Reversing Type 2 diabetes: Dr Sarah Hallberg
414 views • 11/24/2015
TEDEx talk by Dr Sarah Hallberg: Reversing Type 2 diabetes starts with ignoring the guidelines.
| 00:10 - 00:16 | I have the best job in the world. I'm a doctor. |
| 00:16 - 00:19 | No, believe me; that's not why. I'm an obesity doctor |
| 00:20 - 00:23 | I have the honor of working with a group of people |
| 00:23 - 00:27 | subject to the last widely accepted prejudice: being fat. |
| 00:28 - 00:31 | These people have suffered a lot by the time they see me. |
| 00:31 - 00:36 | Shame, guilt, blame and outright discrimination. |
| 00:36 - 00:39 | The attitude that many take, including those in health care, |
| 00:40 - 00:43 | is that these people are to blame for their situation. |
| 00:43 - 00:48 | If they could just control themselves they wouldn't be overweight and they're not motivated to change. |
| 00:49 - 00:52 | Please let me tell you, this is not the case. |
| 00:52 - 00:57 | The blame, if we've got to extend some here, has been with our advice |
| 00:57 - 00:59 | and its time we changed that. |
| 00:59 - 01:04 | Obesity is a disease. It's not something created by lack of character. |
| 01:05 - 01:08 | It's a hormonal disease and there are many hormones involved. |
| 01:08 - 01:12 | And one of the main ones is a hormone called insulin. |
| 01:12 - 01:16 | Most obese individuals are resistant to this hormone insulin. |
| 01:16 - 01:20 | So what does that mean exactly to be resistant to insulin? |
| 01:21 - 01:26 | Well insulin-resistance is essentially a state of pre-, pre-type 2 diabetes. |
| 01:27 - 01:33 | Insulins job is to drive glucose or blood sugar into the cells where it can be used. |
| 01:33 - 01:38 | In a nutshell, when someone is insulin-resistant, they are having trouble getting |
| 01:39 - 01:43 | blood sugar where it needs to go, into those cells. |
| 01:43 - 01:45 | And it just can't hang out in the blood after we eat |
| 01:45 - 01:49 | or we would all have a diabetic crisis after every meal. |
| 01:49 - 01:54 | So when someone is resistant to insulin, the body's response to this |
| 01:55 - 02:00 | is to just make more of it and insulin levels will rise and rise |
| 02:01 - 02:03 | and for a while, years even, this is going to keep up |
| 02:03 - 02:05 | and blood sugar levels can remain normal. |
| 02:06 - 02:12 | However, usually it can't keep up forever and even at those elevated levels of insulin |
| 02:12 - 02:16 | are not enough to keep blood sugar in the normal range. |
| 02:16 - 02:19 | So it starts to rise. Thats diabetes. |
| 02:20 - 02:25 | It probably won't surprise you to hear that most of my patients have insulin-resistance or diabetes. |
| 02:25 - 02:29 | And if you're sitting there thinking, phew, that's not me, |
| 02:29 - 02:38 | you actually might want to think again because almost 50% of adult Americans now have diabetes or pre-diabetes. |
| 02:39 - 02:42 | That is almost 120 million of us. |
| 02:42 - 02:46 | But thats hardly everyone who has issues with insulin |
| 02:47 - 02:51 | because as I was saying, people have elevated insulin levels due to insulin-resistance |
| 02:51 - 02:58 | for years, even decades before the diagnosis of even pre-diabetes is made. |
| 02:58 - 03:06 | Plus its been shown that 16-25% of normal weight adults are also insulin resistant. |
| 03:06 - 03:11 | So, in case you're keeping track, this is a heck of a lot of us. |
| 03:12 - 03:20 | So the trouble with insulin resistance is if it goes up, we are at great risk for developing Type 2 diabetes. |
| 03:20 - 03:29 | But also insulin makes us hungry and the food that we eat much more likely to be stored as fat. |
| 03:29 - 03:33 | Insulin is our fat storage hormone. |
| 03:33 - 03:37 | So we can start to see how it's gonna be a problem |
| 03:37 - 03:41 | for diseases like obesity and metabolic issues like diabetes. |
| 03:41 - 03:45 | But what if we trace this problem back to the beginning |
| 03:45 - 03:50 | and we just didn't have so much glucose around that insulin needed to deal with. |
| 03:50 - 03:54 | Let's take a look at how that could be. |
| 03:54 - 03:59 | Everything you eat is either a carbohydrate, a protein or a fat. |
| 04:00 - 04:05 | And they all have a very different effect on glucose and therefore insulin levels, as you can see on the graph. |
| 04:06 - 04:09 | So when we eat carbohydrates our insulin and glucose are gonna spike up fast. |
| 04:09 - 04:13 | And with proteins, it looks a lot better. |
| 04:13 - 04:17 | But take a look at what happens when we eat fat. |
| 04:17 - 04:19 | Essentially, nothing. A flat line. |
| 04:20 - 04:23 | And this is gonna wind up being very important. |
| 04:23 - 04:29 | So now I want to translate that graph for you into a real-world situation. |
| 04:30 - 04:36 | I want you to go back and think about the last time you ate an American version of Chinese food. |
| 04:36 - 04:40 | We all know there's rules associated with this, right? |
| 04:40 - 04:43 | And the first rule is you're going to over-eat. |
| 04:43 - 04:48 | Because the stop signal doesn't get sent until you are literally busting at the seams. |
| 04:49 - 04:52 | Rule number two is in an hour, you're starving. |
| 04:52 - 04:57 | Why? Well because the rice in that meal caused glucose and insulin to skyrocket |
| 04:58 - 05:02 | which triggered hunger, fat storage and cravings. |
| 05:03 - 05:08 | So, if you're insulin resistant to begin with and and your insulin levels are already higher |
| 05:08 - 05:11 | you really ARE hungrier all the time. |
| 05:11 - 05:19 | And we have this setup: eat carbs, your glucose goes up, your insulin goes up and you have hunger and fat storage. |
| 05:19 - 05:23 | So how do we recommend to these people to eat? |
| 05:23 - 05:27 | Because it seems like that would be really important and it is. |
| 05:27 - 05:30 | Let's focus just on type 2 diabetes. |
| 05:30 - 05:35 | Because the general recommendations are to tell patients with type 2 diabetes |
| 05:36 - 05:41 | to consume 40-65 grams of carbohydrates per meal, plus more at snacks. |
| 05:42 - 05:45 | Trust me on this. That's a lot of carbs. |
| 05:45 - 05:51 | And remember what's gonna happen to glucose and insulin, blood sugar and insulin, when we eat them? |
| 05:52 - 05:58 | Yes. We are essentially recommending that they eat exactly what causing their problem. |
| 05:59 - 06:02 | Sound crazy? It really, really is. |
| 06:03 - 06:07 | Because at its root, diabetes is a state of carbohydrate toxicity. |
| 06:07 - 06:11 | We can't get the blood sugar into the cells |
| 06:11 - 06:13 | and that causes a problem in the short-term |
| 06:13 - 06:16 | but the long-term consequences are even greater. |
| 06:16 - 06:22 | And insulin-resistance is essentially a state of carbohydrate intolerance. |
| 06:22 - 06:28 | So why oh why, do we want to continue to recommend to people to eat them? |
| 06:29 - 06:34 | The American Diabetes Association guidelines specifically state |
| 06:34 - 06:38 | that there is inconclusive evidence to recommend a specific carbohydrate limit. |
| 06:38 - 06:45 | But those guidelines go right on to say what we all know. |
| 06:45 - 06:51 | Our carbohydrate intake is the single biggest factor in blood sugar levels and therefore need for medication. |
| 06:51 - 06:59 | These guidelines then go on to say, hey look, if you're taking certain diabetic medications you actually HAVE TO eat carbs |
| 06:59 - 07:03 | otherwise your blood sugar can go to too low. |
| 07:03 - 07:07 | Okay, so let's take a look at the vicious cycle that that advice just set up. |
| 07:08 - 07:13 | So, its eat carbs - so you have to take medicine - then you have to eat more carbs |
| 07:13 - 07:19 | to avoid the side effects of those medications, and around and around we go. |
| 07:19 - 07:27 | Even worse is that nowhere in the ADA guidelines is the goal of reversing type 2 diabetes. |
| 07:28 - 07:33 | This needs to be changed because type 2 diabetes CAN be reversed |
| 07:34 - 07:38 | in many, if not most, situations, especially if we start early. |
| 07:38 - 07:41 | Not only do we need to let people know this |
| 07:42 - 07:47 | but we have to start giving them the practical advice so they can do this. |
| 07:49 - 07:54 | Consider carbs. First, here's a shocker for you. We don't need them. Seriously. |
| 07:54 - 08:00 | Our minimum daily requirement for carbohydrates is zero. |
| 08:00 - 08:05 | We have essential amino acids, those are proteins, essential fatty acids but nope, no essential carbs. |
| 08:05 - 08:13 | A nutrient is essential if we have to have it to function and we can't make it from something else. |
| 08:13 - 08:19 | We make glucose, plenty of it, all the time. Its called gluconeogenesis. |
| 08:19 - 08:24 | So, we don't need them,the over-consumption of them is making us very sick |
| 08:25 - 08:28 | yet we are continuing to recommend to patients to consume close to, |
| 08:28 - 08:33 | if not more than, half of their total energy intake everyday from them. |
| 08:33 - 08:35 | It doesn't make sense. |
| 08:36 - 08:41 | Let's talk about what does. Cutting carbs, a lot. |
| 08:42 - 08:47 | Yes, in my clinic we teach patients to eat with carbs as the minority of their intake, not the majority. |
| 08:47 - 08:52 | So how does that work? Well, when our patients decrease their carbs |
| 08:53 - 08:56 | their glucose goes down and they don't need as much insulin. |
| 08:56 - 09:00 | So those insulin levels drop and fast. And this is very important |
| 09:00 - 09:07 | because a study looking at our National Health and Nutrition Examination Survey data, better known as and NHANES, |
| 09:07 - 09:15 | showed that the single biggest risk factor for coronary artery disease is insulin resistance. |
| 09:15 - 09:20 | It is responsible for a whopping 42% of heart attacks. |
| 09:21 - 09:29 | Low carb intervention works so fast that we can literally pull people off of hundreds of units of insulin in days to weeks. |
| 09:29 - 09:33 | One of my favorite stories is a very recent one. |
| 09:34 - 09:37 | A young gal but who had an almost 20-year history of type 2 diabetes |
| 09:37 - 09:42 | came in when a physician from another clinic told her she was just sick and should probably get used to it. |
| 09:43 - 09:50 | Her diabetes was way out of control. This despite the fact that she was on multiple medications |
| 09:50 - 10:00 | including almost 300 units of insulin that was being injected into her continuously everyday via a pump. |
| 10:00 - 10:03 | All this, remember blood sugar still out of control. |
| 10:04 - 10:08 | So we put her on a low carb diet and now lets fast forward four months. |
| 10:09 - 10:14 | She lost weight, yes. But better than that, sick no more. |
| 10:14 - 10:16 | Her blood sugar levels were now normal ALL of the time. |
| 10:16 - 10:20 | This on - get this - NO diabetes medication. |
| 10:21 - 10:25 | Gone was the 300 units of insulin, no more insulin pump, |
| 10:25 - 10:32 | no more pricking her finger multiple times each day. Gone. All of it. No more diabetes. |
| 10:33 - 10:38 | One of the greatest joys of my job is to be able to tell a patient like this that they no longer have diabetes |
| 10:39 - 10:42 | and we ceremoniously take it off their problem list together. |
| 10:42 - 10:44 | So, are they cured? Is this a miracle? |
| 10:44 - 10:48 | Well that grandstanding to Doctor Oz. |
| 10:49 - 10:55 | Cured would imply that it can't come back and if they start eating excessive carbs again, it will; so, no not cured. |
| 10:55 - 11:00 | But they don't have diabetes any longer. It's resolved. |
| 11:00 - 11:05 | And it can stay that way as long as we keep away the carbs. |
| 11:05 - 11:08 | So, what does this look like then? How does somebody eat this way? |
| 11:08 - 11:15 | Well, first let me tell you what its not. Low carb is NOT zero carb and it is NOT high protein. |
| 11:16 - 11:21 | These are common criticisms that are so frustrating because they're not true. |
| 11:21 - 11:23 | Next, if we take the carbs out, what are we gonna put it? |
| 11:23 - 11:29 | Because remember there's only three macro-nutrients. If one goes down, one has to go up. |
| 11:29 - 11:32 | My patients eat fat and a lot of it. |
| 11:32 - 11:35 | What?! you say. What's going to happen when you eat fat? |
| 11:35 - 11:37 | Well, let me tell you. You're gonna be happy |
| 11:37 - 11:45 | because fat tastes great and is incredibly satisfying! [laughter and applause]. |
| 11:45 - 11:55 | 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. |
| 11:55 - 12:01 | So I want you to now hear my simple rules for eating. |
| 12:02 - 12:07 | These rules, you have to remember, its even going to be more important if you are one of the tens of millions of Americans |
| 12:08 - 12:11 | who have trouble with insulin levels. |
| 12:11 - 12:14 | Rule number one. If it says light, low-fat or fat-free, it stays in the grocery store. |
| 12:14 - 12:18 | Because if they took the fat out, they put carbs and chemicals in. |
| 12:18 - 12:22 | Rule number two. Eat food. The most important rule in low carb nutrition. |
| 12:22 - 12:27 | Real food does not come in a box and no one should have to tell you real food is natural. |
| 12:28 - 12:30 | You should know that when you look at it. |
| 12:31 - 12:38 | Dont eat anything you don't like. And eat when you're hungry; dont eat when you're not, no matter what the clock says.. |
| 12:39 - 12:46 | And number five is a simple way to remember what we want to avoid. No GPS: no grains, no potatoes and no sugar. |
| 12:46 - 12:50 | That last one is a biggie, right? No grains. Yeah, no grains. |
| 12:50 - 12:53 | But we have to have them?!. No. Theyre a carb. |
| 12:53 - 12:54 | But whole grains are so good for us? |
| 12:54 - 13:00 | Well, first of all there are actually very few foods out there that are truly 'whole' grain, even when they say they are. |
| 13:00 - 13:07 | Most foods that purport themselves to be whole grain are highly processed and the fiber benefit ruined. |
| 13:07 - 13:10 | Or they're coming with highly refined flour. Usually both of these things. |
| 13:10 - 13:16 | So if you are one of the truly insulin-sensitive people, you can eat real whole grain. |
| 13:17 - 13:23 | But if you are in the enormous slice of our population with insulin issues, it's making things worse. |
| 13:24 - 13:29 | So what if you are one of the real insulin-sensitive people, can you still eat this way? |
| 13:29 - 13:32 | Yes. I'm a great example. |
| 13:32 - 13:36 | Over a year ago I decided I would cut my carbs as low as I recommend to my diabetic patients. |
| 13:36 - 13:45 | 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. |
| 13:45 - 13:51 | Unless you have an exceedingly rare syndrome that cutting carbs is gonna be good for you, even if it's not necessary. |
| 13:51 - 13:56 | I want to show you a couple of pictures of my radical food. |
| 13:56 - 14:01 | So this is a common breakfast in my house. So does it look like I just broke my own rule? |
| 14:02 - 14:06 | I didn't because this muffin is made with coconut flour. |
| 14:06 - 14:13 | I bake all the time still. I just use non-grain based flowers: coconut, almond, hazelnut, flax. They make delicious things. |
| 14:13 - 14:18 | And this is a typical dinner in my house, with a typical 'starch'. That would be the sauted mushrooms. |
| 14:18 - 14:25 | Nope, my patients eat delightful food all of the time and enjoy it. |
| 14:26 - 14:33 | But what about the research on this? I mean is this just anecdotal evidence now from my clinic? No. |
| 14:34 - 14:40 | There are dozens of randomized controlled trials, looking at low carb intervention for things like diabetes, cardiovascular risk factors, obesity. |
| 14:40 - 14:42 | They're consistent. It works. |
| 14:42 - 14:49 | Theres even a large number of studies showing that low carb nutrition decreases inflammatory markers |
| 14:49 - 14:53 | which is making it really exciting for diseases like cancer. |
| 14:53 - 15:00 | We just finished a study in our clinic and what we did is we took 50 type 2 diabetic patients |
| 15:00 - 15:04 | that were treated with our low carb high fat based program |
| 15:04 - 15:08 | and we compared them to 50 patients who were treated with the ADA guidelines. |
| 15:08 - 15:14 | And after 6 months not only did we find a significant metabolic advantage for the low-carb group, |
| 15:15 - 15:19 | but and let's face it - this is important a huge cost savings. |
| 15:20 - 15:28 | Our analysis showed that our patients could save over $2,000 a year JUST on the diabetes meds they were no longer taking. |
| 15:28 - 15:36 | Just think how fast that adds up with our diabetes epidemic now that we are spending $250 billion dollars a year on in this country. |
| 15:36 - 15:42 | So I want to show you a slide now that demonstrates where that savings is coming from. |
| 15:43 - 15:50 | So this is looking just at the insulin difference in the two groups after 6 months. |
| 15:50 - 15:56 | And what we can say is that the low-carb group was able to decrease their insulin by almost 500 units a day. |
| 15:56 - 16:02 | Where as in the ADA treated group, they had to increase their insulin by almost 350 units a day. |
| 16:02 - 16:06 | Two important things. Number one, insulins expensive. |
| 16:06 - 16:15 | And number two, not all the people in this study were even on insulin which makes these results even more impressive. |
| 16:15 - 16:22 | But what I would say is that this graph really represents two different approaches to treating this disease. |
| 16:23 - 16:28 | The first, our group, with the goal of reversing the disease. Meaning they need less medicine. |
| 16:28 - 16:32 | And the second group, which very clearly aligns with the ADA guidelines |
| 16:32 - 16:38 | which states that diabetes is a progressive disease requiring more medicine overtime. |
| 16:38 - 16:42 | Progressive. Unless we take away the carbs. |
| 16:42 - 16:47 | So, what's the problem then? Why is this not everywhere? Why isnt low carb the norm? |
| 16:48 - 16:53 | There's two big reasons. Number one: status quo. It is hard to break. |
| 16:53 - 17:00 | There are many agendas involved. We got this notion that low fat was the way to go decades ago. |
| 17:00 - 17:08 | 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. |
| 17:09 - 17:14 | And that's how the carbs got added in. |
| 17:15 - 17:19 | It was essentially a huge experiment on millions of people and it failed miserably. |
| 17:19 - 17:22 | The second reason we don't see it everywhere is money. |
| 17:23 - 17:26 | Don't be fooled. There's a lot of money to be made from keeping you sick. |
| 17:26 - 17:32 | And what we see is with these specialty guideline panels, they are stacked with conflict of interest. |
| 17:32 - 17:38 | So, the solution to the diabetes epidemic in my clinic is exceedingly clear. |
| 17:39 - 17:44 | Stop using medicine to treat food. |
| 17:45 - 17:52 | And for a disease whose root cause is carbohydrates, take away the carbohydrates or at least cut them |
| 17:52 - 17:57 | so we can remember what we used to know. |
| 17:57 - 18:02 | We knew it a long time ago. This was said thousands of years ago |
| 18:02 - 18:04 | and we need, in this day and age, to get back to that notion. |
| 18:05 - 18:05 | Thank you. |
| 18:05 - 18:10 | Subtitles by Dr Linda Komesaroff |
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