Dr. Benjamin Bikman – ‘Insulin vs. Ketones – The Battle for Brown Fat’

There is story after story. Vijay is another example. He was living with type 2 diabetes for 9 years. Neglecting his diet, not really paying attention
to it. He came to use and basically said hey, I need
some help, and we showed him this approach. Over the course of 6 months, he dropped 30
pounds. He
stopped using Metformin diabetes medication. How many of you guys use Metformin? He stopped
using Metformin. He also stopped using a Statin medication
and also stopped using a blood pressure medication. Now, he exercises 6 days a week, and he is
a happy guy as you can tell. Cyrus:
Thank you guys so much (I have a couple of microphones, is this too loud. Ok, great)
Thanks for the opportunity to present here Erin today, appreciate it. Just like Erin said there is a lot of confusion
in the world of diabetes, and our goal here today is to try
and help clear up some of that confusion. Because unfortunately diabetes can be one
of these really grim diagnoses where the doctor says that
you have it, and then from that point onwards it can lead to
complex emotions and a confusion about what to put into your body. Our goal here today is to try to
simplify that a little bit so that you can understand a little bit about what is truly
causing the problem for type 1 diabetes and type 2 diabetes and how
that can be handled. So, I will tell you first a little bit about
myself. I was diagnosed with type 1 diabetes at the
age of 22. I was a senior in college. I was going to
Stanford University. Out of nowhere, I started to feel incredibly
thirsty. I felt very thirsty, and I lost all
my energy. In a very short period of time, I found myself
going to the bathroom every half an hour like clockwork; 17, 18, 19 times a day. I knew that something was terribly wrong with
me, but I did not have the confidence to say anything to anyone. I lived like that for a couple of days. After a couple of days, I
went straight to the health center at school, and I said "here is my symptoms", and they
took a look at me, and they knew immediately what the problem
was. They said you have type 1 diabetes. They took
a finger stick of blood glucose, went into another room, checked it on the meter, and
came back. In the
3 minutes that it took for them to check it on the blood glucose meter and come back,
I had fallen asleep. I woke up, and I did not know where I was. So, I looked up at the ceiling and was like
where am I , how did I get here. Ok, I am in a doctor's office. Who brought me here? What did I get here for? So,
they took me to the ER. They admitted me, and I was there for 24 hours. Over that 24 hour period, they
explained to me that my pancreas, the insulin producing cells in my pancreas failed. As a result of that,
I now have type 1 diabetes which means that I have to inject insulin every day for the
rest of my life. You can imagine as a 22-year-old, you know
I am in the middle of college, I am just a happy-go-lucky guy
and all of a sudden I get this really grim diagnosis, and it scared me. So if you rewind the clock maybe 6
months backwards, I had been diagnosed with 2 other autoimmune conditions. The first one was
hypothyroidism which is a decrease in thyroid production from my thyroid gland. The second was
alopecia universalis which is why I have no hair. I have no hair. No eyebrows. No armpit hair. No nose
hair. Nothing. First, Hashimoto's thyroiditis set in. Then alopecia. Then the icing on the cake was type
1 diabetes. At that point, I was very scared. I did not know what to do. My doctor's basically told me to
follow a low carbohydrate diet because that is the one size fits all prescription for
people with diabetes. I was told to eat foods like you see pictured
here; cheese, eggs, meat, and under no circumstances was I
to eat carbohydrates because the more carbohydrate I ate, the more insulin I would need. So, it
sounded like a pretty reasonable strategy, so I said "ok, fine". I did my best to try and keep my
carbohydrate intake low and then to gravitate towards more fatty and high protein foods. So, I did that
for the first year. Within 365 days, I recognized that things
were going even further South than they had already gotten to. I suffered from incredibly low energy. I became depressed because I did not have
enough energy to go and play sports. I grew up as an athlete. I love playing soccer. I love playing
volleyball, baseball, basketball. You name it, and I could not do it anymore. On top of that, my blood
glucose was a rollercoaster. Eating this way was supposed to make my blood
glucose much more manageable, but it did the exact opposite. It made it so when I checked my blood glucose
at any given moment of time I would see these giant numbers
like 284. Sometimes I would see a 55. Sometimes I
would see a 400. I had absolutely no idea what was causing
this. So after a year of living this way, I
decided I had to make a change. I had to make a big change because this clearly
was not working. So, I
did all this research, and I started reading books and watching movies and attending scientific
lectures. One thing led to another, and I got open to
the ideas that maybe if I adopted a plant-based diet that
maybe that would change things for the better. I was hesitant at first because I grew up
as an athlete, you know, a guy athlete, and we are told from
a young age that if you do not eat meat, if you do not
drink milk, you do not eat cheese that you are going to become scrawny, and you are not
going to become strong, and girls are not going to
like you. So, as a result of that, I said "ok, fine". I eat like a
man. That is how men eat. But then all of a sudden, this ideas of becoming
a plant-based eater came into my mind, and I struggled with it for
a little while. I finally decided that I am willing to try
anything at this point because clearly I do not feel good. So, I adopted a plant-based diet. A low-fat, plant-based,
whole foods diet which I will talk in detail about today. In so doing, it was the single greatest decision
I ever made in my whole adult life. This is what happened. My carbohydrate intake went from about 100
maybe 150 grams per day all the way up to 600 grams per day within the first month. Now, in the
diabetes world, if you tell someone you are eating 600 grams of carbohydrates, they look
at you like you have 4 eyes, right? That is more carbohydrate than most people
with diabetes will eat in a full week. I
was doing that on a daily basis. I was expecting that by increasing my carbohydrate
intake that much that my insulin use would also go up because
like we said earlier, the more carbohydrates you eat the
more insulin you are going to need, right? Well, this is what happened to my insulin
use. It went down. So, I started out using between 40 and 45
units per day and over the course of the first month, it
dropped all the way down to 25, 24 and hovered in that range. So, for 3 weeks, I cut my insulin use by
40%. That is a big deal when you are living with
type 1 diabetes because if you are supposed to inject
insulin every single time you eat a meal, if you are using less and less insulin and
you are pouring in more and more carbohydrates, clearly something
very interesting is happening. So, at this point, I
recognized that this traditional model of carbohydrate metabolism is totally not right. That something
was at play here that I could not explain using words. So, at that point, I decided that I wanted
to investigate this sort of linear carbohydrate
model a little bit more, right? Again, the model goes like this. Eat less carbohydrate, have less blood glucose,
therefore you use less insulin. Pretty straight forward. So, what I did is I went to, I enrolled in
PhD programs all around the country, and I decided that I wanted
to turn this into my intellectual passion because I wanted to explain this experiment. I wanted to be
able to describe what was happening inside of mine brain, inside of my thyroid, inside
of my pancreas, inside of my muscles, but I could not do it
using the words that I wanted to describe it with. So, in this
process, I went to UC Berkeley. I studied nutritional biochemistry for 5 years
and really got to the point of understanding the molecular level of details
of what is happening inside the human body. I went with
a real simple question which is "am I a freak of nature?". That is all I wanted to know. Just a simple
question, right? "So, what do you want to study for your PhD?" "I want to understand if I am a freak". That is what I want to understand, right? Am I a freak of nature in the sense that what
is happening inside of my body just a one off scenario
or is it something I can actually apply to other people. Does it
apply to other people with type 1, with type 2, people who do not have diabetes? So, I was able to
study insulin resistance which we are going to talk about in detail today. Insulin resistance is the root
cause of type 2 diabetes, but is also an underlying factor in many health conditions including
type 1. In
this process, I was able to investigate, do a bunch of studies, and write a thesis specifically
on the effects of insulin resistance. So, here I am today 15 years later from that
initial diagnosis of 2002. I have
reduced my insulin use by 40%. I eat more than 700 grams of carbohydrates
on a daily basis. My A1c
value, which is a 3 month marker of your average blood glucose, is between 5.6% and 6.0%. That is in
the target range where I want to keep it. So, I am going to introduce you to my co-founder,
Robby. Robby also has a very interesting story. He has been diagnosed with type 1 diabetes
as well, and he has got a great story. Robby:
How are you guys doing, can you hear me? Maybe it is better if I do not use this microphone
cause I think this one still is on, but I think it
is ok. Guys, thank you Erin for putting this together
and getting all these people here. This is really wonderful. These people are interested in this information. My name
is Robby Barbaro. On social media, some people know me as "Mindful
Diabetic Robby". I love to post
pictures of what I am eating and videos on YouTube and just sharing this with as many
people as possible. So, it is funny, Cyrus and I were actually
diagnosed with type 1 diabetes in the same year. It
was 2002 that I was diagnosed. My older brother actually has type 1 diabetes
as well. My family is sort
of familiar with it. I was complaining to my mom, "mom, like I
am thirsty all the time, I have to go to the bathroom all the time. I think I have diabetes just like Steve". She was like, "no, don't be silly". So, I
was like, "ok". We were living in Minnesota at the time, and
my parents were in Florida looking at a house because we were going to move there. My mom called me to check in and say hey how
are things going. I said, "mom, I couldn't sleep last night,
I was cramping, felt terrible". She was like, ok, go
upstairs use your brother's blood sugar meter and see what is going on. So, I measure, and I am like
over 450, and my brother right there was like yup you have type 1 diabetes. Pack your bags. You are
going to have to go to the hospital for a few days. So, we went to the regular doctor, and they
run some tests. Then they send you to the hospital. So, I stayed in the hospital, I think, it
was only 1 or 2 nights because my family knew what to do. My parents came back, and they told me don't
worry about. It is
just going to be an inconvenience. My parents were really great about helping
me work through it. So,
in the beginning, I was following the Standard American Diet. Nothing was off limits. We would eat
McDonald's, Twinkies, just normal food. When you are in the honeymoon phase of type
1, you usually are under control. So, I never really was out of whack as far
as my diabetes numbers, but I did have other health problems. So, I took allergy medication. I have Claritin-D all the time. I still got sick every
year. I had terrible acne as a teenager. You did everything. You go and do microdermabrasion. You did
different pills and all this stuff, and eventually they gave me Accutane which is one of the
most serious drugs you can give for acne, and it still
didn't really work that well. Then I also suffer from plantar
fasciitis. So, I was a competitive tennis player, and
it would just hurt, so I had to where these blue boots
at night which was really uncomfortable. I started to read and learn more about how
can I take care of myself, how can I prevent complications, and
eventually I stumbled across the Western A. Price
foundation at some point. I started eating grass fed beef and raw milk
and all that stuff, and I still was limited in sugar and fruits because that was
not good for you. It had too much carbs. After that, I
started learning more and more information. Eventually, I came across a plant-based version
of a low- carb diet. I started learning from Gabriel Cousins. He had like a phase 1 program where you basically
eat only nuts and seeds and oil and lots of greens, so I could have like celery and almond
butter. Basically, I was living off of that stuff. I was in college at the University of Florida
at this point. I followed
it perfectly, and you are going to see later on in this lecture we are going to talk about,
Cyrus is going to talk about insulin use and all that stuff. I was doing that diet, and I was taking the
least amount of insulin that I ever have taken, but the problem
was is I did not have any energy. I was on campus, and I
was like blacking out. I was eating very little amounts of carbs
and of course, injecting a very small amount of insulin. It was not working. At this point, I was getting scared. I tried a lot of things. I really
do not know what to do. I am doing everything I can. So, I went back to a naturopath that I had
seen for many years throughout high school and
college, and she said maybe you should try a chelation
therapy. Maybe it is heavy metals that are causing
some of these problems. I said, "ok". It was going to
be expensive, but I am willing to do anything. I was considering it, and between making the
decision to do that I heard a podcast and found this guru
that started talking about eating fruits and vegetables and
they were great and that fat was actually a big problem for diabetics. I was like this sounds amazing. I
would love to eat some fruit. So, I gave it a try. I signed up for his coaching program. I emailed this guy
every single day for 90 days straight. Every single day. We got to know each other well. I started eating
this diet, and it was the best decision I had ever made. So, I started eating persimmons, mangos,
bananas, papaya. My insulin sensitivity, the amount of carbs
I was eating for the insulin I was injecting was through the roof. It had never been that good before; although,
my total intake went more towards what my pancreas would have been secreting
if I was not a type 1 diabetic. So, things were going
amazingly well. I was absolutely loving it. Now, it is 10 years later. I have been doing this diet for over
10 years. I started December 2006, and in that timeframe
I have never had an A1c above 6.4% with my current A1c which was a couple weeks ago at
5.9%. I am super active every day. I feel amazing. My skin
has cleared up. I do not take any other medication other than
insulin. I am just really passionate about
sharing this message with as many people as possible. So, it is really fun to be working with Cyrus. I am
going to hand it over to him, and he has got a great lecture for you guys. We will talk to you in the Q&A. Cyrus:
Ok, so question, I want to understand who is in the audience today. How many of you guys are currently
living with diabetes? Anyone? Raise them high. We have got a lot of people. Raise your hand if you
have type 2 diabetes. Raise your hand if you have been diagnosed
with prediabetes. Wow, a lot of
people. Raise your hand if you have been diagnosed
with type 1 diabetes. Fantastic. Raise your hand if
do not have diabetes at all. Ok. Some of you raised your hand twice. Ok, great. So, you guys have
probably heard of the term insulin resistance before. Maybe, yes? Ok, I want to know what you guys
think. If you could define insulin resistance in
1 or 2 sentences , what would you say? Raise your hand,
go ahead and shout it out. Anyone know? Ok, so when your pancreas is broken? Ok! Fantastic! You
want to give the lecture? You clearly understand what is happening. What was yours? It was the same
definition? When the insulin you make is not effective. Good. Can you say your definition one more
time back there? Fantastic. You guys nailed it. What I really want to hit on the head is insulin
resistance, and that is sort of the major focus of the talk today because insulin resistance
is the underlying factor present across all forms
of diabetes. A lot of out doctors, the medical community
does not understand this. They were not trained properly to get the
knowledge and the tools and as a result of this, they are giving improper information. Doctors are great people. They are not to blame, but the
fact of the matter is if you really understand what insulin resistance is then you yourself
can treat insulin resistance and reverse it. That is what we are looking for today. So just like you guys said, insulin
resistance is caused by the storage of fat in tissues that are not designed to store
fat. So, remember
that. Insulin resistance is caused by the storage
of fat in tissues that are not designed to store fat. From
now on, you guys are world's experts in insulin resistance. If anybody asks you what is it, you repeat
that sentence right there. So, now we have to understand well how does
that happen in the first place. If you cannot read this it is my fault. Insulin resistance is a very prominent health
condition in our work today, and it influences a lot of other chronic
diseases. So, we talk about insulin resistance in the
context of diabetes and only diabetes, but it actually influences many other health conditions
including cancer, coronary artery disease, hypertension,
atherosclerosis, obesity, high cholesterol, fatty liver,
polycystic ovarian syndrome, Alzheimer's disease, neuropathy, blindness, kidney failure, retinopathy,
and erectile dysfunction. Insulin resistance is a central controlling
health condition that talks to every single one of those and increases your risk
for every single one of those conditions. That is why it is so
important. Now, heart disease is the most important of
all of those conditions that I just mentioned because heart disease is the number 1 killer
of people with diabetes. There is a statistic that scared me
when I first read it. It says that 33% of all people living with
type 1 diabetes, the same diabetes that Robby and I have and 2 other people in this
room, 33% of them will die before the age of 50 due to
heart disease. That is a scary statistic. Heart disease is also very prevalent in the
type 2 diabetes and the prediabetes world as well. You see if you read the literature like I
do in my spare time because I am a nerd you will find that insulin resistance
is very strongly correlated with heart disease. It is strongly
correlated with hypertension, with high cholesterol, with coronary artery disease, ischemia. This is very
scary because if you don't control insulin resistance then ultimately heart disease is
one of the things that can get you. Now, most physicians have been trained to
believe that insulin resistance is only associated with predicates and type 2 diabetes. The model goes like this. First, you develop insulin
resistance. Then you develop predicates. Then you develop full-blown type 2 diabetes. That is it. The
problem, though, is that insulin resistance like I mentioned earlier is actually influencing
all forms of diabetes. So, it influences type 1 diabetes. It influences type 1.5 diabetes which is a
highly misunderstood form of diabetes. It is an adult onset slow progressing version
of type 1 diabetes. It also
influences prediabetes, type 2 diabetes, gestational diabetes, what pregnant women get which is
temporary, and Alzheimer's disease which is now being classified as type 3 diabetes. That is insulin
resistance of your brain. So, we can't really talk about any version
of diabetes unless we talk about insulin resistance because we are just missing
a very large puzzle piece. In order to understand this, let's
understand a little bit about how your pancreas functions. Your pancreas has 2 functions. There is an
exocrine function and am endocrine function. 99% of your pancreas is related to exocrine
function. That is what it performs. Exocrine means it secretes digestive enzymes
that are required for breaking down the food that you eat, so every single
time you open your mouth and you eat food, that food
travels down through your digestive system, your pancreas makes digestive enzymes. 99% of your
pancreas is devoted to that task. The other 1% of your pancreas contains these
things called islet cells. Islet cells are the endocrine function of
your pancreas. Endocrine is a fancy way of saying secreted
into the blood. So, it makes very specific hormones and very
specific proteins that are put into the blood. So, if we look a little bit closer at that
1% and try to understand what islets look like. Islet cells are
actually clusters of cells. So, instead of calling them islet cells, we
will refer to them islet clusters because they are collections of anywhere from
1,000 to 4,000 cells that have a very special function. Those cells have 3 different types. There are alpha cells. There are beta cells. There are delta cells. Don't worry about that. All we need to worry about are the cells in
green, the beta cells because those are the cells that actually secrete the insulin. So, when you eat foods that contain carbohydrate,
those cells sense it. Again, a small population of cells but when
those cells fail, you have a system-wide problem that if left untreated can cause death. It is a very important collection of cells
even though there is not very many of them. So, in the case of type 1 and type 1.5 diabetes,
we have the picture shown here. A normal islet cell function on the left is
when beta cells sense how much glucose is in the
blood stream, and then they can secrete insulin as you see in the red. In the case of type 1 diabetes,
where it is an autoimmune condition, it is when your own immune system is actually attacking
those cells, your immune system creates antibodies. These antibodies then go with a specific task
to just kill beta cells and only beta cells. As a result of that, those cells can no longer
secrete insulin because most of them are dead. Type 2 diabetes on the other hand is a separate
issue. Type 2 diabetes before it
becomes a pancreas problems starts in your muscle and starts in your liver. When we think of type 2
diabetes, we are always thinking about what is happening with my pancreas. What is wrong with my
pancreas. Clearly, my pancreas is not working, right? But your pancreas is a consequence of what
is happening in your muscle and what is happening
in your liver. If we could just focus on treating your
muscle and tour liver properly, then your pancreas can get room to breathe and regain
its normal function. So, this dysfunction that happens to your
muscle and liver is called insulin resistance. Alright,
here is where we are going to have some fun. I need 15 volunteers. We are going to do a little role play
here. Don't all raise your hand at once. One, two, come on up, three, four, five, just
come on up. Over
on that side, anyone? Six, you want to come?, seven, eight, good,
fantastic. So this is the fun part. Do
we have 15? One, two, three, four, five…..we got a lot. Alright, so, I am going to need 3 volunteers
to go stand at the door over there. So the 3 of you here, you guys are all glucose
molecules. So, the 3 of
you are going to go to the door. Alright, great, now I need 3 more people. How about the 3 of you. You
guys are going to be insulin receptors. So, you guys are going to go to the door but
in front of them. Ok? Alright, then we have, 1, 2, 3, 4, 5. Perfect! Can you guys just shift this way a little
bit. "We are not
going to get killed off are we?" "I hope not". Presentation gone wrong, ok, LOL. So, you guys are fatty
acid molecules. OK? Don't read into that statement. Ok, so we are in a cell inside the muscle
tissue and inside of the cell we have the nucleus which
is the super computer over there that has got all the DNA,
and it is constantly processing things and telling the cell what to do. Then we have mitochondria which
are littered all over the place, and they are making energy for us. Then we have energy depos. We have
what is called the glycogen molecule where you store carbohydrate or glycose, and then
you have a lipid depo or a lipid droplet where you store fatty
acids. So, in this cell, we are operating in a person
who has insulin resistance who has developed insulin
resistance through their diet. So what happen is they are
eating a low carbohydrate diet which is a high fat, high protein diet. As a result of that, fatty acids
march their way into the cell. So, you guys all got here because you were
present in the blood stream to begin with and then you just marched your
way right into the cell. Unfortunately, muscle cells have a
very difficult time preventing fatty acids from coming in. So, as soon as you eat fatty acids and it
is in your blood stream, it just goes straight into
your tissues. There is very little you can do about that. So
you guys all got in here because of that process. You guys all congregate together on one side
of the cell. You get to hold hands with each other, and
you form what is called a lipid droplet. So this lipid
droplet is now present inside of the cell. It is a slight problem for the cell because
the cell is not designed to store very much of this. Under normal circumstances, the cell wants
to keep maybe 1 or maybe 2 of these here. Over the course of time a you eat more and
more fat, and you eat more and more protein, this stuff starts to accumulate
so you get more and more. So this lipid droplet is now
causing a problem. The problem is that this lipid droplet can
directly communicate with those insulin receptors. So, raise your hand if you are an insulin
receptor. Beautiful. Ok, so what you guys are going
to tell those insulin receptors is you are going to say, hey stop working. So, the cell is basically saying
alright I have all of this lipid I have to deal with. I have to burn this stuff somehow, but we
have all that glucose over there trying to get into the
cell. It is kind of a problem because now there
is more energy and more energy trying to walk inside this
cell. So what you guys do is tell those insulin
receptors to stop working. So now when you go eat a banana or eat potato
or eat a piece of bread, that carbohydrate breaks down into glucose. That glucose circulates in the blood stream,
and that glucose now has an opportunity to come out of the
cell. In order to get inside the cell, that glucose
has to talk to those insulin receptors. I need 2 more people to act as insulin. Do I have 2 more volunteers? Anyone,
anyone, anyone? One, one more? Two, ok. So, you guys are going to go out in the blood
stream as well with the glucose. Let say you eat a potato, and there is glucose
floating around in the blood stream, that glucose went to your pancreas and told
your pancreas hey let's make some insulin. Your pancreas
made a little insulin. Now, that insulin is floating around in the
blood stream. So, the insulins jobs is to
come into the door of the cell and knock on the door and say hey by the way I have some
glucose. Do
you guys want to take that glucose up? So that is what the insulin molecules do. Raise your hand if you
are insulin. So you guys repeat after me, hey by the way
I have some glucose. You are going to talk to
those insulin receptors and you are going to say hey by the way, I have some glucose. Do you want to
take up that glucose? So the insulin says hey I have some glucose,
do you want to take it up? The
insulin receptors are going to say what? The insulin receptors are going to say what,
they are going to say yes or no? No. Why are they going to say no? Because you told them to say no. Therefore, you say
no, and now the insulin is like great, now I am just going to stand here and do nothing. So now what
happens to the glucose? The glucose can't go anywhere. The glucose stays in the blood stream. So,
now as a result of this lipid droplet, we have a lot of glucose and a lot of insulin
inside the blood. Problem! So you ate that potato. You go check your blood glucose 2 hours later. What do you see? You see a high number. The high number is because that glucose is
trapped. It cannot get inside of the
cell where it wants to be. So, if you guys had the opportunity to reverse
this whole process, what would you do? You got to get rid of these guys first, right? No one likes you guys, LOL. You guys are dead. So
how are we going to get rid of these guys? Are we going to just magically hope they disappear. We
have to do something, right? Throw it out there. What could we possibly do to get rid of these
guys? We could exercise, #1. What else could we do? Change our diet. Be more specific. Go more whole
plants. More whole plants. Not so much fat, cut out the fat. Ooh, not so much fat. Very good, how
did these guys get here in the first place?, because we were eating a lot of fat. Because you invited
them in, LOL. So they got here in the first place because
we were eating a lot of fat in the first place. So
if we either exercise or get rid of the fat or some combination of both, then these guys
will go away. So
over the course of time, you do that, and you start to eat less fat, so as a result
of eating less fat, now this fat gets burned. Ok, there is mitochondria in here. These mitochondria are basically picking you
guys off one by one and saying ha, ha, sorry, I am going to burn you and get rid of you. So, you just got
burned. Thank you. Question… Is the fat from animal fat or vegetables. These are saturated fat
molecules. Saturated fat comes predominantly from the
animal world, but you can also find it from plants. So, this is predominantly animal fat. However, it is present in the plant world
as well. That is a
good question. Sorry, you are done too. So this fat is getting burned. You are also done. Thank you. Thank you for your participation. So now we have a reasonable amount of fat
inside this cell, and that is ok because the cell can incorporate just a
small amount, not a large amount. So as a result of this, what
are those insulin receptors going to do now? Right, the insulin receptors are going to
say come on in, go for it. So what happens is that the glucose molecules
now can come on in. Ok, the insulin stays at the
door. The insulin says hey I got some glucose, but
I am not going to go inside the cell. Then the glucose
goes flooding in. So, glucose molecules come in. Round of applause. Thank you. Come in, all the way
in. So, the glucose molecules come in the door,
and now you guys are going to come in and stand in
that part of the cell, and you are going to go into what is called the glycogen molecule. Glycogen is
basically stored glucose. So, you guys go build up that glycogen molecule,
and then the mitochondria can start top burn you guys if it wants and
also starts to burn some of that. Over the course of time you
see that we are shifting away from fatty acids and more towards glucose and towards the glycogen. That is how you reverse insulin resistance. How do we do this, one more time? So, if we reduce our
intake of fat we can start to selectively burn these guys. That is one thing that happens. If we go and
exercise, what does that do? It burns this, and it burns that. It burns both of them which is ok because
even if we get rid of those guys we can always refill it. So, the goal is to burn and burn and refill
only. We don't have to go into a fat free diet. No such thing exists. We are just going to go into a low-fat diet,
and that is going to solve this problem all together. Thank you, guys. Appreciate it. So, if we go back to
what we said earlier, insulin resistance is what? Very good, the storage of fat in the tissues
that are not designed to store fat. There are 2 main tissues that we need to worry
about. Your muscle which is what
we just went through. This same exact situation happens in your
liver. When your muscle and your liver
become insulin resistant, glucose becomes trapped in the blood, and that is a problem. So, again, if you
go into the part of the research and you start to really investigate what is happening here,
you will see this all over the place. They have all these fancy pictures with these
transport proteins and insulin molecules and insulin receptors, and you end
up with a picture that looks like this. So, let's walk
through this right here. First step called fatty acid flux or basically
increase in fatty acids in your diet. So, that happens in the blood first. The second step, tell the insulin receptors
to reject insulin. Step 3,
don't allow glucose to enter the cell using these things called glucose transporters. As a result of that,
last glucose comes in to build a glycogen molecule and as a result you end up with less
glycogen. See
the problem? Too much fat to begin with. Now, we can't store carbohydrate or glucose. So, again I
want to reiterate this and hit this on the head, the accumulation of fat in muscle and
liver traps glucose in the blood. That is the problem. That is insulin resistance. That is predicates. That is what happens in
type 2 diabetes as well. Now, it turns out that dietary protein also
has a very similar effect independent of fat. So, in some studies that were performed to
try and understand exactly how protein effects your
blood glucose values, what some researchers found was very eye opening. You see this complicated
graph here on the left. Let's walk through it really slowly. On the very bottom, we have a curve that
shows what happens to your blood glucose after you eat a low fat, low protein meal. So, you see how
your blood glucose rises and then comes right back down? That is what is called a normal glucose
response or a normal glycemic response to a meal. If you simply increase the amount of protein
in that meal, you go from 5 grams of protein to 40
grams of protein, look what happens. Your blood glucose
response goes up. We did not touch fat. We only added protein. If you add fat and you take away the
protein, you get a similar response. What happens if you add fat and protein together? If you add fat
and protein together, you get that response. So, what this shows you here is that by simply
adding either fat or protein, and I am talking considerable
quantities of either one, you end up elevating your
blood glucose even more and more. If you have a meal that contains both fatty
acids and protein together, your glucose is highest. It is a problem. So, now what happens is that when you have
been diagnosed with diabetes, how many of you guys
have been told to restrict your carbohydrate intake? Raise your hand high, raise your hand high. I want to see it. A lot of you. Ok. So, again, doctors are not
bad people. I have 5 doctors in my family, absolutely
wonderful people. The tools they have been given,
the education they have been given is insufficient. As a result of that, they say, oh you have
been diagnosed with diabetes, carbohydrates are
your enemy. Let's put you on a low carbohydrate diet. So,
that is what happens, you shift away from the blue, the carbohydrates, and you start
to eat more red and more green, more fat and more protein. This complicates the problem. So, whether you have type
1, type 2, gestational diabetes, prediabetes, that is what happens. They push you towards this high fat,
high protein diet, and you become more and more insulin resistant. So, low carbohydrate diets have
been given a ton of different names over the course of time. We first started with the Atkins diet back
in the 1970s. Then that became the defacto low carb diet. From that point in the 1990s came the
South Beach diet, the Zone diet, the Paleo diet, you have the ketogenic diet, and then
you have things like Dr. Bernstein who is the ultra-low carbohydrate
solution. Have you guys seen these types of diets
marketed on TV commercials? Ok. They are all just different carnations of
a low carbohydrate diet. They all have the same effect which is that
they increase the level of insulin resistance. Now, here is
another thing that kind of complicates the fact. If you look in the literature, you will see
these types of studies that get reported in the New York
Times and Washington Post where they basically say, look, we
directly compared a low-fat diet vs a low carb diet, and here is what we found. The title of this paper
basically says the comparison of low and high carbohydrate diets for type 2 diabetes. The conclusion
shown here in red is, I will read it to you, "Both diets achieve substantial weight loss
and reduced hemoglobin A1c (again that is your average
blood glucose marker) and fasting glucose. The low
carbohydrate diet which was high in unsaturated fat and low in saturated fat achieved greater
improvements in the lipid profile (so that means that your cholesterol level came down). Blood glucose
stability and reductions in diabetes medication requirements suggesting that low carbohydrate
diets are an effective strategy for the optimization
of type 2 diabetes management." So, the conclusion that the
authors came to is that a low carbohydrate diet, what? It is better than a low-fat diet but if you
do a little bit of digging and you actually read
what happened in the study, what you will find is this. That in
the low carb diet, ok, the high fat diet, they are eating 60% of their calories from
fat. That is exactly
right, that is what happens in a low carb diet. In the low-fat diet, they are actually eating
30% of their calories from fat. So, they call it a low-fat diet, but they
feed people 30% calories from fat. It is not a
low-fat diet. It is not even close to a low-fat diet. So, these types of studies are flawed at their
core. They are all over the place. They drive people, and they drive policy changes
towards more low carbohydrate diet, more low carbohydrate diet. So, you guys are now educated. When you see this
type of information, dig deep and find out what is actually happening here. Robby and I like to say this
all the time there is not a single low fat study that shows that a truly low fat diet
which is less than 10 or 15% of your diet does worse than a low carbohydrate
diet. There is not a single study that we can find. When we are talking about a low-fat diet,
we are talking about a diet that contains at most 15% of
calories from fat. That is very important. So, low carbohydrate diets promote short-term
improvements in a lot of things. How many of you guys know somebody that has
eaten a low carbohydrate diet? How
many of you guys are on low carbohydrate diets right now? Raise your hand. Raise them high. How
many of you guys have interacted with somebody who said, oh ya, I went on this low carbohydrate
diet and I lost a ton of weight? I lost weight. My glucose improved. My cholesterol dropped. Right? You
have heard this before, right? That is because low carb diets work. They absolutely work, but they work
in the short-term. They are not an effective long-term strategy. They are not an effective long-term
solution because they actually increase your risk for chronic disease, but you can't see
that in the short- term because all you are focused on in the
short-term is that you get a better A1c value, you reduce
your blood glucose variability meaning you get less swings and you get a much more stable
blood glucose which is a good thing, you can reduce
your total insulin use, you can reduce your LDL cholesterol
(the bad cholesterol), and you can lose a ton of weight. The problem, though, is if you look at the
literature and really try and understand what is the effect of a low carbohydrate diet in
the long-term, I am talking 6 months, 9 months, 12 months,
2 years, 5 years, 10 years of a low carbohydrate diet, what
you will find is that low carbohydrate diets that are high in fat and high in protein end
of developing a lot of the problems that you see here. So as far as heart disease is concerned, we
have increased risk for heart disease, for hypertension, increased
LDL cholesterol, increased triglycerides, and increased risk for
atherosclerosis which is the hardening of blood vessels all around your body. You also see in the glucose
side of things you get an increased level of insulin resistance. Does that make sense why insulin
resistance is what starts to predominate? Right? Think of the picture we painted earlier. More fat
causes less glucose, glucose has to stay out, it gets trapped in the blood so you get more
insulin resistance and as a result of that your liver
builds up fatty acids, and you can develop a condition known
as fatty liver which can eventually lead to liver cirrhosis and eventually liver failure. You can also
significantly increase your risk for cancer. This is now being shown. You can significantly increase your
risk for kidney failure because your protein intake is very high. You get increased total body
inflammation which is measured by a protein called C-reactive protein. Then in the long-term we see
people end up actually either gaining weight or preventing the loss of further weight. Low energy,
impaired digestion, food cravings. The list goes on. So, that is why we have to understand that
low carb diets even though they work in the short-term
are not effective strategies for the long-term because
they will actually increase your risk for the development of other health complications. So, the question
really becomes well what are we going to do about that. How do you actually reverse it through diet? Your brought that up earlier. What was your name? Lynn, so tell everybody, how do you reverse
it through diet? Wow, that is great. Cut out the oil and get lots of exercise. What else are you going to do
on your diet? Whole foods, plant based. I love it. She is not a plant. I did not put her there. Ok, you
are living proof this works? (Audience telling story…..applause). That is great. That is how you do it. A
low-fat, plant-based, whole food diet. That is how you reverse insulin resistance
and gain insulin sensitivity. That is exactly how Robby decreased his insulin
use. That is how I decreased my insulin use
by 40% even though my carbohydrate intake went through the roof. That is insulin sensitivity. More
carbohydrate for less insulin. That is what it means. So, people who adopt a low-fat plant based
approach, we recommend eating 15% of your calories from fat at the max and 15% of your
calories from protein as the max. So, if you max out both of those at 15%, then
the balance becomes carbohydrate. So, you can call it a high carb diet. You can call is a low-fat diet. A low fat, low protein diet. Call it
whatever you want. The fact of the matter is you are eating a
lot more carbohydrate and a lot less fat and protein. So, on this approach you might be wondering
well what the heck can I possibly eat, right? Is there anybody else in this room that is
also a plant based eater? Raise your hand and raise them high. I am preaching to the choir. Look at that. I didn't even know. Ok, we have got a lot of people. This is
great. Ok, so we like to separate foods into the
red light, yellow light, green light categories. So, let's
start with the green light category. Fruits, all fruits, non-starchy vegetables
like tomatoes, cucumbers, okra, zucchini, cauliflower, broccoli, starchy
vegetable like potatoes, squash, rutabaga, things that grow
in the grounds, beans, lentils, and peas, green leafy vegetables like lettuce, arugula,
intact whole grain, herbs and spices which have significant documented
antioxidant activity. So, if you focus your diet on
these green light foods and stay away from the red foods over on the right, just watch
what happens. The red foods we have on the right – dairy
products like milk, cheese, ice cream, yogurt, eggs, process
meats, red meat, white meat, poultry, fish, and shellfish, oils of any kind. This is a very important thing
to understand even though oils come from plants. Oils are not food. Oil is the most refined product in
the supermarket. Oil is the fat equivalent of sugar. You take a red beat as an example and you
process it to death, and you end up with a white crystal. You take olives and you process them and you
end up with a liquid called oil. It is a pure fat, and even small amounts of
that fat can damage your endothelium which is the lining of your blood vessels,
and it can increase this fatty acid deposit that happens inside of
tissues causing insulin resistance, so all oils are out. Eat the olive, don't have the olive oil. Eat the
coconut, don't have the coconut oil. Then we also have in this category refined
sugars and pastries and bread which are refined carbohydrates. Foods that are in the center category are
the foods that you don't have to avoid, just have to have them
in a very moderate amount. Nuts and seeds documented
anticancer effects, documented antidiabetic activity but again when you eat nuts and seeds
it is very easy to overeat on these foods. It is very easy to overeat on them, so you
just have to be a little bit moderate in that. Avocados, coconuts, olives – these are higher
fat foods which have a definite place in a plant based diet, but again we just have
to exe4rcise moderation. Then we have pastas and pasta
alternatives. These are more refined products that can definitely
cause blood glucose spikes in a lot of people. So, if you know that is the case for you,
you have to limit those in your diet or eliminate them
entirely. Sprouted bread would be the last one. Question from audience… – Fish and shellfish are in the
red category for a number of reasons. 1) They contain high amounts of saturated
fat so we have been told over and over that fish is really good
for us because why? Omega 3 fatty acids. Right. Omega 3
fatty acids are found in the plant world. They are found in flax seeds, chia seeds. The omega 3s that you
get from fish and shellfish are slightly different than the omega 3s that you get from the plan
world. I do
not want to go into the detail of that, but the fact of the matter is that when you eat
fish you are getting omega 3s but you are also getting a lot of
saturated fat, you are getting a lot of environmental contaminants, and you are getting mercury. I don't care where that fish came from. It could come from
the deepest ocean in the Pacific 3,000 under the surface. It still has mercury inside of it, and that
is a problem. Pasta alternatives are made either out of
quinoa, lentils, brown rice, beans, corn. It looks like
pasta. It tastes like pasta. It is shaped like pasta. It just does not use whole wheat as its base. So, this is
what low fat, plant based, whole food nutrition looks like. As you can see, it is super colorful. People
who become plant eaters take a lot of pictures of their food, right? How could you not. I mean look at
it, it is tasty. I am getting hungry just looking at this. Very colorful food. Foods that are extremely
colorful are rich in compounds known as antioxidants. You guys have probably heard of that before,
right? Ok. Antioxidants are pigments. The more colored your food is the higher antioxidant
value, the more antiinflammation it will promote inside
of your body so that is why when your mother told you to
eat the rainbow, she was right, even though she did not know why she was right, she was. We are
talking about dishes that look like this. We have got beans. We have got fruit. We have got root
vegetable soups. We got corn, fruits, salads, all types of
food. If you don't think that this food is tasty,
I challenge you. This stuff is incredibly tasty and very addicting. Again, we take a lot of pictures of our
food for good reason because it is tasty. How could you not? So, let me show you a couple of examples. This is Patricia. She has type 1 diabetes. She came to us because she was diagnosed with
type 1 diabetes at the age of 63. Type 1 diabetes at the age of 63. She did not know what to do. She was
following this low carbohydrate Bernstein style approach which basically says limit
your carbohydrate intake to 30 grams per day. That is it maximum. So, she was doing that for a long period of
time. As a
result, she ended up getting very low energy, her blood glucose was all over the place,
and she was injecting more and more insulin over time. So, she came to us and said hey guys I need
some help, so we told her about the low fat, plant based,
whole foods approach. She adopted this approach, and here
is what happened. She started out with an A1c value of 7.1%
elevated. She dropped it from 7.1 to 5.6%
in less than 8 months. She lost 42 pounds without even trying. She reduced her insulin use by 25%. She
almost ten-tupled her insulin sensitivity. Now, she has so much energy she does not know
what to do. I
have been encouraging her to exercise, and she still refuses, but she now claims that
she has enough energy to do it if she wanted to. Question from audience…. Great question. So, insulin sensitivity is
defined as the total number of grams of carbohydrate that you eat in a 24-hour period divided by
the total number of units of insulin you use in
a 24-hour period. So, when she first came to us, her
carbohydrate intake was low. It was somewhere in the 30s, and her insulin
usage was somewhere close to I believe it was 30-40, so she had an insulin
sensitivity of 30 divided by 30 which is 1. Over the course
of time, that 30 grams of carbohydrate has now gone up to 350 grams of carbohydrate per
day. She
uses something like 31 units of insulin. So, it is 350 divided by 31. She is now operating at a 10:1 ratio,
an 11:1 ratio. The point being that is how she has increased
her insulin sensitivity. The more
carbohydrates for less insulin. In her case, more carbohydrate for the same
amount of insulin. There is
story after story. Vijay is another example. He was living with type 2 diabetes for 9 years. Neglecting
his diet, not really paying attention to it. He came to use and basically said hey, I need
some help, and we showed him this approach. Over the course of 6 months, he dropped 30
pounds. He stopped using
Metformin diabetes medication. How many of you guys use Metformin? He stopped using Metformin. He also stopped using a Statin medication
and also stopped using a blood pressure medication. Now, he
exercises 6 days a week, and he is a happy guy as you can tell. It is also important to understand Statin
medication increases your risk for type 2 diabetes. So even though you are taking a Statin medication
to keep your cholesterol low, what it is doing
is actually increasing your risk for the development of type 2
diabetes. So, if you don't have type 2, now you are
at a higher risk. If you have type 2, now it is going to
become more complicated. So, what that means is either you are going
to need more medication if you continue the same habits or you have to completely
change your lifestyle from the ground up. So, we
got Sharon another prefect example, lost 25 pounds in 4 months. She is studying nutrition at Berkeley. She is 2 years behind me in school. She is living with type 1 diabetes. She didn't even know. She had no
idea that she had 25 pounds to lose. She didn't know. It just felt normal to her. She adopted this
approach, and the weigh flew off of her, and now look at her. Twenty-five pounds less. She has
reduced her insulin use by 40%. Now, she is active. She is a happy girl. So, these stories you see these
over and over and over again. The same story that happened to Robby. The same story that happened
to me. The same story that happened to, what's your
name? Lynn. The same story that happened to
Lynn. If any of you guys want more information,
the business we run is called Mastering Diabetes.org. Go to that website. There is a lot of information on there. There are a lot of cool things that you can
learn about, about diabetes. If coaching is something you need, then go
for it. No worries. If you are
looking for more information, do that. Also, nutritionfacts.org. Like I said earlier, if you are not on Dr.
McGregor's newsletter, please do it. He is a personal friend of ours. He is brilliant. His information will
change your life. So, please do that.