Reversing Type 2 diabetes starts with ignoring the guidelines | Sarah Hallberg | TEDxPurdueU
Translator: Alena Novotn Proofreader: Martin Polakovi I have the best job in the world. I’m a doctor. But believe me, that’s not why. I’m an obesitologist. I have the honor to work with a group of people who are victims of the most widespread accepted prejudice: that they are fat. Before I meet them, these people will suffer a lot: They are ashamed, guilty, remorse and discriminated against. The approach of many people, including health professionals, is that these people are to blame for their problem. If they only managed better, they wouldn’t be overweight, and they don’t even want to change. Believe me, it’s not like that. They’re to blame if I divorce it a little, our own advice. And it’s time to change that. Obesity is a disease, not something caused by a lack of character. It is a hormonal disease, and there are a lot of hormones in the role. One of the main ones is a hormone called insulin. Most obese people are insulin resistant. So what does it actually mean to be insulin resistant? Well, insulin resistance is actually a condition that precedes type 2 diabetes. Insulin is used to deliver glucose, blood sugar, into those cells where it can be used.
In a nutshell, when someone is resistant to insulin, it’s a problem for him to get blood sugar where he needs it, into those cells. And yet he can’t just stay in the blood after every meal, otherwise we would find ourselves in a diabetic crisis after every meal! So when someone has insulin resistance, the body responds with even more insulin production. And insulin levels will rise more and more, and for a while, even for a few years, it will continue, and blood sugar can easily remain normal.
Usually, however, this condition does not last forever, nor did the elevated insulin level it cannot keep the sugar level in the normal range. So it starts to rise. It’s diabetes. You probably won’t be surprised that most of my patients suffer from insulin resistance or diabetes. And if you’re sitting there thinking, “Ugh, not me yet,” maybe think again Because almost 50% of Americans now have diabetes, or prediabetes. That’s almost 120 million of us. But it’s hard for anyone with insulin problems.
Because like I said, people have elevated levels due to insulin resistance years, or decades, than are diagnosed even for prediabetes. In addition, it turned out that 16-25% of adults of normal weight It is also resistant to insulin. So if you’re still counting, it’s a hell of a lot of us. The problem with insulin resistance is this: When it rises, we are at risk of type 2 diabetes. But also, because of insulin, we’re hungry, and it is more likely that the food we eat will be stored in fat stores. Insulin is our fat storage hormone. So we’re starting to see why this will be a problem, for diseases such as obesity and for metabolic disorders such as diabetes.
But what if we followed the problem to its beginning, and we didn’t have that much glucose to have to compete with insulin? Let’s see how to achieve this. In everything you dream of is either a carbohydrate, a protein or a fat, and each has a different effect on glucose and insulin levels, as you can see on the chart. So when we eat carbs, both glucose and insulin levels shoot up. It looks better with protein. But see what it looks like when we eat fat. Basically nothing, no ripples.
And this is definitely very important. I’ll explain the graph to you now with the help of a real situation. I want you to come back and remember how you last ate an American version of Chinese food. It is clear to us that there are things that happen regularly. The first is the fact that you desire. Because no STOP signal was sent, until you literally cracked at the seams. The second rule is: you will be hungry in an hour. Why? Well, because rice causes both glucose and insulin peaks in food, which triggered hunger, fat storage and sweet cravings.
So if you suffer from insulin resistance, and insulin levels are already high, you’re really still hungry. And we work on this setting: Eat carbohydrates, glucose will rise, insulin will rise, and you are hungry and store fat. So what kind of food do we recommend to these people? This seems to be very important. Let’s now focus on type 2 diabetics, because the usual recommendations for all type 2 diabetics They eat 40-60 g of carbohydrates in one meal, and other carbohydrates during snacks. Believe me, that’s a lot of carbs. And remember what happens to glucose and insulin, with blood sugar and insulin, when we eat them? Yes. Basically, we recommend to eat exactly what is causing their problem. Doesn’t that sound crazy? It’s really crazy. Because basically diabetes is a state of toxicity from an excess of carbohydrates. We can’t get blood sugar into the cells, and this causes a problem very soon.
But the long-term consequences are even worse. And insulin resistance is basically carbohydrate intolerance. So why do we still recommend people to eat them? Nutritional recommendations of the American Diabetes Association they state precisely that there is inconclusive evidence on recommending carbohydrate restrictions. But these recommendations agree on what we already know: Our carbohydrate intake is the single biggest factor affecting glucose, and also the need for medication. These recommendations then say: Look, look when you’re taking certain medication, in fact, you have to eat carbohydrates, otherwise your glucose levels would drop too much. Good. So let’s see to the vicious circle caused by this advice. Eat carbs so you have to take medication, then you have to eat more carbohydrates, to avoid the side effects of these medicines, and still around. Even worse, you won’t find it anywhere in the ADA recommendations a goal that would reverse the course of type 2 diabetes. That must change, because type 2 diabetes can be reversed, in many, in most cases, especially if we start soon.
Not only do we have to tell people about it, but we must begin to give them practical advice to be able to do so. Think about carbohydrates. First, it will be a shock to you: we don’t need them. Seriously! The minimum daily carbohydrate requirement is zero. We have essential amino acids, those are proteins, essential fatty acids, but no, no essential carbohydrate. Nutrients are essential if we need them to work and we can’t make them out of nothing else. We make glucose, in fact all the time and quite a lot, this is called gluconeogenesis. So we don’t need them, we are sick due to their excessive consumption, and yet we recommend to patients to eat almost, or maybe more than half of the daily energy intake in the form of carbohydrates.
It makes no sense. Let’s say what makes sense. Significant carbohydrate reduction. Yes, we teach patients in my department, to eat carbohydrates to a minimum, not at the maximum. And how does it work? Well, when our patients reduce their carbohydrate intake, their glucose will drop so they don’t need as much insulin. So the insulin level drops rapidly. And that’s very important, because the study which examined data from the National Health and Diet Research, better known as NHANES, showed that the single biggest risk factor coronary heart disease is insulin resistance. He is responsible for as much as 42% of heart attacks. The effects of a low-carb diet will be so rapid that that we can reduce human insulin doses by hundreds of units within days or weeks.
One of my favorite stories happened recently. A young girl who has had type 2 diabetes for almost 20 years she came to us after a doctor told her from elsewhere that she was simply ill, and she should get used to it. Her diabetes was completely out of control. Even though she was taking several drugs, including almost 300 units of insulin, which the pump injected into her body. And all this, remember when glucose was out of control. So we recommended a low-carb diet to her and let’s go 4 months forward.
She lost weight, yes, but it’s even better that she’s not sick anymore. Her blood sugars were normal all the time. What’s more, she wasn’t taking any diabetes medication. Gone with 300 units of insulin, no more insulin pump, no finger prick several times a day, gone, no more diabetes. One of the greatest joys of my job is just telling such a patient that he no longer has diabetes, and we will solemnly remove her from the list of their troubles. So are they cured? Is this a miracle? We’ll leave this play to the Wizard of Oz. “Cured” would indicate that he could not return. And if they start eating too much carbohydrates again, they’ll come back. So not “cured”, but they no longer have diabetes. It is solved, and it can remain so until we get rid of the cause.
So what does it look like? What does the diet actually look like? Well, first I’ll tell you what it doesn’t look like. Low carbohydrate does not mean carbohydrate free and is not high in protein. These are common criticisms, and they’re so frustrating, because they are not true. Next, if we reduce carbohydrate intake, how do we replace it? Because, we know that there are only three macronutrients: When we reduce one, we must increase the other. My patients eat fat. And they eat him a lot.
“What?” You say to yourself. What happens when you eat fat? Well, let me tell you, you’ll be happy because fats taste great, and are incredibly satisfying. (Applause) (Laughter) But, remember that fat is the only macronutrient which keeps glucose and insulin levels low, and this is very important. So here are my simple rules on how you should eat. These rules, remember, will be even more important to you, if you are one of the tens of millions of Americans, who have problems with insulin levels. Rule # 1: If it’s low-fat, light, or fat-free, leave it in the store. Because when they cut fat, they replaced it with carbohydrates and chemistry. Rule No. 2: Eat food. The most important rule of a low-carbohydrate diet: real food is not out of the box, and no one needs to remind you that it is natural. You should know this at a glance. Don’t eat anything you don’t like. And eat when you are hungry, do not eat when you are not, and it doesn’t matter what time it is.
Number five is an easy way to remember what to avoid. No BOC: potatoes. cereals and sugar. That’s quite a charge, isn’t it? No cereals? No, none. But we need them. No, they’re carbohydrates. But wholegrain is good for us. So first, there are very few foods which are truly whole grain, even if they claim it. Most foods that claim to be whole grain they are highly processed and the fiber in them is destroyed. Or they are made with highly refined flour, but usually it’s both. So if you don’t really have insulin resistance, you can eat real whole grain foods.
But if you’re in the majority of the population with insulin problems, things only make it worse. So what if you don’t have insulin problems? Can you eat like this? Yes! I’m a great example. More than a year ago, I decided to cut carbs, as much as I recommend to my patients. It’s not as necessary for my health as it is for theirs, I’m not insulin resistant, so, would that be a problem? No! And that’s what it’s about. If you do not have a very rare syndrome, then reducing carbohydrates in your diet will benefit you, although it is not necessary. I want to show you a few photos of my radical diet. This is a regular breakfast at home. Didn’t I just break my own rules? No, because this muffin is made from coconut flour. I’m still baking. I only use flour without cereals: coconut, almond, flax, hazelnut. They are great things.
And this is what a typical dinner with the usual “starches” looks like. These are roasted mushrooms. No, my patients and I always eat great food all the time and enjoy it. And what about some research? Isn’t that just my unsubstantiated evidence from my office? No! There are dozens of randomized controlled trials on a low-carbohydrate diet, due to risk factors such as obesity, cardiovascular risks, diabetes. They are consistent. It works! There are even many more studies that show that a low-carbohydrate diet reduces inflammatory markers, which are very exciting prospects for diseases such as cancer. We have just completed one study at our clinic. We took 50 type 2 diabetics, which we treated with a low-carbohydrate diet, and compared them with 50 patients, who followed the ADA recommendations. After six months not only have we noticed a significant metabolic improvement in the low-carbohydrate group, But also, and this is important, huge cost savings.
Our analysis has shown that patients can save up to $ 2,000 a year only on medications for diabetes that he no longer has to take. Just think of how it adds up. We are now going through an epidemic of diabetes, for which we give $ 250 billion a year in this country. Now I’ll show you the page which proves where the savings come from. Just look at the difference in insulin needed in both groups for 6 months. We see here that the low-carbohydrate group was able to reduce its doses about 500 units a day. While in the ADA group they had to increase their insulin by 350 units a day. Two important things. One: insulin is expensive. And two: not all people in this study needed insulin at all, thanks to that, the results are much more impressive. But I would say that this graph rather shows two different approaches to treating this disease. This first, our group, in order to reverse the disease, so that people no longer need medication.
And the other group, which sticks to the ADA’s recommendations, and which claims that diabetes is a progressive disease, which over time requires higher and higher doses of drugs. It is progressive until we eliminate the cause. So where is the problem? Why isn’t this talked about? Why is a low-carb diet not the norm? There are two big reasons. One: the status quo. It’s hard to break. There is too much politics in that. We have had this low-fat idea here for decades. But a recent study released which shows that there is no randomized controlled evidence that to help Americans remove fat from their diets. And that’s how carbohydrates started to be added. It was actually a huge experiment of millions of people and failed immensely. The second reason why we don’t see it written anywhere is money. Don’t let anything be persuaded, a lot of money is invested to make us sick. And we see on those specialized boards with recommendations, that they crack at the seams due to a conflict of interest. So the solution to this diabetic epidemic in my clinic is clear: stop taking medication and treat yourself with food.
And for a disease whose roots are carbohydrate consumption: stop eating or reduce carbohydrates, it will only return you to what we knew before. We knew it a long time ago, it was said thousands of years ago, and today we must return to this idea. Thanks.
Translator: Iris Xholi Reviewer: Helena Bedalli I will never forget that day of the spring of 2006. Isha resident surgeon at Johns Hopkins Hospital on receipt of emergency calls. Around 2am I was notified by ER to go see a woman with diabetic ulcer at her feet. I still remember that kind of rotten blood smell, to I was pulling the curtain to see him. We all there thought that woman was very sick and needed to be hospitalized. This was not in question. The question I was asking was another, did she need amputation? Now, turning our heads back to us that night I would desperately want to believe I treated that woman, that night, with the same empathy and compassion that I told to the 27-year-old newly married which came to the ER three days before with low back pain which turned out to be advanced pancreatic cancer.
In her case, I knew there was nothing I could do that would save his life. The cancer was very advanced. But I was committed to making sure that I would do everything possible to make it feel more comfortable. I brought her a warm blanket and a cup of coffee. I also brought it for her parents. But look, the most important thing is that I did not prejudge him, for it was evident that she had done nothing that could cause this to herself. Then, how is it possible that a few nights later, to stay in the same emergency room and set that my diabetic patient needed amputation, why did I say this in such a bitter way? The difference is that unlike the woman of the night before, this woman was suffering from type 2 diabetes. She was healthy. And we all know that this comes as a result of eating too much and lack of physical activity, right? I mean, how hard can it be? As I watched him lie down I thought to myself, as if you cared very little, you would not be in this state now with a doctor you had never seen before preparing to cut your leg.
Why did I feel justified judging her? I would like to say that I do not know. But this is not true. With the pride of my youth, I thought I had psychologized him. She has eaten a lot. She has been unlucky. I got diabetes. That’s the job. Strangely, at the time, I was researching about cancer, immune system therapies for skin cancer, to be more precise, from where I had learned that I should have doubts about everything, not to take anything for granted and you measure with the highest scientific standards. Meanwhile, when it comes to diabetes which kills 8 times more Americans than melanoma, I never tested the knowledge until then. I accepted you well, any link in the chain of pathological causes that leads to it. Three years later, I discovered I was very wrong. But this time, I was patient. Although I exercise 3-4 hours a day, and the implementation of the food pyramid with precision, I had gained a lot of weight and had developed something called metabolic syndrome.
Some of you may have even heard of it. I was immune to insulin. You can think of insulin as this omnipotent hormone that controls what our body does with the foods we eat, if we store them or burn them. In medical language this is called “energy sharing”. Insufficient insulin production is not compatible with life. And insulin resistance, as the name suggests, occurs when cells become more and more resistant from the effects of insulin trying to do its job. When you become insulin resistant, you become diabetic, what happens when the pancreas can not withstand resistance and produce enough insulin. The increase in the amount of sugar in the blood starts, and a waterfall of pathological problems get out of control, which can lead to heart problems, cancer, or even Alzheimer’s, and amputation, just like that woman a few years ago. With this problem, I started to change my diet drastically, removing and adding things you would find obviously shocking. I did so and lost 20 kg, although I did less exercise. As you can see, I’m not overweight. What is more important is that I no longer have insulin resistance.
But even more important, are these three questions that I have left and which do not want to be removed from me: How did this happen to me when I was thinking that I was doing everything right? If the science of healthy eating has been false, was it the same for others? And in analyzing these questions became almost obsessed in trying to understand the real connection between obesity and insulin resistance. Now, many researchers believe that obesity is due to insulin resistance. Logically, when treating insulin resistance, it forces people to lose weight, right? Treats obesity. What if it is exactly the opposite? What if obesity is not the cause of insulin resistance? In fact, what if it were a symptom of a much bigger problem, the tip of an iceberg? I know that sounds a little strange, since we are in the middle of an obesity epidemic, but listen to me a little.
What if obesity is a camouflage of a much more serious problem that has roots in the cell? I’m not suggesting here that obesity is benign, but what I am suggesting is that it may be the lesser evil of the two evils of metabolism. You can think of insulin resistance as disability to distribute fuel, as I referred to a minute ago, to get the calories we provide with food and proportionately burn one part and preserve the other. When we become insulin resistant, homeostasis in this type of balancing is disrupted. So now, when insulin tells the cell, I want to burn more energy than the cell considers it safe, it actually responds, “No thanks, I will save this energy.” And since we do not find them in fat cells those complex cellular machines found in other cells, is the best place to store it.
Many of us, about 75 million Americans, insulin resistance response it may be to preserve it in the form of fat and not the other way around, having insulin resistance in response to obesity. This is actually a small change, but with severe consequences. Consider the following analogy: Think about the abrasions you experience on your skin when you accidentally slam your knee on the coffee table. Obviously the wound hurts a lot and you do not like the fact that it is smoky, but we all know that the wound itself is not the problem. In fact, it is the opposite, it is a healthy response to a trauma, are the immune cells that run where the damage occurred to help the cells there and stop the spread of the infection to other parts of the body. Now, imagine if we thought the wound was actually the problem, and conduct any research and medical culture about wound treatment: masking creams, painkillers, and more, completely ignoring the fact that people are still slamming the cart on coffee tables.
How much better it would be if we dealt with the causes– telling people to be more careful as you walk through the living room– instead of the effect that is created? Understanding cause and effect, makes all the difference possible. To be mistaken, the pharmaceutical industry may continue to be profitable for its investors but for people with cartilage killed nothing improves. Cause and effect. What I am suggesting is that perhaps we have the wrong cause and effect when faking for obesity and insulin resistance. Maybe we should ask ourselves, is it possible that insulin resistance causes weight gain and obesity-related diseases, at least in most people? What if being obese is simply a metabolic response to something much more threatening, a hidden epidemic, what should we worry about the most? Let’s take a look at the facts.
We know that 30 million obese Americans in the USA do not suffer from insulin resistance. And by the way, they do not seem to be us any greater risk for disease than weak people. Meanwhile, we know that 6 million people are weak in the USA are insulin resistant, and by the way, they are thought to be at greater risk for those metabolic diseases I mentioned above, in contrast to the obese group. I do not know why, but maybe it comes as a result of the fact that in their case, the cells have not yet figured it out what to do with the excess energy.
So if a person may be obese and may not have insulin resistance, or it may be weak and have it, this indicates that obesity may be a camouflage for what is happening. So what if we were fighting a wrong war, to fight obesity instead of insulin resistance? Even worse, it’s like blaming the obese does that mean we are blaming the victims? What if some of our core ideas on obesity are you wrong? Personally, I can not have it with the luxury of arrogance lets not talk then about the luxury of complete security. I have my ideas of what the problem might be, but I am open to suggestions. My hypothesis, because everyone asks me, this is.
If you are wondering, what is trying to protect the cell when it becomes insulin resistant, the answer is probably not, food surplus. But most likely, excess glucose: blood sugar. We know that processed cereals raises blood sugar levels in the short term, and there are also reasons to believe that sugar may lead directly to insulin resistance. If these psychological processes are put to work, casts the hypothesis that may be the cause of obtaining that processed grains, bulk sugar, what it brings epidemic of obesity and diabetes, but through insulin resistance, and not as an effect of overeating or not exercising. When I lost 20 kg a few years ago, I did it simply by limiting these things, which suggests I have a side based on my personal experience. But that does not mean that my bias is wrong, and most importantly, all of these can be scientifically proven. But the first step is to accept the opportunity that our belief about obesity, diabetes and insulin resistance may be wrong and should therefore be tested.
I bet my career on this. Today, I dedicate all my working time to this problem, and I will go everywhere to take science. I have decided that what I have I can not and will not do anymore is to pretend I have the answers when I do not have them. I have been humbled by everything I do not know Last year, I was quite lucky that I worked on this problem with a wonderful group obesity and diabetes researchers in the country, and the most beautiful part is that, just as Abraham Lincoln surrounded himself with a rival working group, and we have done the same.
We have recruited a working group with rival scientists, the best and the brightest but they all have their own hypotheses about what may be at the heart of the epidemic. Some think it is the large amount of calories consumed. Others think that it is a great consumption of a fatty diet. For others, the problem lies in the consumption of cereals and starches. But this working group of multi-disciplinary researchers, quite educated and quite talented, agree on two things. First, this problem is very important to continue to ignore it simply because we think we know the answers.
And second, if we admit we are wrong, if we accept to challenge the knowledge so far with the best experiments offered by science, the problem can be solved. I know it’s pretty tempting to learn the answer right now, policies and measures, dietary recommendations– eat this, not that– but if we want to identify it exactly, we have to do a pretty rigorous science before we start giving recommendations. In short, to address this, our research program is focused around three main topics or questions. First, how do the different foods we consume affect in metabolism, hormones and enzymes, and through what molecular mechanism? Secondly, based on these data, can people make the necessary changes to their diet in a way that is safe and practical implementation? And finally, when we identify it what safe and practical changes people can make to their diet, how can we direct their behavior in that direction to become everyday and not the exception? Knowing what to do does not mean that you will always do it. Sometimes it is necessary to put data around people to make it easier, and believe it or not, this can be studied scientifically.
I do not know how this journey will end, but that seems clear to me at least: We can no longer blame the overweight and diabetic patients as bera une. Most of them actually want to make the right genes, but they need to know what that is, and should work. I dream of the day when our patients will be weakened and cure themselves of insulin resistance, as a medical professional, we have sweated our mental baggage and we have healed ourselves from resisting ideas enough to return to our ideals of origin: open mind, with courage to throw away yesterday’s ideas when they do not yield results, and understanding that scientific truth is not the last word, but in constant evolution. Staying true to that path will be better for our patients and better for science, If obesity is nothing but camouflage of metabolic diseases, what good is it to us to punish those who suffer from it? It happens to me to think about the night in the emergency 7 years ago.
I wish I could talk to that woman again. I would like to tell you how sorry I was. I would tell you that as a doctor, I gave it to her the best clinical service I could, but as human beings, I did not treat it properly. You did not need my judgment. You needed my sympathy and pity, and above all you needed a doctor who would be willing to consider the fact that you could be outside the system. Maybe the system, of which I was a part, did not help you. If you are seeing this now, hope you can forgive me. (Applause).
There are two main types of diabetes, Type 1 and type 2. The two have different physical problems but both are serious. However, there are some other rare types of diabetes. There are similarities between all types of diabetes, That is because they cause too much glucose in the human blood. But we all need some glucose Is, which gives us strength. We get glucose when our body is what we eat or drink It breaks down carbohydrates And that glucose is excreted in our blood. We also need a hormone called insulin. It is made by our pancreas And this insulin enters our blood glucose into our cells Lets do and fuels the body. If you do not have diabetes, glucose is in your bloodstream Your pancreas can feel it when it enters and Releases the right amount of insulin So that glucose can enter your cells. But if you have diabetes, This method does not work. If you have type 1 diabetes, you cannot make any insulin. However, if you have type 2 diabetes, it is a little different, yours Made insulin either may not work effectively or you do it Can’t produce enough.
For both types of diabetes, Since glucose cant get into your cells, its yours Begins to clot in the blood. And too much glucose in your blood Causes a variety of problems. It starts with the symptoms of diabetes, Such as frequent urination, extreme thirst And feel very tired. You may also lose weight, have an infection like thrush, or You can suffer from wounds that heal slowly. For a long time, in your blood If you have high levels of glucose, it affects your heart, eyes, legs and kidneys Can cause fatal damage. These are known as diabetic complications.
But with proper treatment and care, People can live healthy lives. And as a result of this The risk of experiencing complications is low. If you have diabetes, you have it Lots of information and help related to our website and You can get it using the helpline. In addition to running a proper care campaign for everyone with diabetes, Diabetes UK provides funding for all types of diabetes research So that we can come up with new treatments and find a cure one day.
In our next video you will find Type 1 and Type 2 Diabetes And learn more about its treatment..
Diabetes is a disease that occurs when the amount of glucose, or blood sugar, gets too high. This is glucose, the main source of our bodys energy which comes mostly from the food we eat. Normally, insulin, a hormone made by the pancreas, helps glucose from our food get into our cells to be used for energy. But what happens if we cant produce enough insulin or we produce none at all? Lets take a look at the pancreas, where insulin is made. With type 1 diabetes, our bodys immune system destroys the cells in our pancreas. This means our body can no longer make insulin and we need to take it daily to live. In type 2 diabetes, either our body doesnt use insulin well or the pancreas makes some insulin but not enough to carry sufficient glucose into our cells.
Either way, we need to make up the difference by taking insulin or other diabetes medications to control our blood sugar. With either type of diabetes, glucose levels in our blood can get too high, which can lead to health problems, including heart, kidney, nerve, and eye diseases. Though diabetes is serious, it can be managed so its less likely to cause health problems. For people with diabetes, check your average blood glucose level with an A1C test to determine whether that level is within your target range to reduce health problems. We also need to take our prescribed diabetes medicines, make healthy food and activity choices, manage our blood pressure and cholesterol, and quit smoking to help us live healthier lives. To learn more about diabetes and how you can delay or prevent health problems, visit www.niddk.nih.gov or call 18008608747..