Reversing Type 2 diabetes starts with ignoring the guidelines | Sarah Hallberg | TEDxPurdueU (1)

Translator: Anders Björk Reviewer: Ivan Stamenković

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.

That's diabetes.

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.

Why?

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.

Sound crazy?

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.

Consider carbs.

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.

(Applause)

(Laughter)

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,