undone

Episode 60: Can we undo type 2 diabetes? (Part 3)

Have you ever thought that giving up certain foods to reverse type 2 diabetes is hard? If so, this episode is for you! 

In this last episode of the 3-part series on undoing type 2 diabetes, join Dr. George Cho as he interviews Dr. Wes Youngberg, the creator of the Diabetes Undone program, and Dr. John Kelly, founding president of the American College of Lifestyle Medicine. Dr. Youngberg and Dr. Kelly will encourage and educate you on the benefits of a whole-food, plant-based diet.

They’ll explore the following questions:

  • I’ve heard that nuts make you gain weight. Are nuts and seeds okay for a diabetic to eat?

  • Are there certain times of day that I should be eating?

  • What specific vegetables should I be eating?

  • Can I eat animal products in moderation?

  • Is juicing good?

  • What’s your response to patients who say, “I know I have to give up meat and dairy. I know I have to eat a whole-foods, plant-based diet. This just seems very hard!” ?

Let’s learn and be encouraged on the steps to take to reverse type 2 diabetes!

The recording is from Lifestyle MED LIVE, a series of free online events on today’s most important health and lifestyle medicine topics.

Links

Lifestyle MED LIVE

Diabetes Undone

Pathways Clinics

Lifestyle Is Medicine

The Lifestyle Is Medicine podcast is produced by Pathways to Wholeness Lifestyle Medicine in Toronto, Canada and Lifestyle Is Medicine.

Pathways is a group of clinics in Toronto that prevents, treats and reverses disease using evidence-based lifestyle medicine. Pathways provides compassionate, evidence-based care at three locations in Toronto: North York, Junction, and Scarborough Learn more at: www.pathwaystowholeness.ca

Lifestyle Is Medicine is a not for profit that shares the principles of lifestyle medicine to help individuals and families prevent and reverse today’s leading chronic conditions. Learn more at: www.lifestylemed.org

Music credits

Positive

Akashic Records

Podcast logo NEW.png

Listen and subscribe on your favourite platforms!


Episode Transcript

 

Dr. George Cho: Hello everyone! Welcome to the Lifestyle is Medicine podcast brought to you by Lifestyle is Medicine. Today we bring you to the final part of our 3 part series about type 2 diabetes. This was during a webinar that we did not too long ago where we had Dr. Wes Youngberg and Dr. John Kelly speak to us regarding the lifestyle medicine approach to addressing type 2 diabetes. We hope that you are blessed by this discussion!

 

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Dr. Cho: Dr. Kelly, this one’s for you. So, you talked about excess calories and weight gain and so forth. So a lot of people say, you know, nuts and seeds. They have a lot of calories. Nuts make you fat. So forth. Are nuts okay? What are your guidelines, what are your thoughts on nuts and seeds?

 

Dr. John Kelly: Well when it comes to type 2 diabetes, I do not find whole nuts to be a problem. I do know of course and respect Dr. Caldwell Esselstyn who is one of the more prominent clinicians that restricts nut intake for very severe heart disease patients. But in my own experience and studies that I’m aware of, the fact is that whole nuts, especially whole raw nuts, are helpful not harmful. And so I do not encourage people to avoid nuts at all, but to take them in moderation.

 

Dr. Wes Youngberg: I agree.

 

Dr. Cho: Dr. Wes [Youngberg], there’s a lot of… it’s kind of a fad now but you know intermittent fasting, time-restricted fasting, meal timing and all of this. When someone has type 2 diabetes-- Is there certain times of the day they should be eating or does it matter? What are your thoughts on intermittent fasting and time-restricted fasting?

 

Dr. Youngberg: Yeah, great question! I’m actually a big fan of this. And I tell my patients that the challenge has to do with what medicines they’re currently taking. Our goal is to get to the point where we’re adjusting the medicines to the lifestyle not adjusting the lifestyle to the medicine which--

 

Dr. Kelly: Yes.

 

Dr. Youngberg: --could get you into all kinds of trouble. But as you initiate that approach where you are adjusting your medicines to your new healthier lifestyle, you have to work with your prescribing physician and let them know what you’re doing so that they can start adjusting your medicines immediately!

Because if you’re on insulin or you’re on the medications that increase the production of insulin and you’re produced by your pancreas, and you start exercising after meals and you start doing other forms of exercise to get fitter and you start eating a healthier diet and getting a lot of nutrients. All of a sudden, your body’s ability to control blood sugars improves dramatically and now you’re overmedicated!

And so one of the worse things that can happen is that you end up in the emergency room because your blood sugars have crashed because you’re on a healthy lifestyle program. But the reality is that happened because you did not adjust your medicines accordingly.

So that’s the very important caveat that we always say at the beginning of any diabetic management program.

You have to be checking your blood sugars regularly: before and preferably 2 hours after meals. The first week or two, I would do it 2 hours before and 2 hours after every meal so that you get a feeling for what’s going on and you can quickly then adjust your medications according to a schedule that your doctor has given you knowing that you’re going to be doing it.

Basically tell your doctor, “If I were to go on an intermittent fast or any form of fast, how would you restrict my medicine intake?” And then follow that. We would rather your blood sugar run too high for a period of time then run too low. Too low is far more dangerous than too high, especially in the short-term.

 

Dr. Cho: Can you describe intermittent fasting? Like the timeframes of intermittent fasting.

 

Dr. Youngberg: So basically, eating a good breakfast and then 5 hours later or so a good lunch, and then if you want to have a more rapid weight loss or reversal of insulin resistance which is the main underlying driver of diabetes, then you just skip the meal. Now that’s too dramatic for you, you eat a very light evening meal and then you have nothing to eat later than that early evening meal so that you have at least 12-14 hours of no calories between a early evening meal and your next breakfast.

If you’re doing a 12+ hour intermittent fast, that gives your body a chance to get used to burning its own fat stores as Dr. Kelly pointed out. That’s when you can get rid of some of that lipotoxicity associated with unnaturally high levels of fat built up in parts of your organs that damage the ability of the body to do what it’s designed to do.

 

Dr. Kelly: Yeah, I would just add to that. Intermittent fasting can be done by fasting 1 day a week. Clears throat. Excuse me. But I do like the plan that Dr. Youngberg just mentioned which is actually… If you look in the research it’s called “early time-restricted feeding.” This idea of intermittent fasting each day is called “time-restricted feeding.” Anyway, I know we’re short on time and there’s so much--

 

Dr. Youngberg: Yeah, for diabetics you wouldn’t want to do a full day of fasting because then that really messes up. Unless they’re not on any meds.

 

Dr. Kelly: Correct.

 

Dr. Youngberg: If you’re on medicines, you’re better off with setting a time-restricted eating option of that, which mostly you can refer to as intermittent fasting which…

 

Dr. Kelly: Yeah, thank you for explaining that! That’s true. I should definitely… It can be harmful if you’re on insulin or whatever and you have nothing to eat all day. That’s a problem.

 

Dr. Cho: Alright, last few questions here. Dr. John [Kelly], there’s a lot of questions about: Are there specific plant foods that people should be eating or not? Because you both talked about generally whole foods plant-based. We know that that means plant foods that are generally less processed.

But even amongst fruits and vegetables, do you recommend a lower glycemic index? Are bananas okay? People ask these types of questions. What are your thoughts?

 

Dr. Kelly: Sure, no those are good questions. Actually, I don’t think we’re going to be… I mean there’s individualized aspects to this so I want to say that right off. If I were a physician, I would certainly want to talk to the patient before answering this specific question for them. But overall, in general, diabetics have been taught to be way too afraid of food.

You know, it’s not the food! But, what I have had diabetics that are the most difficult to control like Dr. Youngberg was saying: Maybe their pancreas has gotten weak and they can’t produce as much endogenous insulin, etc. But I’ve had patients all the time that say, “But I’ll do whatever it takes to get off of medicine.” If they’re really honest with that, I put them on the intermittent fasting that he was talking about. So we’re skipping suppers. And what I use for meals is what I’ve come to call leaf, stem and flower.

So we’re going to give them veggies instead of fruits for the majority of their diet. We’re going to give it to them like cruciferous vegetables. The leaf, stem and fruit.

We’re going to have the broccoli. We’re going to have the cauliflower. We’re going to have greens like kale and other kinds of things. Cooked or raw is fine. And with some flavoring.  

But where I’m headed is.. Um this is only during this period of time where we’re getting their metabolism back to more normal. You do not have to eat like that for the rest of your life. It’s a therapeutic diet. And once… I have all the time people that start this way. They get their sugars under control, they get off their medicines, and then they start to eat a more normal whole food plant diet.

 

Dr. Cho: Okay, great great. You know, Dr. Wes Youngberg, I want to show you something here. This is the Canadian Food Guide that was just released. As you can see, it’s pretty good but they still recommend moderate use of animal foods. What if someone says to you, “You know, everything in moderation.” Just very quickly, could you comment on that? Everything in moderation. Why do I need to go “extreme”?

 

Dr. Youngberg: Well, you know, remember: food is politics. It’s been said that it’s easier to change someone’s religion than it is to change their diet. In any organization, whether it’s a nonprofit organization or a government organization or government itself, there’s always politics, and you’re never going to get a recommendation that is not watered down in terms of the science. There’s always going to be compromise from any recommendation or any consensus development statement. So that’s why I choose to listen to the experts that I trust more so than organizations. Because you’re always going to get a watered down, mediocre approach when you listen to organizations.

But, speaking to your question directly: Dr. Walter Willett, who’s one of the most respected nutritional epidemiologists ever from Harvard University, said it best when he says: “There’s definitely some foods we should avoid completely! There’s definitely some foods that we should take in on a regular basis. There’s many other foods that are maybe what we call 'yellow light’ foods or secondary, second class foods.”

In our programs and in the book “Goodbye Diabetes   ” we outline the green light foods which means, “Have it and enjoy it! Eat as much as you want of those!” And then the yellow light foods are, “Okay you have to be a little more cautious! Those are okay to incorporate, but those are the foods that you eat in moderation.” And then the red light foods are the ones that, “No!” You stop, you just completely avoid those. Also known as 1st, 2nd and 3rd class foods.

Do you want to have 1st class health or 3rd class health?

These are really our choices. I never force anything on anybody, because I believe that each person is a chairman or chairwoman of their own health. Nobody else should have control over what we do for our health! No one, okay? That’s our decision, but we need to accept the consequences of our choices. That forces other people to pay for those consequences, right? Because it’s on us!

So when people say it’s too hard, like we see on the screen: “It’s too hard to change my diet!”

Well yeah nothing is easy, but is that harder than going through the complications of COVID-19?

Is that harder than having a heart attack or a stroke?

Is that harder than having your leg amputated?

Is it harder than going blind or having all the complications associated with diabetes?

Absolutely not!

It’s relatively easy to do this. Where there’s a will, there’s a way. So I just encourage everybody listening to say, “No, it’s not too hard!” Okay? It’s a willingness to put ourselves out there and make choices and learn about how to do this and so I applaud you, Dr. Cho, and your organization there in Toronto and for fellow Canadians and people all over the world watching that this information is doable.

It’s not too hard! Okay? Especially if you decide it’s not going to get you down!

 

Dr. Cho: Great and for those who wondered why he brought up COVID-19, at the start [see podcast Episode 58] we talked about how they’re finding that those who have diabetes, hypertension or other chronic diseases have a greater risk of getting more severe forms or severe illness from COVID-19.

Just to comment, I guess everyone draws a line somewhere, right? No one actually believes in everything in moderation.

Dr. Kelly, just one last question before we close off here. There’s a question about juicing. Do you think that juicing is good? How much? When? What are your thoughts? Very quickly.

 

Dr. Kelly: Yes, that’s a really great question. Bottom line is, keep in mind that juicing usually refers to a refined product. You take a whole food and you put it through a juicer and you end up with pulp. [Pulp] comes out one place and juice comes out of another place. We call it a smoothie if it’s got everything. The whole thing!

So I don’t actually recommend juicing or juices. I recommend the entire foods, so smoothie would be a more appropriate way to do this. I have definitely found that you can make green smoothies and they can be very effective ways to help you change your diet! So if that’s something that someone likes and they make them in such a way that it’s a whole food, then yes: I think it works well! It can work well.

 

Dr. Cho: Great thank you! Just to close off, Dr. Wes [Youngberg] already addressed the question on the screen. Dr. Kelly, you’re also a clinician. You’re not just a researcher. You see many, many patients. Someone’s listening to this saying, “Whole foods, plantbased, cutting out meat and dairy. This all sounds really too hard!” I’m pretty sure you’ve had patients who’ve had concerns. What would you say to that? Someone’s listening to this and saying, “This sounds really hard!”

 

Dr. Kelly: Well, Wes let me be brief. Let me go first and then you can finish.

 

Dr. Youngberg: I already did it, go for it.

 

Dr. Kelly: But anyway, I just want to say that I had… of course we have this all the time. There are people that say, “Dr. John, I’ve tried this before. I’ve tried many times and it just won’t work.”

And so I spend time with them trying to encourage them. “Will you give this a trial? Will you give me 2 weeks? If you give me 2 weeks, then evaluate is this going to work for me or not?”

Then, what I do is I help them to see that number 1: What they are doing with their lifestyle change is changing the switches on their genes.

We can literally change one cell into another cell as I’m sure you know, Dr. Cho and Dr. Youngberg. Maybe not all of our audience, but we now are able to take a fibroblast and change the gene switches and turn it into a functioning heart cell. It’s been done in mice! That’s how powerful… I’m telling you this because that’s how powerful changing switches is! And the most powerful modulator or change agent for gene switches is diet!

I can change more gene switches more rapidly by changing my diet than anything!

So why am I talking about this? The person that’s saying this is hard. Because when you understand the power of lifestyle, it becomes a lot less of a problem.

If you think of it, “Oh I’m going to have to fast. I’m going to have to give up this…” No, it’s not about giving up. It’s about actually turning on the switches that will give you good health. It’s a very different way of looking at it.

The other thing I say about sounding too hard is I tell them about this study that was published in Diabetologia 2 or 3 years ago. Or maybe it’s 4 or 5… but anyway the Taylor group from the United Kingdom published a study showing that they reversed the triacylglycerols in the liver and in the pancreas within just a matter of about a week or 2. The insulin response of the pancreas is normalized in 4 weeks!

They then started getting people calling and asking them, “Can I put myself on this diet?” They published this study showing that almost 100 people who had put themselves on a very low energy diet to reverse their diabetes. The interesting thing was. They asked them about working with their doctor. About ⅓ of them, their doctor worked with them to change their medicines and whatever. ⅓ didn’t tell their doctor that they were doing it and the other ⅓ the doctor told them, “Oh my goodness don’t do that!”

So my point is, it may sound too hard. I’m glad that word is in there. Sound. It sounds hard, but it’s actually really easy. Studies show that when you see results, when you see the reversal of your disease and you feel better than you ever have, it seems easy to you.

 

Dr. Youngberg: Let me just add to that. If you’re checking your blood sugars both before each meal and 2 hours after the beginning of that meal, and you’re looking at the impact of the change of diets, start with the first 2 days of not changing your diet. See what happens! Most people never know how high their blood sugar goes.

 

Dr. Kelly: Sure. True.

 

Dr. Youngberg: They say, “Oh my goodness my blood sugar is over 300 or 2-3 times higher than it should be!” Then they start checking it after they implement the meal changes, the exercise after the meal changes, and all of a sudden now they are convinced because they see the power associated with these relatively simple strategies.

 

Dr. Cho: Thank you so much. So thank you, Dr. Wes [Youngberg] and Dr. Kelly for your input, your insight on nutrition! I know due to time we couldn’t address other aspects of diabetes care like exercise and so forth. We’ll probably adjust those in future lectures. Just to remind everyone that you can also follow Dr. Wes [Youngberg] and Dr. Kelly on different platforms.

We talked about Dr. Wes’s [Youngberg] book, “Goodbye Diabetes.” He also has a program that’s online called Diabetes Undone. I highly recommend it!

Also there’s a website called Audioverse.org where you can listen to Dr. Wes [Youngberg] and Dr. Kelly’s talks if you search on there. I’m pretty sure you’re also on YouTube as well.

Also, I just want to thank the organizations that put this on. Pathways to Wholeness Lifestyle Medicine Clinics, Lifestyle is Medicine and of course the Downsview Seventh-Day Adventist Church. We want to thank the church so much for sponsoring and supporting this program!

 

 

 

 

 

 

 

 

 

 

Episode 59: Can we undo type 2 diabetes? (Part 2)

This is part 2 of a 3-part series of episodes on whether we can reverse type 2 diabetes. Dr George Cho is joined by two leading diabetes experts, Dr Wes Youngberg, the creator of Diabetes Undone program, and Dr John Kelly, founding president of the American College of Lifestyle Medicine.

The recording is from Lifestyle MED LIVE, a series of free online events on today’s most important health and lifestyle medicine topics.

Links

Lifestyle MED LIVE

Diabetes Undone

Pathways Clinics

Lifestyle Is Medicine

The Lifestyle Is Medicine podcast is produced by Pathways to Wholeness Lifestyle Medicine in Toronto, Canada and Lifestyle Is Medicine.

Pathways is a group of clinics in Toronto that prevents, treats and reverses disease using evidence-based lifestyle medicine. Pathways provides compassionate, evidence-based care at three locations in Toronto: North York, Junction, and Scarborough Learn more at: www.pathwaystowholeness.ca

Lifestyle Is Medicine is a not for profit that shares the principles of lifestyle medicine to help individuals and families prevent and reverse today’s leading chronic conditions. Learn more at: www.lifestylemed.org

Music credits

Positive

Akashic Records

Podcast logo NEW.png

Listen and subscribe on your favourite platforms!


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.

Episode 58: Can we undo type 2 diabetes? (Part 1)

Can lifestyle practices really prevent, treat and potentially reverse type 2 diabetes? In this part 1 of a 3-part series of episodes, join Dr. George Cho and leading diabetes experts Dr. Wes Youngberg, creator of the Diabetes Undone program, and Dr. John Kelly, the founding president of the American College of Lifestyle Medicine, as they explore this question. They will also be answering these common questions about diabetes:

  • What is type 2 diabetes?

  • Does sugar cause type 2 diabetes or is that a myth?

  • Why does someone's blood sugar go up when they have type 2 diabetes?

  • Is type 2 diabetes genetic?

  • Is there a link between type 2 diabetes and COVID-19?

The number of people diagnosed with type 2 diabetes is increasing every year. Let’s implement changes to our lifestyles from what we learn in this podcast episode and series!

The recording is from Lifestyle MED LIVE, a series of free online events on today’s most important health and lifestyle medicine topics.

Links

Lifestyle MED LIVE

Diabetes Undone

Pathways Clinics

Lifestyle Is Medicine

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Listen and subscribe on your favourite platforms!


The Lifestyle Is Medicine podcast is produced by Pathways to Wholeness Lifestyle Medicine in Toronto, Canada and Lifestyle Is Medicine.

Pathways is a group of clinics in Toronto that prevents, treats and reverses disease using evidence-based lifestyle medicine. Pathways provides compassionate, evidence-based care at three locations in Toronto: North York, Junction Lifestyle, and Scarborough Learn more at: www.pathwaystowholeness.ca

Lifestyle Is Medicine is a not for profit that shares the principles of lifestyle medicine to help individuals and families prevent and reverse today’s leading chronic conditions. Learn more at: www.lifestylemed.org

Music credits

Positive

Akashic Records


Episode Transcript

Pathways Lifestyle Medicine Clinics / Lifestyle Is Medicine

Time: 16:01

 

Dr. George Cho: Hello everyone, welcome to the Lifestyle is Medicine podcast brought to you by Lifestyle is Medicine. For the next 3 episodes, we take you to the webinar we recently did on diabetes.

 

We had Dr. Wes Youngberg and Dr. John Kelly speak for the audience on how to use lifestyle medicine to prevent, treat, and potentially reverse type 2 diabetes. We hope that you are blessed by this talk. Here is Part 1.

 

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Dr.George Cho: Today our topic is going to be type 2 diabetes. A very important discussion! We all know that diabetes is going up and up, but we believe that through lifestyle practices this disease can be addressed effectively. Today we have 2 speakers who are well-qualified to speak on this topic. I am going to introduce them to you at this time.

First, we have Dr. John Kelly. Dr. John Kelly is a physician and founding president of the American College of Lifestyle Medicine. He is also an Assistant Research Professor in the Nutrition Department at Loma Linda University. He was a principal investigator for a multi-million dollar diabetes research project in the Marshall Islands and continues to do research in lifestyle interventions for diabetes. He is also the director of Oak Haven Lifestyle Center in Michigan.

The other presenter today is Dr. Wes Youngberg. He has a doctorate degree in public health. He is a clinical professor for both the Department of Preventive Medicine at Loma Linda University School of Medicine and also Loma Linda University Department of Public Health. He is also the founding director of the American College of Lifestyle Medicine. Dr. Youngberg spent 14 years in Guam researching diabetes and has written a book on diabetes titled, “Goodbye Diabetes.” He has developed an online diabetes program called Diabetes Undone.

Dr. Kelly and Dr. Youngberg, welcome to Lifestyle Medicine live!

 

Dr. Kelly: Thank you. Dr. Cho. It’s good to be with you, and this is indeed a very important topic. I’m really pleased to be with Wes, my friend, Dr. Youngberg.

 

Dr. Youngberg: Likewise! Dr. Kelly and I go way back. Back in Loma Linda days but as well as the Marshall Islands. We’re looking forward to being on this webinar with you today, Dr. Cho.

 

Dr. Cho: Great! You know, Dr. Youngberg, just to break the ice a little bit: You don’t know this but when I was an intern in naturopathic college, I used your book to help guide me and treat my patients with type 2 diabetes. It’s great to speak with you!

 

Dr. Youngberg: I’m honored.

 

Dr. Cho: Before we get to the main discussion on diabetes, I just want both of you to comment right now. Just bring it a little closer to home. Right now we know that COVID-19 is happening, SARS-CoV-2 virus. But diabetes has a big role to play in that, right? We don’t want to get too deep into the weeds of that, but can you comment on that? People may not be aware of the research coming up linking diabetes and COVID-19.

 

Dr. Youngberg: Yeah, there’s a tremendous amount of research. In fact, the big concern has been that people having problems with COVID-19 (if they’re infected) are the ones that have underlying medical complications like diabetes in particular. That’s one of the first ones that you hear about. It can be asthma; it can be hypertension. It can be heart disease or diabetes. In fact, many emergency room physicians are reporting that their patients respond very well to many of the strategies that are introduced there in the ICU unit, but if they’re diabetic they’re the ones that are amongst the highest risk to go on to develop serious complications requiring ventilator support. Between 50-80% of people who go on a ventilator don’t come out of the hospital alive.

My passion has been, over the last 3 months, to educate diabetic individuals that if there was ever a time to really focus on the natural and lifestyle medicine strategies to help reverse the underlying triggers or causes of diabetes, this is the time because you have the most to gain and the most to lose if you do not follow this protocol.

What Dr. Kelly and I will be sharing with you all is the good news that diabetes can be undone! That we literally can say goodbye to diabetes much of the time! And even if we don’t--even if we do all the strategies that are well documented in medical literature that help many people reverse their diabetes. Just by simply following those strategies, even if you may remain a diabetic, you are dramatically lowering your risk of complications because of COVID-19. Because treating the underlying causes of diabetes are also treating the underlying factors that drive somebody’s immune system to depression that then allows the body to succumb to the virus. Otherwise, the vast majority of people have an immune system that is capable of being victorious over this virus. So we want everybody to be victorious including our diabetic population!

 

Dr. Kelly: And Dr. Cho, just to cite one statistic. Just 2 or 3 days ago, there was an article in the Journal of the American Medical Association looking at the results in 5,700 patients from New York City and the risk. Those who needed to go on the ventilator had almost twice the likelihood of having diabetes than the ones that did not. That completely verifies what Dr. Youngberg was just saying.

 

Dr. Cho: It’s amazing how one chronic disease can affect an acute disease. Well, let’s go right into diabetes. Dr. Kelly, I’ll direct the first question to you.

Many people know that type 2 diabetes is when your blood sugar is high, but many people do not know why it’s high. They’re not told the underlying pathogenesis, pathology. Can you explain exactly what type 2 diabetes, and what is the root cause? Why is blood sugar going up?

 

Dr. Kelly: This is a fantastic question! It is true. A lot of people do not understand. Even people that have diabetes sometimes do not understand. So, I would have to say first off that I cannot explain exactly because I don’t think that we know exactly yet. What we do know is this:

We know that the problem is not sugar. We call it diabetes, or sugar diabetes in my part of the country, but it’s not sugar that causes diabetes. It’s actually excess calories. The chronic excess calories lead to storage of energy in the form of adipose tissue. When these excess calories build up, then it leads to lipotoxicity throughout the body causing insulin resistance, causing problems in the liver and gluconeogenesis in the pancreas. And so, this is becoming more and more widely known.

Right now Dr. Youngberg, myself, and others are working on a course for the American College of Lifestyle Medicine: Reversing insulin resistance and diabetes with lifestyle. We’ve been doing a lot of recent research in the literature. I can tell you that I can see studies, and over the last 10 years there’s more and more recognition on what I’m saying. 10 years ago or 20 years ago, it was thought that the cause was genetic, that it was strictly senior genes and you couldn’t do anything about it. All you could do is thank God for insulin. Well it turns out that insulin may be great for type 1 diabetes, but many ways it’s a curse for type 2.

 

So to answer the question about what is diabetes? What is going on? Chronically excess caloric intake leads to hyperstorage of adipose which then invades other tissues.

Normally you want to store your calories in adipose cells, but when they start being stored in the liver cells and in the pancreatic cells and in the muscle cells, things start to go awry and the body produces more and more insulin to try and keep the blood sugars down into the normal range. Eventually, that cannot happen and the blood sugar starts to rise. That’s when we say we have pre-diabetes or diabetes. But in reality, as you’re going to learn through the rest of this seminar, this is a process that started way before your blood sugar went up. The solution is not managing your carbohydrates or managing your sugar intake. That only controls the symptoms. If you really want to fix this disease, you have to go to the chronic excess caloric intake. That’s my short answer.

 

Dr. Cho: Dr. John [Kelly], you mentioned a word, “lipotoxicity.” Can you distill this down in easy language for us?

 

Dr. Kelly: Yes, thank you. So what we’re talking about is when our cells in the body are forced by this high insulin level to take up glucose that they’re not using. They don’t need that glucose for their normal level of function. Then they actually store this in the form of lipid or fat in the cell. So we call this lipotoxicity because lipo meaning “fat”. This is harmful to that cell’s functioning. So that’s what we mean by lipotoxicity.

 

Dr. Cho: Dr. Wes [Youngberg], fat and cells and diabetes. Not too many people make that connection. They always think it’s sugar and insulin.

 

Dr. Youngberg: Well, it’s a combination as Dr. Kelly just said. It’s excess calories. And so the number 1 cause of excess calories is too much refined carbohydrates. This number 2, or close to it, would be excess fat especially of the animal fat variety or the free oil variety that is just unnecessary in our diet and simply adds excessively to our caloric load which the body metabolically can’t handle. So that’s why when I’m working for the first time with a new diabetic or someone who struggled with their diabetes over years and decades, I simply say 2 things.

Number 1: The reason why your blood sugars are high is because your metabolism is depressed. We need to figure out what all the triggers are that are contributing to that depressed metabolism. In medicine, we call it metabolic syndrome or insulin resistance syndrome. So we help educate them about how to reverse insulin resistance because the cells of the muscles are throughout the body. The cells of the liver [are] specifically not wanting to let sugar into the cells, so the blood sugar goes high and that can be quickly remedied within days and sometimes within meals if we’re eating the right foods. And then, on a practical note, if we can get individuals to balance their meals and eat the right foods, right? The whole plant-based diet is the goal.

[Number 2]: The second goal is to get them exercising lightly after every meal because that clearly brings down the after meal blood sugars which is by far the most important blood sugar for the diabetic. That has the biggest impact on the caramelization effect, the glazing effect that proteins throughout their whole body and bloodstream. And so, if we can get them exercising a little bit (not get sweaty, just go walking or do some light activity immediately after eating), that’ll lower the after meal blood sugar by anywhere from 1-3 points for every minute that they do light exercise. That can have a powerful shift on their blood sugar!

Most people never check their blood sugars after meals. They always check before the meal. But how are you going to know the impact of your meal if you don’t check your blood sugar after the meal? That’s what gets people focusing on how my body responds to the choices that I make. We see great success when people start doing that.

 

Dr. Cho: Dr. Wes [Youngberg], Dr. Kelly talked about excess calories and building up of fat. So the next question is--Is type 2 diabetes mainly genetic? A lot of people say, “My mom and dad had diabetes. Therefore, here I am with diabetes.” Your comment? How much does genetics play into this?

 

Dr. Youngberg: Well, genetics always plays a role. If it wasn’t genetic, it wouldn’t happen. Genes have a lot to do with our help, but they’re not the primary reason we develop the problem. Genes open the window, but we can choose if we jump out the window or not. So, researchers have been clear over decades. We’ve known that easily 70% of the world population have at least some major gene mutations associated with diabetes. But that should never be an excuse (as Dr. Kelly pointed out) to say, “Well mom had it. Dad had it. My aunt had her leg amputated. My uncle went blind. It’s just in the cards for me! It’s just something that’s going to happen eventually. Que sera, sera. Whatever will be, will be.” That’s precisely a fatalistic viewpoint that will get us into trouble.

The reality is that we can change the expression of those genes favorably. We call that epigenetics. The influence of things outside of genetics-- on how those genes operate. How we turn those on or off is dictated by the choices that we make with our diet, with exercise, with sleep habits, with our environmental exposures. So that’s why lifestyle is medicine! It’s the most important medicine of all.

 

Dr. Kelly: I always like to tell folks that we don’t only inherit our genes from our parents. We inherit cookbooks! It’s a fact that actually we’re now realizing that type 2 diabetes is more epigenetic than it is genetic. It’s really more about our lifestyle affecting the gene switches than it is about the genes themselves.