can be absorbed from the blood into the body’s cells. This works quite well for a certain period of time. However, if high amounts of sugar are constantly consumed over a period of years – especially in the form of highly processed foods or sugary drinks – this system comes under increasing pressure. On the one hand, the pancreas has to produce more and more insulin to control blood sugar. On the other hand, the liver also plays a central role in sugar metabolism. If large amounts of sugar, especially fructose, have to be processed on a permanent basis, fat is often stored in the liver because this otherwise strong organ, which can withstand a lot, simply reaches its limit at some point. The resulting so-called metabolic fatty liver is a very common problem today. It is not caused by alcohol – it used to be said that if you drink too much alcohol, only you will get a fatty liver – but by a permanent overload of the metabolism. In many cases, it develops in connection with obesity, insulin resistance and elevated blood sugar levels. The problem is that these changes usually go unnoticed for a long time. Fatty degeneration of the liver can develop gradually and can even lead to fibrosis or, in severe cases, to liver cirrhosis. For this reason, we now regard fatty liver as an important link between diet, metabolic disorders and the development of type 2 diabetes.”
Lifestyle and environment: what role does environmental pollution play?
ZW: “At the same time, we now live in an environment in which we are confronted with many additional burdens, such as particulate matter, pollutants in the air and heavy metals. What role do such factors play in the development of diabetes?”
RW: “Such factors certainly seem to play a role, as is slowly becoming apparent, but they have to be realistically classified and a lot more research is needed here. If you try to assess which causes contribute most to the development of type 2 diabetes, then lifestyle is still clearly in the foreground. However, there is also increasing evidence that environmental factors can have an additional influence. These include, for example, fine dust particles from the air or certain pollutants such as pesticides, cadmium, lead or other metals. Such pollution can influence the metabolism and thus indirectly contribute to the development of insulin resistance. If you want to roughly quantify this, then these influences are probably in the order of perhaps ten percent. That is comparatively little. Nevertheless, this shows that diabetes is not just a simple “sugar disease”, but a complex interplay of various factors in which environmental conditions can also play a role. We can look forward to future research in this area, as environmental toxins such as microplastics or PFAS, i.e. perpetual chemicals, have only been around for a few decades and are man-made. Accordingly, science is facing a mammoth task here – and not just in relation to diabetes.”
Diabetes is not just about blood sugar. It is a systemic metabolic disease that is associated with inflammatory processes throughout the body.
Prof. Raimund Weitgasser
Stress and its influence on metabolism: a factor that is still underestimated
ZW: “Another factor that is also being discussed in science today is stress. Many people live under constant psychological strain, as the prevalence figures for depression clearly show. Can stress also have an influence on blood sugar and the development of diabetes?”
RW: “Yes, stress can indeed play a role. When the body is under stress, various hormones are released that increase blood sugar. These include adrenaline and cortisol, for example. To a certain extent, these hormones act as antagonists to insulin. They ensure that more sugar is available in the blood because the body wants to provide energy in a stressful situation. If such stress reactions occur frequently or are permanent, this can cause blood sugar levels to fluctuate more or be higher overall. Sharp fluctuations in blood sugar levels are particularly problematic because they can put additional strain on the blood vessels and organs. This is why the psychological factor also plays a certain role in the development and progression of diabetes.”
Microbiome, metabolism and diabetes: what role does the gut play?
ZW: “The microbiome has become a major research topic in recent years. Many studies suggest that the intestinal flora could play an important role in metabolism. Can the microbiome actually have an influence on blood sugar and the development of diabetes?”
RW: “There is now evidence that the microbiome is linked to metabolism. If you look at different groups of people, you can see that the composition of the intestinal flora can vary greatly. For example, overweight people often have a very different microbiome to slim people. And people with type 2 diabetes also sometimes have different bacterial patterns in their gut than people with a healthy metabolism. Of course, this does not automatically mean that the microbiome alone is the cause of such diseases – we have to make a clear distinction here. But it does show that there are obviously connections between gut flora, body weight and metabolic processes that are very interesting from a scientific point of view and are currently being studied intensively.”
ZW: “So the microbiome can actually have an influence on metabolism?”
RW: “There are certainly various experimental indications of this. For example, some studies have investigated what happens when intestinal bacteria are transferred from one person to another – for example as part of a stool transplant. It has been observed that the metabolism actually changes in certain cases. For example, if the microbiome of a slim person is transferred, the metabolism of the recipient can improve, at least temporarily. This shows that intestinal bacteria can indeed play a role in metabolism. However, it must be emphasized that such results come primarily from experimental studies and no simple therapeutic strategy can yet be derived from them. A great deal of research is still needed.”
Prediabetes: Can this development still be stopped?
ZW: “Many people are in a so-called prediabetes phase – in other words, in a state in which their blood sugar is already elevated but diabetes has not yet manifested itself. Is there still a realistic chance of stopping the disease in this phase?”
RW: “Yes, there is definitely a chance of prevention, but it requires self-discipline and close cooperation with the doctor treating you. Especially in the prediabetes phase, you can still achieve a lot through lifestyle changes. Especially if you are overweight, this includes losing weight, being more physically active and adjusting your diet. You really should avoid sugar, including hidden sugar, as much as possible. This means avoiding ready-made meals, including drinks such as fruit juices, which are also high in fructose. Instead, protein and fiber and several small meals a day are important. If you are in a pre-diabetic phase, you can also seek advice and support from trained dieticians via your doctor. If overweight can be reduced and the metabolism relieved, elevated blood sugar levels can be normalized or at least significantly reduced. However, this remains an ongoing task, as the basic parameters for diabetes do not disappear without a trace.”
ZW: “If we’re talking about prevention here: The entire metabolism must also be considered – not just blood sugar and nutrition, but also gut health, the microbiome and possible stresses on the body. In your opinion, could it make sense to relieve the body as a whole in such a situation – for example by ensuring healthy gut function or supporting measures that stabilize metabolic processes?”
RW: “In principle, it certainly makes sense to support the metabolism as much as possible if someone has an increased risk of diabetes. As I said, there is increasing research into factors such as gut health, the microbiome and chronic inflammatory processes in the body. These areas certainly play a role in metabolism. If certain measures can help to relieve the body and support healthy metabolic regulation, this can make perfect sense as part of a comprehensive prevention concept. However, it is always important that such approaches do not replace traditional medical therapy, but can at best be seen as complementary.”
ZW: “Preventive and regulatory medicine is also discussing natural substances that could relieve the body. One example is PMA zeolite, a specially optimized clinoptilolite zeolite of volcanic origin, which has been the subject of intensive scientific research over the past two decades. Various studies have investigated whether such mineral substances can, for example, support the intestinal barrier or contribute to the binding of certain harmful substances in the intestine. There are also indications that stabilizing intestinal function can in turn provide a basis for a healthy microbiome and that PMA zeolite can indirectly relieve the liver. Do you think it makes sense to consider such approaches in the case of metabolic disorders – of course always in addition to traditional measures such as diet, exercise and medical therapy?”
RW: “Such approaches do not yet play a major role in diabetology. The focus is still on lifestyle measures, good metabolic control and, if necessary, drug therapies. In principle, however, if a measure such as PMA zeolite has been scientifically investigated, is safe for the patient and can help to stabilize or relieve the organism as a whole, such approaches can certainly be included as part of a comprehensive prevention concept. With type 2 diabetes in particular, we know that many metabolic processes interact, including liver function and chronic inflammatory processes. An overall stable metabolism and a healthy organism are therefore naturally important prerequisites for positively influencing risk factors such as obesity or insulin resistance.”
Lifestyle remains the basis of any treatment. Diet, exercise, weight reduction and a balanced metabolism continue to play a central role.
Prof. Raimund Weitgasser
Modern diabetes therapy: what options are available today
ZW: “If a patient has already been diagnosed with diabetes: What therapeutic options are actually available today?”
RW: “The treatment of diabetes has developed enormously in recent decades. In the past, there were essentially only a few drugs available, whereas today we have a whole range of modern treatment options. However, the basis of any treatment remains, and I emphasize this once again, lifestyle. Diet, exercise, weight reduction and a balanced metabolism still play a central role. In type 2 diabetes in particular, these measures can have a huge impact on the metabolism. If these changes alone are not enough, drug therapies are added. One of the oldest and at the same time most important drugs is metformin. This biguanide derivative has been used for many decades and has proven to be very effective and safe. Metformin works primarily by reducing sugar production in the liver and improving the sensitivity of the body’s cells to insulin. In many cases, it is therefore the basic therapy for type 2 diabetes.”
ZW: “However, metformin has been pushed out of first place in the treatment of type 2 diabetes in recent years. What drugs are there?”
RW: “Drugs that inhibit the reabsorption of sugar excreted via the kidneys and thus lower blood sugar are now the first line of treatment. These are called SGLT inhibitors and also have positive effects on protecting the heart and kidneys. Another group of drugs are analogs of intestinal hormones. These are usually injected once a week in the same way as insulin and, in addition to lowering blood pressure, have a vascular protective effect. They are particularly suitable for people at risk of cardiovascular diseases such as heart attacks or strokes. As an additional effect, a sometimes pronounced weight reduction has been observed, so that these drugs are also used with great success in cases of prediabetes, overweight or obesity. This is very important: Today, we treat each diabetes patient individually and monitor them closely. This means that we give effective medication, but as little medication as possible, also to reduce any side effects.”
ZW: “However, these therapies are often no longer sufficient at some point during the course of the disease. That’s when insulin therapy comes into play. What does this treatment look like today?”
RW: “That’s right. Many people with type 2 diabetes initially manage to control their blood sugar well with a combination of lifestyle changes and medication. Over the years, however, it can happen that the pancreas produces less and less of its own insulin. Insulin therapy may then become necessary. In many cases, so-called basal insulin is used to start with. This is a long-acting insulin that covers the body’s basic needs throughout the day and night. This insulin is usually injected once a day and ensures that the blood sugar level remains stable between meals. Modern basal insulins work relatively evenly over many hours and do not have a very pronounced maximum effect. This means that blood sugar levels can often be kept more stable and the risk of hypoglycaemia can be reduced. In combination with the above-mentioned tablets or intestinal hormone injections, this can often be sufficient therapy for years. If the diabetes progresses further, it may become necessary to give short-acting insulin with meals in addition to this basal insulin. This is known as basal-bolus therapy, in which the long-acting insulin covers the basic requirement and a fast-acting insulin intercepts the blood sugar rises after meals.”
ZW: “So that means that insulin therapy is now much more closely aligned with natural metabolic processes?”
RW: “Exactly. Modern insulin therapies try to mimic as closely as possible how the body normally produces insulin itself. This includes long-acting basal insulins on the one hand and short-acting insulins with meals on the other. Their use has also improved significantly. Many patients now use insulin pens or continuous glucose monitoring systems, which can make everyday life much easier. The goal always remains the same: to keep blood sugar levels as stable as possible and avoid long-term complications and damage.”
Prevention remains the most important measure: what everyone can do for their metabolism today
ZW: “If you look at all these developments – the rising numbers of diabetics worldwide, modern medication, insulin therapies and, at the same time, new scientific findings about nutrition, gut health, the microbiome and environmental factors: In summary, what advice would you give to our readers who either already have diabetes, are in a prediabetes phase or want to do something for their metabolism in a very basic preventative way?”
RW: “The most important point really remains lifestyle. This includes a balanced diet, regular exercise and a healthy body weight. Obesity plays a key role in type 2 diabetes in particular. It is also important to classify obesity correctly. Obesity is not a question of a lack of discipline, but a complex metabolic disease. People who are severely overweight should therefore seek medical support as early as possible. Regular check-ups are just as important. As type 2 diabetes often develops unnoticed over many years, early diagnosis can be crucial in order to take timely countermeasures. Anything that helps to stabilize the metabolism and support the body as a whole – provided it has been scientifically tested and is safe for patients, such as the PMA zeolite you mentioned – can therefore be useful as part of a comprehensive prevention concept. Moreover, prevention is better than cure. Have your HbA1c value, i.e. long-term blood sugar, checked at your next visit to the doctor! Ultimately, prevention is always the best way to avoid metabolic diseases such as diabetes for as long as possible or to positively influence their progression.”
ZW: “Professor Weitgasser, thank you very much for this informative interview!”
Prof. Dr. Raimund Weitgasser
Medical Council Prim. Univ.-Prof. Dr. Raimund Weitgasser is one of the most renowned diabetologists and metabolic physicians in Europe.
The internist and specialist in endocrinology and metabolic medicine is Head of the Competence and Study Center for Diabetes at the MavieMed Private Clinic Wehrle-Diakonissen in Salzburg and has been active in international diabetes research for decades.
His scientific career has taken him to the Joslin Diabetes Center at Harvard Medical School in Boston, one of the world’s leading centers for diabetes research. Prof. Weitgasser has been involved in numerous international studies and has published more than 100 scientific publications on diabetes, metabolic diseases and preventive medicine.
In addition to his clinical work, he is intensively involved in medical teaching at the Paracelsus Medical University of Salzburg and the further training of doctors. As a university professor and speaker at international specialist congresses, he is one of the influential voices in European diabetology.
His work focuses in particular on the prevention and modern treatment of diabetes mellitus, metabolic diseases and the question of how chronic diseases can be better prevented through early diagnosis and lifestyle interventions.
Contact:
https://www.privatklinik-wehrle-diakonissen.at/de/arzt/raimund-weitgasser
