Episode Transcript
Pathways Lifestyle Medicine Clinics / Lifestyle Is Medicine
Time: 21:37
Dr. George Cho: Hello everyone! Welcome to the Lifestyle is Medicine podcast brought to you by Lifestyle is Medicine. Today we take you to a webinar that we did recently on type 2 diabetes. We had Dr. Wes Youngberg and Dr. John Kelly speak for us, and we bring you part 2 of the discussion. Hope that you are blessed by this talk.
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Dr. George Cho: I have another question for both of you. I was looking at the 2018 Diabetes Clinical Guidelines for Canada, and if you... through the whole document they mention nothing about reversal. The word that they use is “management,” but both of you… Dr. Wes [Youngberg], I read your book and clearly you believe that diabetes can in some way, shape or form, be reversed. At least there’s a possibility of that. I know that Dr. Kelly--You and the American College of Lifestyle Medicine believe that type 2 diabetes is potentially reversible.
So, who should we believe? What does the science say cause these folks who are making the guidelines, clinical guidelines, are saying… They don’t use the word “reversible.” But you’re saying that potentially it is. So you can explain?
Dr. Youngberg : I say that we’re all right, Dr. Cho. We’re all right.
It was Henry Ford who said, “Whether you think you’re right or you think you’re wrong. Whether you think you can or you think you can’t, you’re right!” He said.
And so, the reason why many people don’t believe that diabetes is reversible is because they themselves have never seen it because they have never actually researched or figured out how to do it. The average physician, especially somebody trained years ago who had no exposure to even the thought-- the consideration that diabetes may be reversible. They never, never implemented a clinical protocol or strategy that would even come close to helping their patient reverse their diabetes. Therefore, it’s impossible. Yet under those circumstances it’s impossible. And that’s what we still see broadly in the medical world, is that people don’t believe it’s possible because they’re not privy to understanding the underlying triggers. So that’s why we began this discussion--we need to understand what drives it in the first place. Once we do that, the vast majority of people, especially if caught early in the disease process before the pancreas has lost the vast majority of its ability to produce insulin. That is a condition where we can reverse it.
Let me give you a quick example. Some people say, “Well, maybe somebody who’s fairly young. Maybe they can reverse their diabetes. Maybe for a year, but after that it comes back. Right?” Well, anything can come back if we do not continue to follow the strategies that allowed us to reverse it in the first place.
Six years ago, I had an 89 year old patient who wanted to address his diabetes. He had blood sugars well above 300, and Dr. Cho you can tell your Canadian friends what that means in terms of world units vs. U.S. units. Very, very high blood sugars that’s way, way too high! About 2-3 times too high after meals. He was under the impression that there’s nothing that could be done about it. When he worked with me, he learned… he was a very successful businessman. He just said, “Tell me what to do, and I’ll do it!” We just had one session, and I told him what to do. He started implementing all the strategies.
And Dr. Cho, within 5 weeks he calls me up and he says, “Dr. Youngberg! I want to get tested again.”
“It’s only been 5 weeks,” I said.
Patient: “Well, it’s going to be my 90th birthday and I want to be able to tell them where I’m at in my goals to reverse diabetes.” We tested him, and his hemoglobin A1C had dropped from 7.2 (which is clearly diabetic) to 6.2 (which is clearly not diabetic) based on that guideline. That was 5 weeks! That was based on his diet change and his exercising after meals. He stopped snacking in the evenings.
Then what happened is that he kept this up, and after 3 months he wasn’t even prediabetic anymore. After 6 months, his A1C went down to 5.1%, and it stayed there. And he’s 96 years old now!
So nobody can make the excuse that I’m too old!
It’s just a question: Are you willing to get on the program to follow the recommendations. And you will get dramatic results if you do.
Dr. Kelly: Dr. Cho, if I might share a thought. I appreciate the question and there are people who genuinely are concerned that those of us who say you can reverse this disease when the so called “recognized experts” say you cannot. So let me just speak very plainly and clearly to that, because I appreciate Dr. Youngberg’s first case example. But the reality is what happened is in the 80s we started using bariatric surgery to treat morbid obesity. Lo and behold, one of the side effects was people with type 2 diabetes were being cured or their diabetes was going away. That fact really is what made us change!
In 2009, the American Diabetes Association, it was the first time they published a consensus statement on what is remission. They had to define it because it’s happening. We’ve been forced into this, but now many organizations are realizing that it is possible to do this without surgery.
In fact, amazing study done by Lingvay-- I can give you the citation. But they did this study where they asked the question: Is the diabetes remission due to the surgery or to the diet? They did a crossover study where they had people that were going to get the surgery randomly assigned to go on the diet for a couple weeks before the surgery or to get the surgery and go on the diet for the 2 weeks. What they found was… believe it or not. This was a Roux-en-Y, very aggressive bariatric surgery. The people who went on the diet without the surgery actually did better. [They] had better remission than the ones that had the surgery before they went on the restricted diet
So diet alone can reverse diabetes. Unequivocal, absolutely.
Dr. Youngberg: Absolutely, yes!
Dr. Cho: Well, you both mentioned nutrition so we’re going to start getting a little deeper into that. We will walk through some of the specific controversies that are out there or the misconceptions that are out there that people have.
So first thing for you, Dr. Wes [Youngberg]… there’s a lot of discussion about ketogenic diet. Paleo is kind of a modified ketogenic diet, if you will. High carb, low carb. Some people are saying that, “Carbohydrates aren’t good. I shouldn’t eat rice.” Can you comment on the low carb, high carb, low fat, high fat controversy there.
Dr. Youngberg: First of all, Dr. Kelly and I both had the privilege to work with Brenda Davis, a registered dietitian who’s Canadian! In my opinion, she’s the most respected, from my perspective, most respected dietitian in the world relative to diabetes management.
Dr. Kelly: Yes.
Dr. Youngberg: She was of course involved with the Diabetes Undone project, but we first met in Dr. Kelly’s research project in the Marshall Islands where he was medical director of this big project that was working with some of the sickest of the sick. These are diabetics that had amputation risk, they had blindness risk. These were hardcore diabetics! He took this message of addressing diabetes management using lifestyle medicine to the Western Pacific. That’s how we met Brenda Davis specifically.
Well, the challenge here is sometimes the way the question is posed creates a more of the controversy.
In my opinion, it’s not so much about the amount of carbohydrates or amount of fat as it is the type of carbohydrate and the type of fat. That’s why the emphasis from a clinical standpoint should be on a whole plant-based diet. It should be plant strong, meaning the majority of the calories or the volume of the meal planning comes from whole plants. Ideally, 100% from whole plants because that’s where you get the nutrition!
How do you heal any chronic lifestyle related disease?
It’s by Number 1: Dramatically increasing the amount of nutrients. Not calories clearly, but nutrients! The way you get more nutrients is by eating foods that are high in nutrients. Those are the whole plant-based foods. Those are the non-starchy vegetables first and foremost. The green leafy vegetables, and the colorful vegetables.
So those are carbohydrates, so to say that carbs are bad or you can eat all the carbs you want is really the wrong way to pose the question, I believe. I think the right way is to help educate people to eat the right types of carbohydrates where every morning I eat a big carbohydrate breakfast, but it’s primarily non-starchy carbohydrates.
I never would have thought that I would be eating stir-fried vegetables for breakfast guys, but that’s my favorite part of any meal of the entire day! Where I get a big bowl: 3-4 cups of stir fry purple cabbage and mushrooms and onions and baby spinach and a couple of slices of avocado on top of that! That’s good stuff! That is tasty and is full of fiber, but more importantly it’s rich in nutrients.
We have a high nutrient: calorie ratio. And then, here’s the key: How do you determine what other forms of carbohydrates? The more starchy carbohydrates we include with our meals? Any meal. That’s to be determined in large part for a diabetic at least, by looking at the after meal blood sugars.
If you check your blood sugar an hour or maybe 2 hours after the beginning of your meal. That tells you what your tolerance is for regular starchy carbohydrates or fruits. That should be the determining factor more than following one plan for all.
Dr. Kelly: Thank you, Dr. Youngberg. Can I make a comment, Dr. Cho?
Dr. Cho: Sure, yeah.
Dr. Kelly: What I say when people ask me about the ketogenic diet is:
Number 1: Statistics show that the majority of the people who say they’re on a ketogenic diet are actually not in ketosis. They’re not eating in a way that is literally keeping them in ketosis. So, that’s the first thing. They don’t even realize that because the fad diets. People don’t really know that.
Second thing: There are companies that are actually doing this, and they’re keeping people in ketosis and they’re seeming to get some good results. In fact, [researcher name] and some others have published papers showing some apparently good results with a ketogenic diet that maintains ketosis. However, there was a review in journal Nutrients just recently, where the expert panel--there were about 12 or 15 people. They looked at this question, and they looked carefully at the literature. They showed that the fact is the ketogenic diet has not been studied for more than 1 year. The longest period of any study has been 1 year.
[Thirdly], there’s plenty of measures that tell us that those people who are on a keto diet still have insulin resistance. Yes, it’s helping apparently their blood sugar and keep their glucose down, but it’s not actually fixing the underlying problem. So many of us who are trying to find the best answer are aware of the fact that this is simply not, right now, it’s not the right way to go. I’m not saying that it may not be workable in the future, but it’s not the way to go.
However, having said that, as a clinician if I encounter a patient that is controlling their weight and blood sugar with keto diet, I do not tell them, “Oh my goodness this is the end of the world! You have to change!” I say, “Let’s see how this goes for you.” Because for most people, it’s not a long term solution that you’re happy with. Most of them find out that it works better in the short term and not so well in the longer term.
Dr. Cho: In my experience, they start to feel bad. They start feeling unwell after being a while on the ketogenic diet.
Dr. Youngberg: Let me also add that first of all: I loved Brenda Davis’s lectures on this very topic because she points out that there’s actually a lot more in common between a properly done ketogenic diet and what we refer to as a whole plant-based diet.
A properly done ketogenic diet actually encourages more of the non-starchy vegetables, etc. Now an improperly done ketogenic diet, which is unfortunately the way most people do a ketogenic diet, where they’re saying. I hear it all the time from some of my colleagues who promote a ketogenic diet. They say, “Well, you can’t be on a ketogenic diet unless you eat meat!” I go, “No, that’s not true!” I understand the potential value of it, but I also understand the great risk that is taken when somebody buys into the perspective that you have to eat meats, animal protein, to be on a “healthy ketogenic diet.”
My problem with the ketogenic diet as done by most people is primarily the damage that it does to your kidneys.
I’ve had many patients that went through esteemed institutions in the United States and saw well-known physicians who were promoting a ketogenic diet and it blew out their kidneys. Which is layman’s term for causing an aggressive advancement of chronic kidney disease to the point where they were very close to requiring kidney dialysis. Then, they came to me and I nurtured them back to healthier chronic kidney function literally reversing the stages of chronic kidney disease. We did that by going on a 100% plant-based diet!
Now, I am not one that insists that all my patients eat a 100% whole plant-based diet! I do that. I recommend that, but I’m not going to insist that you have to do that or you can’t be my patient. I’m helping lead people in a direction to make better lifestyle choices for themselves.
But when I get a patient that comes to me, Dr. Cho, who has advanced chronic kidney disease or basically is coming to me because they’re being told that the doctor, nephrologist, wants to put a port in them and wants to get them ready for kidney dialysis. Now, finally, they’re starting to think about their health and what they can do to prevent that eventuality. Well, that’s a far in the continuum of advanced disease of the kidneys. Okay?
But even then, I’ve had patients who’ve come to me with a glomerular filtration rate of 21 which is getting very dangerously close to stage 5 chronic kidney disease where the doctors are already preparing him for kidney dialysis. Now, a year and a half later, the same patient has a kidney filtration rate of 89 which is better than a lot of college students I know!
In other words: The kidneys can regenerate.
We can heal if we remove:
Number 1: The toxic influence of animal-based proteins. To me, that’s a bigger issue than the fats or the carbohydrates. That animal protein is really bad for the kidneys and we know... in fact the president of the National Kidney Foundation in the US spoke several years ago at a national conference and said the best thing she knows of for these individuals is to put them on a plant-based diet. It dramatically slows progression.
If we do other things at the same time, in other words if we take a more broad perspective to lifestyle medicine and natural medicine, we’re able to actually help reverse the condition in many people especially if they’re starting at stage 3A or stage 3B chronic kidney disease.
That would be my main argument against the typical ketogenic diet is that you’re much better off going away from animal-based proteins and just getting healthy plant-based proteins which are not damaging to your kidneys.
Dr. Cho: Great, alright let’s get more specific into nutrition! We’re a little bit tight on time, so maybe have one person for each question. A common question people have is fruits.
So, Dr. Kelly, can people with type 2 diabetes have fruit? Just very quickly.
Dr. Kelly: Sure, well the answer is that the question itself is problematic. Because if you have type 2 diabetes that you are not treating with lifestyle, you definitely want to avoid foods, some foods like fruit that if you are actually however treating your diabetes with a healthy lifestyle, fruit in general is not a problem!
So, what I would say to answer this question is--Yes, when I’m treating a patient with lifestyle change that has type 2 diabetes, I use fruit as part of their food. However if I’m talking to a person that is a conventional, typical patient, then yes: I acknowledge to them that fruits can be a problem with your blood sugar.
So anyway, the answer is: If you are on a healthy lifestyle and you’re reversing your diabetes, fruits can be a part of your diet.
Dr. Cho: Dr. Wes [Youngberg], how about dairy?
Dr. Youngberg: From a clinical standpoint, one of the first things that I encourage my patients to stay away from if they’re coming to me for pretty much any health issue is to get off of dairy! I even tell them to do that before I start talking to them about getting off of meats.
The reason for that is because dairy products are such a big factor in creating allergies, in creating autoimmune issues with digestion. If you’re not digesting food very well, that means you’re not assimilating nutrients very well. If you’re not getting your nutrients, you’re not healing very well. It sets you up for immune depression, for all kinds of health problems. I strongly discourage the use of dairy, even from a clinical standpoint, even above other things.
Dr. Kelly: And in fact, cheese is the worst form of dairy.
Dr. Youngberg: Agree!
Dr. Kelly: We’re short on time so I won’t go into that.
