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Reversing Type 2 diabetes starts with ignoring the guidelines | Sarah Hallberg | TEDxPurdueU
I have the best job in the world.
I'm a doctor.
No! Believe me that's not why.
I'm an obesity doctor.
I have the honor of working with the group of people
subject to the last widely accepted prejudice: being fat.
These people have suffered a lot by the time they see me:
shame, guilt, blame and outright discrimination.
The attitude that many take, including those in healthcare,
is that these people are to blame for their situation.
If they could just control themselves, they wouldn't be overweight,
and they are not motivated to change.
Please let me tell you this is not the case.
The blame, if we've got to extend some here,
has been with our advice.
And it's time we change that.
Obesity is a disease, it's not something created by lack of character.
It's a hormonal disease, and there are many hormones involved.
And one of the main ones is a hormone called insulin.
Most obese individuals are resistant to this hormone, insulin.
So, what does that mean exactly, to be resistant to insulin?
Well, insulin resistance is essentially a state of pre-pre-type 2 diabetes.
Insulin's job is to drive glucose, or blood sugar,
into the cells where it can be used.
In a nutshell, when someone is insulin resistant,
they are having trouble getting blood sugar where it needs to go,
into those cells.
And it just can't hang out in the blood after we eat
or we would all have a diabetic crisis after every meal!
So, when someone is resistant to insulin,
the body's response to this is to just make more of it.
And insulin levels will rise and rise,
and for a while, years even, this is going to keep up,
and blood sugar levels can remain normal.
However, usually it can't keep up forever,
and even those elevated levels of insulin
are not enough to keep blood sugar in the normal range.
So it starts to rise.
It probably won't surprise you to hear
that most of my patients have insulin resistance or diabetes.
And if you are sitting there thinking, "Phew, that's not me,"
you actually might want to think again,
because almost 50% of adult Americans now have diabetes or prediabetes.
That is almost 120 million of us.
But that's hardly everyone who has issues with insulin.
Because as I was saying,
people have elevated insulin levels due to insulin resistance
for years, even decades,
before the diagnosis of even prediabetes is made.
Plus it's been shown that 16-25% of normal-weight adults
are also insulin resistant.
So, in case you're keeping track, this is a heck of a lot of us.
So, the trouble with insulin resistance is:
If it goes up, we are at great risk for developing type 2 diabetes.
But also, insulin makes us hungry,
and the food we eat much more likely to be stored as fat.
Insulin is our fat storage hormone.
So we can start to see how it's going to be a problem
for diseases like obesity and metabolic issues like diabetes.
But what if we traced this problem back to the beginning,
and we just didn't have so much glucose around
that insulin needed to deal with?
Let's take a look at how that could be.
Everything you eat
is either a carbohydrate, a protein or a fat,
and they all have very different effect on glucose and therefore insulin levels,
as you can see on the graph.
So when we eat carbohydrates,
our insulin and glucose are going to spike up fast.
And with proteins it looks a lot better.
But take a look at what happens when we eat fat.
Essentially nothing, a flat line.
And, this is going to wind up being very important.
So, now I want to translate that graph for you
into a real-world situation.
I want you to go back
and think about the last time you ate an American version of Chinese food.
We all know there's rules associated with this, right?
And the first rule is: You're going to overeat.
Because the stop signal doesn't get sent
until you are literally busting at the seams.
Rule number two is: In an hour you're starving.
Well, because the rice in that meal caused glucose and insulin to skyrocket,
which triggered hunger, fat storage and cravings.
So, if you are insulin resistant to begin with,
and your insulin levels are already higher,
you really are hungrier all the time.
And we have this setup:
Eat carbs, your glucose goes up, your insulin goes up,
and you have hunger and fat storage.
So, how do we recommend to these people to eat,
because it seems like that would be really important, and it is.
Let's focus just on type 2 diabetes,
because the general recommendations are to tell patients with type 2 diabetes
to consume 40 to 65 grams of carbohydrates per meal,
plus more at snacks.
Trust me on this, that's a lot of carbs.
And remember what's going to happen to glucose and insulin,
blood sugar and insulin,
when we eat them?
Yes, we are essentially recommending
that they eat exactly what's causing their problem.
It really, really is.
Because, at its root, diabetes is a state of carbohydrate toxicity.
We can't get the blood sugar into the cells,
and that causes a problem in the short term.
But the long-term consequences are even greater.
And insulin resistance is essentially a state of carbohydrate intolerance.
So why, oh why, do we want to continue to recommend to people to eat them?
The American Diabetes Association guidelines
specifically state that there is inconclusive evidence
to recommend a specific carbohydrate limit.
But those guidelines go right on to say what we all know:
Our carbohydrate intake is the single, biggest factor in blood sugar levels,
and therefore need for medication.
These guidelines then go on to say:
Hey look, if you are taking certain diabetic medications,
you actually have to eat carbs, otherwise your blood sugar can go too low.
Okay, so let's take a look
at the vicious cycle that that advice just set up.
So it's: Eat carbs so you have to take medicine,
then you have to eat more carbs
so you avoid the side-effect of those medications,
and around and around we go.
Even worse is that nowhere in the ADA guidelines
is the goal of reversing type 2 diabetes.
This needs to be changed,
because type 2 diabetes can be reversed, in many, if not most, situations,
especially if we start early.
Not only do we need to let people know this,
but we have to start giving them the practical advice so they can do this.
First, here's a shocker for you: We don't need them.
Seriously! Our minimum daily requirement for carbohydrates is zero.
We have essential amino acids, those are proteins,
essential fatty acids,
but, nope, no essential carb.
A nutrient is essential
if we have to have it to function, and we can't make it from something else.
We make glucose, plenty of it, all the time,
it's called gluconeogenesis.
So, we don't need them,
the overconsumption of them is making us very sick,
yet we are continuing to recommend to patients
to consume close to, if not more than,
half of their total energy intake every day from them.
It doesn't make sense.
Let's talk about what does.
Cutting carbs, a lot.
Yes, in my clinic we teach patients
to eat with carbs as the minority of their intake,
not the majority.
So, how does that work?
Well, when our patients decrease their carbs
their glucose goes down, and they don't need as much insulin.
So those insulin levels drop, and fast.
And this is very important,
because a study
looking at our National Health and Nutrition Examination Survey data,
better known as NHANES,
showed that the single, biggest risk factor
for coronary artery disease
is insulin resistance.
It is responsible for a whopping 42% of heart attacks.
Low-carb intervention works so fast
that we can literally pull people off of hundreds of units of insulin
in days to weeks.
One of my favorite stories is a very recent one.
A young gal, but who had an almost 20-year history of type 2 diabetes,
came in when a physician from another clinic told her she was just sick,
and she'd probably get used to it.
Her diabetes was way out of control.
This despite the fact that she was on multiple medications,
including almost 300 units of insulin,
that was being injected into her continuously every day via a pump.
All of this, remember, blood sugar still out of control.
So we put her on a low-carb diet, and now let's fast-forward four months.
She lost weight, yes, but, better than that, sick no more.
Her blood sugar levels were now normal all of the time.
This on, get this, no diabetes medication.
Gone was the 300 units of insulin,
no more insulin pump,
no more pricking her finger multiple times each day,
gone, all of it, no more diabetes.
One of the greatest joys of my job is to be able to tell a patient like this
that they no longer have diabetes,
and we ceremoniously take it off their problem list together.
So, are they cured, is this a miracle?
We'll leave that grandstanding to Doctor Oz.
Cured would imply that it can't come back.
And if they start eating excessive carbs again, it will.
So no not cured, but they don't have diabetes any longer.
It's resolved, and it can stay that way as long as we keep away the cause.
So, what does this look like then? How does somebody eat this way?
Well, first, let me tell you what it's not.
Low-carb is not zero carb, and it is not high protein.
These are common criticism that are so frustrating
because they are not true.
Next, if we take the carbs out, what are we going to put in?
Because, remember, there's only three macronutrients:
if one goes down, one has to go up.
My patients eat fat, and a lot of it.
"What!?" you say. What's going to happen when you eat fat?
Well, let me tell you, you're going to be happy,
because fat tastes great, and it is incredibly satisfying.
But, remember, fat is the only macronutrient
that's going to keep our glucose – blood sugar – and insulin levels low,
and that is so important.
So, I want you to now hear my simple rules for eating.
These rules, you have to remember, are even going to be more important
if you are one of the tens of millions of Americans
who have trouble with insulin levels.
Rule number one: If it says light, low fat or fat-free, stays in grocery store.
because they took the fat out, they put carbs and chemicals in.
Rule number two: Eat food.
The most important rule in low-carb nutrition:
Real food does not come in a box,
and no-one should have to tell you real food is natural.
You should know that when you look at it.
Don't eat anything you don't like.
And eat when you're hungry; don't eat when you're not,
no matter what the clock says.
And number five is a simple way to remember what we want to avoid.
No GPS: no grains, no potatoes and no sugar.
That last one is a biggie, right, no grains?
Na, no grains.
But we have to have them.
Nope, they're a carb.
But whole grains are so good for us.
Well, first of all, there are actually very few foods out there
that are truly whole grain even when they say they are.
Most foods that purport themselves to be wholegrain
are highly processed and the fiber benefit ruined.
Or they're coming with highly refined flour,
usually both of these things.
So if you are one of the truly insulin-sensitive people,
you can eat real, whole grain.
But if you're in the enormous slice of our population with insulin issues,
it's making things worse.
So what if you are one of the real insulin-sensitive people?
Can you still eat this way?
Yes! I am a great example.
Over a year ago I decided I would cut my carbs
as low as I recommend to my diabetic patients.
Now, it's not mandatory for my health like it is for theirs;
I'm not insulin resistant, so would this be a problem?
No! That's just the thing.
Unless you have an exceedingly rare syndrome,
then cutting carbs is going to be good for you,
even if it's not necessary.
I want to show you a couple of pictures of my radical food.
So, this is a common breakfast in my house.
So does it look like I just broke my own rule?
I didn't because this muffin is made with coconut flour.
I bake all the time still.
I just use non-grain-based flours: coconut, almond, hazelnut, flax.
They make delicious things.
And this is a typical dinner in my house with a typical starch.
That would be the sautéed mushrooms.
No, my patients and I eat delightful food all of the time and enjoy it.
But what about the research on this?
I mean is this just anecdotal evidence now from my clinic?
There are dozens of randomized controlled trials
looking at low-carb intervention
for things like diabetes, cardiovascular risk factors, obesity.
They're consistent. It works!
There are even a large number of studies showing
that low-carb nutrition decreases inflammatory markers,
which is making it really exciting for diseases like cancer.
We just finished a study in our clinic.
And what we did is,
we took 50 type 2 diabetic patients
that were treated with our low-carb-high-fat-based program,
and we compared them to 50 patients
who were treated with the ADA guidelines.
And after six months,
not only did we find a significant metabolic advantage
for the low-carb group,
but, and let's face it, this is important, a huge cost savings.
Our analysis showed that our patients could save over $2,000 a year
just on the diabetes meds they were no longer taking.
Just think how fast that adds up.
We are in a diabetes epidemic now
that we are spending $250 billion a year on in this country.
So, I want to show you a slide now
that demonstrates where those savings are coming from.
So this is looking just at the insulin difference
in the two groups after six months.
And what we can see is
that the low-carb group was able to decrease their insulin
by almost 500 units a day.
Whereas in the ADA treated group,
they had to increase their insulin by almost 350 units a day.
Two important things.
Number one: Insulin is expensive.
And number two: Not all the people in this study were even on insulin,
which makes these results even more impressive.
But what I would say is that this graph really represents
two different approaches to treating this disease.
The first, our group, with the goal of reversing disease,
meaning they need less medicine.
And the second group, which very clearly aligns with the ADA guidelines,
which state that diabetes is a progressive disease,
requiring more medicine over time.
Progressive unless we take away the cause.
So, what's the problem then?
Why is this not everywhere? Why isn't low carb the norm?
There's two big reasons.
Number one: status quo. It is hard to break.
There are many agendas involved.
We got this notion that low fat was the way to go decades ago.
But a recent study just came out
showing that there was zero randomized control evidence
to recommend to Americans to remove the fat from our diet.
And that's how the carbs got added in.
It was essentially a huge experiment on millions of people,
and it failed miserably.
The second reason we don't see it everywhere is money.
Don't be fooled, there's a lot of money to be made from keeping you sick.
And what we see is, with these specialty guideline panels,
they are stacked with conflict of interest.
So, the solution to the diabetes epidemic in my clinic is exceedingly clear:
Stop using medicine to treat food.
And for a disease whose root cause is carbohydrates,
take away the carbohydrates, or at least cut them,
so we can remember what we used to know.
We knew it a long time ago,
this was said thousands of years ago,
and we need, in this day and age, to get back to that notion.