Two Big Lies about Type 2 Diabetes

this talk is about type 2 diabetes and what we're going to talk about is it's called ideology and reversibility because this is kind of a whole different way that we approach type-2 diabetes which is different from the way we've approached it before and what I really you have to understand what really causes the type 2 diabetes in order to reverse the disease and that's something we've never really talked about before which is reversing the type 2 diabetes and this is the paper comes from it's called the twin cycle hypothesis of type 2 diabetes and it was published in diabetes care by dr. Taylor in the UK and it's quite complicated so we're going to take it through kind of very slowly and the thing you have to understand about what causes the diabetes is that there's actually two phases of type-2 diabetes so this is taken from the diagnosis so if you go look back here's the time of diagnosis and if you go back in time you can see that there's two distinct phases of diabetes there's the slow rise in the blood sugars and that really corresponds to the increase in insulin resistance that develops but then just before the diagnosis of diabetes you actually get a very sudden spike up and that actually reflects the beta cell dysfunction which is the pancreas all of a sudden can't produce quite enough of the insulin and the blood sugars really spike up and you have to understand what causes these two phases of diabetes in order to really reverse it so I'm going to start off with a case so this is a case of Margaret we're going to have a chance to talk to her afterwards and she had been diagnosed with diabetes for 27 years and she started insulin Dabo eight years ago and she was really desperate by the time I had seen her she had gained about a hundred pounds after she started the insulin and she said some months it felt like she was putting on ten pounds a month and when I saw her in the office she could barely drag herself in she had no energy she couldn't move yet she'd go to the you know her doctors and say you know I can't take this anymore she tried to lose weight but no matter what she ate and no matter what she did the weight kept coming on and coming on and coming on and that's an experience that we see with a lot of people who are on high doses of insulin the insulin makes you gain a lot of weight in order to keep her blood Sugar's controlled she wound up on a hundred and twenty units of insulin a day which is a fairly high dose as well as two grams of metformin per day so we talked to her about the you know how we're going to reverse the diabetes and she started on the program and about three weeks later we had taken her off of all her insulin we also took her off of her metformin and her a 1c as you see didn't shoot up it went from seven percent to six point six percent her blood Sugar's were averaging between five and six off of all the medications and for all intents and purposes her diabetes was reversed she had lost 64 pounds in the process and seven inches off of her waist so it's been about six eight months now and her husband who's also here saw her doing so well he started the program as well so he started on 80 units of insulin and we're still working with him he's down to about 10 to 20 and really feeling very good and what that demonstrates is that this is actually not a disease that's chronic and progressive this is a disease that's completely reversible but not only that very quickly reversible because now Margaret comes in and she's like you know you can't stop her she have so much energy like it was amazing how she was before compared to how she is now and these are really the two big lies of type two diabetes this is the stuff that we tell patients which is simply not true so the two big lives the first one that diabetes is a chronic progressive disease we're taught this in medical school we teach this to our patients we basically say you know you have type 2 diabetes you'll have it for the rest of your life get used to it but it's not true it's actually not true in any sense which means it's a big lie the other big lie that we tell ourselves is that lowering the blood sugar is the primary goal of the therapy so we focus almost exclusively on how we're going to lower this blood sugar right so if you need to take 200 units of insulin a day to keep your blood Sugar's down well then by god that's what you're going to do because that's what you need to get better but the truth is that that's not the actual disease the disease is about high insulin resistance so the therapy really has to be directed at insulin resistance and not the blood sugar that was only the symptom and the problem is that we've proven that we're going that we're going to take questions up so when we talk about the you know the the first myth which is that it's a chronic progressive disease that means it can't be cured and this is actually not true and you can easily show that type 2 diabetes is reversible and they've done that of course with many different cases so I'll present three cases all of which are real patients and you'll see that this is not a chronic progressive disease at all so you can take bariatric surgery and there's many studies of bariatric surgery I had a patient your long-standing diabetic was morbidly obese he underwent bariatric surgery which is you know also called stomach stapling where they cut your stomach into the size of a walnut so you really just can't eat he started off on 500 units of insulin a day and really after a month of after the surgery he was on 0 so his diabetes was pretty much gone and this is well known to happen actually we have multiple studies that show that this type of surgery cures diabetes so this study published in the New England Journal of Medicine shows that when you intensive medical therapy well at the end of the day at 12 months they're really just on as much medication as it used to be but if you do bariatric surgery well what happens is that very quickly they come off of all their diabetic medications and there's two different types of surgery there's the Rouen why bypass and the sleeve gastrectomy both of which do very well you can also do this thing called gastric banding which is where you put a like a belt around your stomach on the inside and tighten it so you can't eat and they also do very well so their weight comes down but the blood glucose very quickly over a matter of weeks goes back down to normal which means that they're reversing their diabetes another way to go is fasting so this is another patient of mine who had diabetes for more than 10 years and we started him on a regimen which included fasting and after 50 pounds he came off of all his insulin and really you know a year and a half later he's still off of all of his insulin and he's doing very well so again here's another case of somebody who's lost a lot of weight and his diabetes went away well that's very interesting because I thought there was no cure I thought this was chronic and progressive but clearly it's not and even after so many years and even as you know on 500 units of insulin today these diseases are curable and in fact the fasting in the treatment of type 2 diabetes was mentioned almost a hundred years ago so this is a diabetes by the name of Elliot Joslin who's probably the most famous died Batala gist in history and he writes in the Canadian Medical Association Journal August of 1916 so pretty close to a hundred years ago but temporary periods of undernutrition are helpful in the treatment of diabetes will probably be acknowledged by all after these two years of experience with fasting back then of course there was really no drug therapy there was no insulin there's no other thing so fasting was one of the kind of well recognized treatments and he says the practice observed by many clinicians of the old school who advantageous Lee fasted their diabetics one day a week have given the cue to intermittent fasting so these things are not things that were simply made up these things were known almost for a hundred years if you look during the war periods so this is World War one in World War two you have severe food rationing so you're not talking about just not eating a little bit of sugar you're not talking about not eating very much of anything at all right but when that happened you can look at type 2 diabetes and type 2 diabetes mortality and then go down quite substantially during the period of food rationing so you can actually compare fasting in bariatric surgery and you can see that when you compare people who undergo bariatric surgery this is the surgery to the diet alone which is the fasting you can see that not only do you get a little bit better weight loss but you'd get better blood sugar control as well which is very interesting that means they're almost equivalent in a third case is somebody I'm at the 27 year old graduate student in physiology she was diagnosed with the diabetes with a hemoglobin a1c of 10.4% which is quite high her doctor immediately started her on three medications but she didn't want to take that so she kind of dug through the internet and stopped and she decided to put herself on a ketogenic diet which is an extremely low carbohydrate diet so she lost some pounds she lost about 20 pounds and when she went to her visit she's her hemoglobin a1c was 5.5 percent in other words her diabetes completely reversed with a ketogenic diet so all these three cases are cases of cure there's also cases of cure that you don't really hear about for instance if you have a diabetic and they start on you know a lot of insulin you never hear that oh I started all this insulin now I'm great I'm off from all my insulin that happen right this is same with drugs right metformin so faunal ureas nobody says oh I started the sulfonylurea now I'm doing great I stopped taking everything and my sugars are fine in these cases diabetes is not cured in fact it tends to get worse over time when you treat people with insulin with medications they tend to get worse over time so you can actually break these treatments into two groups right so there's one side which leads to a cure there's the bariatric surgery the fasting and the very low carbohydrate diets those all lead to a cure for diabetes because you stopped your medications you do very well and there's other ones other treatments that don't need to a cure which is the insulin the drugs and the low fat diet and of course the you'll never guess of course which path we choose right we choose with all our treatments with all our research and our all our goals like published by the diabetes associations to go this way towards the path where we know that there's no cure we know it because we've been doing it and people aren't your so this is the problem if you look at the American Diabetes Association they have several facts this fact for most people type 2 diabetes is a progressive disease well that's actually a lie it's not true because you have lots of people who are being reversed who are being cured right and what they say here is that oral medications eventually may not be enough to keep blood glucose levels normal using insulin to get blood glucose levels to a healthy level is a good thing not a bad thing right that's crazy right because if you're on insulin it means that your diabetes is more severe so that's kind of like saying oh sometimes cancer metastasizes into your liver this is a good thing that's not really a smart thing to say if you're on insulin that's much worse than if you were on nothing at all so that's really really stupid right there's no way that having severe disease is better than not having disease right and here they are telling you that oh it's good it's good you're on insulin right and it gives people a sense of learned helplessness right this is the problem they're telling you you can't fix it don't even try they're saying you go blind you'll go on dialysis but get used to it there's nothing you can do right that's shameful really and it's not just the American Diabetes Association here's diabetes Australia the same thing over time most people will need insulin it's important to note that this is just the natural progression of the disease here it is again the chronic progressive disease there's nothing you can do about it don't even try forget diet forget everything else don't even try so the second big lie of type-2 diabetes is that lowering blood sugar is the entire goal of the treatment of disease so this is the way we think about it right so both type 1 and type 2 diabetes leads to high blood sugars and through various mechanisms like oxidative stress and advanced glycation end-products this leads to the complications of diabetes right that's how we kind of conceptualize it so if you get rid of the high blood sugars then you get rid of the complications of diabetes that's kind of what has driven our treatment of diabetes you know for the last 50 years there was a problem though it wasn't true so about five years ago there was four very well done very large studies that showed that treating blood sugars makes no difference right so the first of these which got a lot of press was the Accord study where they randomized over 10,000 patients diabetics to very tight control versus not so tight control after three and a half years the study was stopped because the patients who were tightly controlled weren't doing bed they were doing worse so they had an increase in the risk of death about you know 20 percent increased risk not only that about twenty seven point eight percent gained a lot of weight over ten kilograms like 20-plus pounds right so this is the problem it wasn't doing them any good it was really really bad so that was quite revolutionary at the time but three other studies came out right after that that showed exactly the same thing the Advanced Study which just recently came out with the long term follow-up showed again that you can take people and really control their blood Sugar's really well but it doesn't mean that they do any better right so it makes no difference well controlled or not well controlled it just makes no difference and there's other studies that show that the low a1c is actually not very good for you at all and there's a lot of studies coming out from various places or this is dr. Currie in The Lancet 2010 which looked at 20,000 patients and they looked at people who went from kind of one pill to two pills or a pill plus insulin you can see especially with the insulin that you know really high blood sugars aren't that good for you but neither are really low blood sugars right so if you have a hemoglobin a1c of like 6% you think you're doing really good but in fact you're doing really bad because your risk of dying is about the same as if you're a one sees ten and a half right it's not good for you it makes no difference so this is the thing about type 2 diabetes is that we're kind of chasing the wrong thing so you really have to understand what causes the diabetes in order to treat it so what's the cause of die type-2 diabetes well it's often the insulin resistance right but it's not the high blood sugars which causes it but what do we treat we treat the high blood sugars so of course it's not going to make any difference you're not treating the disease so if you take an analogous situation so suppose you have a bad infection right you have a big abscess somewhere well the cause is the bacteria so you need to treat the bacteria with antibiotics right what you don't do is you say oh I have a fever so I'm going to treat the fever because that's just symptomatic treatment right if you treat the infection the fever goes away but treating the fever makes no difference right it's the same as the high blood sugars the high blood sugars is a result of the insulin resistance so if you're not treating the insulin resistance you're not going to get any better you're going to get worse and that's exactly what you see so if you look at virtually all of your patients with type 2 diabetes what happens is that they start with metformin then they go on to drugs and three drives and insulin and more insulin and more insulin and what you see is that over the span of you know 10 years 20 years whatever it is you started with one medication and you wound up like Margaret on 120 units of insulin so your diabetes is not better it's worse it's worse than it's ever been in fact at no point in the entire treatment was the diabetes actually getting better and that's the experience not just a Margaret but virtually a hundred percent of conventionally treated patients so if we think about how we're going to start moving now towards a cure for diabetes we have to start with what causes the diabetes right what causes that insulin resistance and what causes the beta cell failure that comes so the easiest thing to do of course is to start by looking at those situations where we know there's a cure already so bariatric surgery for instance has been a very well studied so the question is how does that bariatric surgery work right and there's a several hypotheses one of them is that it's the GI effect that is it's something to do with cutting out that stomach and rewiring that intestine that makes it work but that doesn't make sense because there are several different types of surgery including the band where you don't even cut the stomach and they all work equally well so that doesn't really make sense the second is that it's all due to the weight loss and that doesn't really make sense either because it's not the weight the diabetes goes away within two to three weeks those bariatric patients who are like 500 pounds they can often take you know two years to lose all that weight it's really hard to lose all that weight but the diabetes goes away well before the weight goes away and also you could actually take out the subcutaneous fat with liposuction and they've done this study where they basically vacuum out 10 20 kilos of fat it makes no difference to the diabetes in the end the only thing that makes it different so is the acute profound caloric reduction so in both fasting and bariatric surgery you have a period of time where you're eating almost nothing right and that's what seems to be beneficial the counterpoint study was another study done in the UK by dr. Taylor where he looked at the twin defect so those two defects were talking about which is the insulin resistance and the beta cell failure and his hypothesis is that we get rid of that with acute negative energy balance alone that is just the restriction severe restriction of calories causes a reversal of both defects and what he showed was that if you put people on a very very low calorie diet their diabetes reverses so this is the fasting glucose so you see very quickly within seven days these people go from you know a sugar of nine to like five point eight and it stays down okay so the sugar comes down first the other thing that's very interesting is that the liver fat comes down very quickly so here's the normal situation and you can see that people with diabetes have a lot of fatty liver that is what comes down first you get a 30% decrease in the liver fat and over time you also see a decrease in the pancreatic fat and again here's normal so it starts out very high so these people with fatty livers also have fatty pancreas but over time as you put them on these very low calorie diets they steadily come down and down and as that fatty pancreas kind of comes down and down the beta cell starts to work again so you can measure various you know like the maximum insulin response how much of insulin they're actually putting out but they're putting out more okay so it was not that the beta cells were dead it was just that they were blocked up with fat there was a lot of fat there so this is the twin cycles hypothesis is that it's all due to the fatty liver which causes the fatty pancreas right so if you think about it well first of all you know that there's a relationship between people with diabetes and people with fatty liver but what's interesting is that the fatty liver long precedes the diagnosis of diabetes so here's the West of Scotland for coronary Prevention study about 6,500 patients and they froze blood from them so they are able to look back 18 months before the diagnosis of diabetes so these are the people that died eventually got diabetes and you can see this is the alt a measure of their liver function what you can see is that those people that have the eventually diagnosed are eventually diagnosed with diabetes they are showing fatty liver before the diagnosis those who don't get diabetes don't have that right and what you can show also is that as you reverse the hepatic fat the insulin sensitivity goes back to normal that is here's another study of 12 weeks of a very very low calorie diet and what this is is a huge fatty liver and at week 12 it's come down almost 30% but it comes down first before a lot of the other way comes down so if you look at the hepatic fat compared to the weight the hepatic fat the liver fat comes way down 30% for a relatively modest reduction in the weight so all that weight elsewhere doesn't come down first because the fat in the liver is easily accessible so when you are fasting or eating very very few calories the first place they're going to take the fat out of is the liver not from the subcutaneous tissue for instance and along with that what you see is a restoration of the hepatic sense insulin sensitivity so here's the control so they're normal this is the normal situation you can see the type 2 diabetes have very low insulin sensitivity after you put them on these very low calorie diets take out all that liver fat they go back to normal so reducing the liver fat seems to reduce seems to restore the insulin sensitivity which is really the heart of type 2 diabetes that's what it is it's not high blood Sugar's its insulin sensitivity so how do you get that fatty liver in the first place that's the question right and the answer is it's high insulin levels and excess carbohydrates and if you think about it this is what happens in the normal situation okay so insulin is a hormone that is released when you eat okay so you eat food insulin goes up that's normal and what you do is you store some of that excess energy as sugar in the liver so that's glycogen or you store some of it as fat so the fat will the deliverer will produce fat in a process called de novo lipogenesis right and that's a storage form of energy when you don't eat or when you fast the process happens in Reverse so your insulin level goes down and then you start to pull out some of this liver fat pull out some of this glycogen that's a normal situation okay so what happens to these excess carbohydrates well you can burn it but if you're eating and you insulin is high you're not going to burn it so you really have to you can send it elsewhere through VLDL or you can store it in the liver okay so how do you get fatty liver well it's really very simple and you can do this to people and this is a study they took people and they gave them an extra thousand calories a day but not just any old thing they gave them Pepsi fruit juice and a bag of candy okay so basically sugar so every day they gave them an extra thousand calories of sugar and what happens is that they only gain two percent increase of weight right so their weight went up but not very much but there is a 27 percent increase all mostly 30 percent increase in liver denovo lipogenesis so this is the new fat production from the liver and almost a 30 percent increase in the liver fat so as you go from baseline you get more liver fat as you make them lose the weight again they go back to normal so it's all about the excess carbohydrates excess insulin and you of course you knew that already because this is how you make foie gras right you take the goose you shove a tube down and you force-feed it high starch corn mash right that's like the candy that we gave those patients and they all get fatty liver then you kill them and you eat their liver so we know this already this happens in other species it happens in humans as well and there's actually very close correlation between the amount of insulin that you give a type-2 diabetic and how much liver fat they have because it's all about the insulin so if you look at the insulin dose and you correlate it to the liver fat there's about a 77 percent correlation between how much fatty liver they have and how much insulin they take and if you look at type 1 diabetics that's the exact opposite situation their insulin levels are extremely low and what do you find they have less fat in their liver than normal people it's all about the insulin so if you think about it this is really what's happening the liver is like a storage like a balloon right so you eat food insulin goes up you store some sugar as glycogen you store some of it as fat right when it's down it goes back and this is the normal situation when you don't have a big fatty liver but this is the situation when you have a big fatty liver you're trying to shove more fat into this big fatty liver and it's much harder right because it's going to take a lot more force to shove it in because there's a lot of resistance think about your suitcase right so if you fill up your suitcase a couple sweaters is fine no problem but then when it gets full all of a sudden you're jumping on it you know you're trying to shove it down that's what you're trying to do you're trying to shove all this lot into a huge fatty liver that means it takes more force more insulin to move the same amount of fat in there in other words that's insulin resistance if you are not you know jumping on your suitcase and you let up for a second you don't take that insulin for a second what happens all of that sugar comes whooshing out so that's what happens so all these people who are on all this insulin all it's doing is keeping it bottled up in the liver right and that's its normal situation so this is where we can start to connect the dots of the twin cycles hypothesis that is what's happening in type-2 diabetes is that you have the excess carbohydrates too high insulin which is leading to the fatty liver the fatty liver leads to insulin resistance and the insulin resistance leads to higher insulin levels because you need more of that force to push it in and this is a classic vicious cycle right the longer you go the worse you get right because this insulin is causing insulin to go up but it's worse than that actually because there's two cycles that are going on here so on the one hand you got the insulin causing fatty liver on the other hand some of this fat goes into the pancreas so now you get fatty pancreas you get beta cell function and you're not producing and much insulin and your Sugar's go up and then you respond by trying to increase your insulin even more when it fails then you start giving people exogenous insulin but here's the problem of course right insulin is at the heart of it it's the high insulin that was the problem in the first place this is what drives the entire cycle insulin drives the resistance which causes it to go up itself it's a vicious cycle and this is a vicious cycle you have two vicious cycles going on in other words insulin is what actually causes type 2 diabetes so the question of course is that if it's causing it insulin is not the solution insulin is the problem so if you think about how we're going to move towards a cure for diabetes you have to think this is the problem right excess carbohydrates high insulin that's what's causing the problem in the first place so the cure obviously is to decrease insulin and decrease carbohydrates so what's going to happen when you decrease insulin decrease carbohydrates is that now you're going to pull out all that fat from the liver you're going to reduce your insulin resistance and now you're driving the cycle backwards in the longer term you're going to start pulling fat from the pancreas and then you're going to reverse that beta cell dysfunction and as you reverse that beta cell dysfunction your own body can start producing the normal amounts of insulin again so if you reverse the two fundamental defects and type 2 diabetes and that's going backwards so what you can do is look back at our initial construct here you say well this is leading to worsening diabetes we know that because we've been doing that for 25 years we've been making these diabetics worse right how because we're increasing insulin that's the entire problem we're giving insulin we're giving drugs that increase insulin we're putting the email low fat diets which are high in carbohydrates which stimulate insulin right and what happens is that if you look on the side of the cure the whole point is to decrease the insulin that's the only way you're going to get better because it was the insulin that was causing the problem in the first place so you got to remember that type-2 diabetes is a disease of too much insulin who thought it was a smart idea to give the disease where you have too much insulin more insulin that's like giving an alcoholic more alcohol here have another drink it'll do those shake some good yeah okay but the alcoholism is much worse but that's what we're doing we're giving people who have too much insulin more insulin it don't make you better it makes you worse and that's the whole problem this is really stupid but this is what we're doing all of us that's what we're all doing right you go to guidelines you go to Canadian Diabetes Association that's what we're doing we're making it worse we're giving those alcohols another you know beer alcoholics another beer and when they start to get more shakes we're like take two beers right it's like that didn't work in the first place it's not going to work now right if they have too much insulin what do we do we just keep giving patients like Margaret more and more insulin this is smart and that's what we did for Margaret we took her insulin down it's all about lowering the insulin and as you lower the insulin you drive that cycle backwards so the question then is can we cure type-2 diabetes well if you think about it for a second it's incredible because if you don't have diabetes DD's you don't have to worry that they're going to bet diabetic kidney disease you don't have to worry that they're going to get blind from diabetic eye disease they're not going to get their feet chopped off because of peripheral vascular disease there's the cancers there's the strokes there's the MI and all of it is available to all of us for no cost right you're only talking about there's no drugs there's no expensive drugs that we're giving people there's no fancy surgeries where we're going to cut people's stomachs out and there's no cost in fact they'll save money because they're not buying food right so there's no cost to them and the only thing it needs is the knowledge and the courage to challenge this conventional thought that's all we need because if you think about diabetic nephropathy for instance this is the what we think about all the time right diabetes causes the nephropathy so what are we going to give people to take care of the nephropathy right you can use ACE inhibitors a Arby's direct renin inhibitors this that there's huge trials spending millions of dollars trying to find what are we going to give people to take care of this nephropathy but the answer stares you right in the face anyway if you're going to get rid of the nephropathy all you got to do is get rid of the diabetes it can be done it can be done you know in Margaret's case 27 years of diabetes you can still get rid of it in a month right it's not going to take five years ten years you can get rid of it in a month and that's really what you have to understand that this is a disease that's curable in 90% plus of cases right we've proven that with our bariatric surgeries you can take the worst the fattest diabetics the worst diabetics and you can still cure 90% of them so all these simple cases there's there's no reason and there's no reason why we can't get started right now not a matter of funding it's a matter of knowledge that's all we need and we actually have lots of cases so here's a few more cases so he Richard who I had a picture of he had diabetic diabetes for 11 years he was on 56 units of insulin again we took him down he came right down off everything within six weeks he lost 67 pounds 16 inches and you know the year and a half later he's still doing fine he's still not taking insulin Beverly who he just saw seen broke the record at the time she had diabetes for seven years but she was on 210 units of insulin right and again her story was the same she was desperate she was getting worse and she knew it she could feel herself getting worse you know and then she'd go to a doctor and there's like here you know go exercise right go lose some weight well the weight was all coming on because of the insulin right so it's not going to get off until you get off that insulin what happened well within three weeks she was off of all her insulin it's easy it's not easy it's simple for a once II went from 7.2 to 6.7% she lost 30 pounds I mean she's relatively new so we're still working with her to get rid of the rest of it but it can be done even in the worst diabetic cases Michael had diabetes for 13 years and he was on three medications right we started working with him he took a little longer but within 16 weeks a so about four months he went from three medications to zero he went from his a1c went from eight point six percent to five point seven percent in fact he had so much energy he felt so well again he started working out again right now he looks really good his weight loss actually doesn't look that impressive but he actually recently because he's been you know lifting weights has actually gone up quite a bit but it's all lean weight so it's very good again another case of a patient completely reversed this is one of my patients who I treated incorrectly for like 50 years he was diabetic for 43 years he was taking 75 units of insulin a day and again he took a little longer because he had diabetes for a lot longer because again he's been in that cycle of insulin resistance for a long time but again within half a year he's on zero right on zero he lost 37 pounds and his a1c went from 7% to 6.1 percent so even though he's on less medications his sugars are better that means his diabetes is actually better not his blood Sugar's right his diabetes the actual real disease that we're trying to treat that's actually better Walter had diabetes for 30 years he was on 70 units of insulin a day by week 19 boom he's off of everything a 1c 5.5 percent he doesn't have diabetes he's on no medications his a1c is 5.5 percent he suffered with diabetes for 30 years unfortunately he's also my patient I treated him incorrectly for 20 years before then but he was also we took him down like once we realized we took him down in 20 weeks for months so is it worth it for months of hard work to reverse 30 years of diabetes sounds like a pretty good deal to me he doesn't have to worry anymore that he's going to develop diabetic eye disease diabetic kidney disease because he doesn't have diabetes he lost only about 7 pounds but again it's not simply the weight it's the fatty liver that's important then Kirk he actually was diabetic for 18 years and we took him down from four medications to one he had a long way to go this fellow actually lost 117 pounds over the last 18 months so it's been steadily going down even as his triggers have stayed stable he actually was just about to go for bariatric surgery he had bet with the surgeon he was scared but he was going to go ahead with that he told me I said whoa hold on one second there her before you go ahead and do the surgery where they you know rewire intestines why don't you just if the the fasting a try if fasting is what works then do the fasting don't do the surgery so you can do the fasting and it turns out it wasn't as hard as he imagined it was and here he is a hundred and seventeen pounds lighter and feeling great and he's another one again he could barely walk he could barely get in the door now he's moving around he's jumping around so I'm gonna ask Margaret and Ken to come up so these are these these are two patients of dr. Boutros actually who referred him to us and you know the thing is that where you can have a seat over here so what I wanted to do was you know just talk have them share their experience with you because you might think okay well this is great it's going to work but nobody's going to be able to do it right and that's actually not true it's actually much easier than you might imagine it is it's not easy but it's doable and I think that that's that's really what's really what's important so maybe I'll start with you Margaret so how did how are you before you before you came on why don't you just tell us a little bit about that they drained not worth living I had no reason to lay him yeah and I felt bad all the time yeah my eyesight I couldn't look at my watch I couldn't do anything yeah yeah I wasn't doing good yeah and it was really obvious because we you know she could really just barely get in the door like she barely made it down to the office and so we put her on a fairly she was desperate so we put her on a fairly intensive regimen of fasting and how did you find that I was shocked it was the easiest thing I've got in my life the easiest like first day went by hey I did it and then it just kept continuing I could have went I think the rest of my life that I didn't like saying you need to eat right then I went back to eating one day fasting the next and I'm finding this is working for me yeah I think you're doing great 21 days yeah she actually went 3 weeks we actually had we were seeing her actually weekly after that and she said she's feeling great and I said if you're feeling good then just go ahead just keep going right we're monitoring the blood work we're monitoring the sugars we're keeping it close on you if you have no problems and the thing that people don't understand is that the hunger actually disappears usually within a couple of days because what happens is that the body starts pulling out this fat right and the body is essentially just feeding itself through the fat but because you're feeding yourself you're not hungry right and that's what happened to her and then finally exactly so in school if you can keep that the moment when it should be you're not going to be but if you tighten like exactly it's exactly right and that's that's what we do with these with these type 2 diabetics they have all this insulin resistance and so their insulin goes up and then we give them more right and then they get hungry and then they go to the doctor and the doctor says well you got a diet and exercise it's like well the reason why I'm gaining weight is the insulin buddy right and then the doctor says oh well here take more insulin and exercise well that's not my problem the problem was the insulin she knew it everybody knew it the answer obviously is to get rid of the insulin but that's how what people don't understand but when we when she did it exactly as dr. Boudreaux says the hunger goes away and the sugars go down obviously because if you're just burning off all that sugar and the sugars are going to go down and you're not going to need it put those sweets in your body yeah and and how are you in terms of your energy were you tired because a lot of people are worried about that they say oh I can't exercise while I'm fasting I'm gonna be tired I'm gonna tired all the time how did you feel don't thought he was going to not make it and then all of a sudden bang I got energy that I never knew I had huh and I've worked my whole life on my feet and so it's not like I've been lazy my whole life but I got the point where I was lazy I couldn't I couldn't bend down I had him pull up my slacks yeah good morning because they wouldn't go on me you know like I was being destroyed by my body yeah and my mind wouldn't convince me to do something about it dr. Boutros was would tell me go on a diet and I agreed with him it works but it wouldn't stay off me it was come right back and when I went to him he referred me to you yeah it's a best thing that's ever happened to me in my life and I thank both of your service thank you and so Ken how did you feel so Ken Ken saw she was doing really well and he decided that he would try as well so how did you find the fast about jabbing myself I said to her okay go ahead jab me if she no no you do that yourself so I watched her very closely and a couple times she was weak and then my washing lemon she would you told her and she said she's not on him spin anymore I just shot ya know I said I'm going to try it and I've lost about 25 pounds I take about ten units twice a day I still take for metformin but I washed I believe hundred-percent and I believe in another couple of months I will be taken instrument for them and how did you feel like you're telling me about your legs I wore a brace on this week because arthritis my current walk and the authorises of this meat and I can't watch when I was at work the guy who all look at and that but I walked by and I feel great yeah just a whole new change our lives was it was it very difficult no not really I watched her I said she said okay here last two days on fasting you know my daughter phone how's dad hurt he's on his fourth day he's gonna win this 50 or 60 come up she said well is that advant no I'm going to go to Saturday make it 8 days breakfast I you got to realize I got to have breakfast in the morning I will I'll get a headache migraine sick I don't even think of practices I went to Rexroat a nice breakfast with one of the guys retiring ok but I don't crave right now anymore we went to the mandarin that's fine that really didn't very well but those they can item going the football game I'm going to have my sausage on a bun you know but that's what I'm looking forward to but when I came in Oh help yourself and I don't I'm out of fasting pancetta and most likely I'll go a couple more days because I'm looking for something that's coming up for us and I want to make sure I enjoy it so Frank it's fantastic I just the whole idea the incident when I go into work and I see different people's I know and I found out for one of the kids I watch grow up and everything doubts that he lost a toe and that's big throwing that and I say myself that doesn't happen I drink diet coke I drink diet coke separate cans a day when I watched her I stopped I haven't touched any good whatsoever yeah yeah so is lasting water only um non-caloric drinks basically so but no artificial sweeteners there those are chemicals that are pretty bad for you as well so we usually recommend water tea coffee but no sugar and like a bone broth which is like you know you basically take bones and vegetables and boil them for like a long time you just take the soup right and then it's very nutritious actually there's a lot of nutrients and gelatin and stuff in there and that's what you that's what you do and basically if you're not taking any caloric fluids you're basically forcing your body to burn off all that sugar because really in the end what happens is that you're type 2 diabetes is there's too much sugar in the body so you got to get it out and this is the problem with insulin right insulin doesn't get it out insulin doesn't get rid of the blood sugars it simply takes that sugar that's in the blood and it shoves it back into your body right and that sugar goes everywhere it goes into your eyes it goes into your you know kidneys and basically everything just starts to rot because the sugars everywhere diabetes affects every single part of your body because you're taking it out of the blood and just shoving it somewhere else which is like taking garbage and shoving it under the rug you might say look I have no garbage but then your whole house starts to smell right so all the while which is really you know sometimes the most unfair part of things is you sometimes you see these patients you're super diligent they're dabbing themself four times a day they're poking their fingers four times of data recording it and all the while they're just getting worse and worse they still go blind they still go on their dialysis but they didn't need to they needed to go the other way they're actually heading and completely the wrong direction and I'll just end on one one more thing so just to touch quickly on a new class of medications which is topically flows in which is one of the new sglt2 inhibitors I'm actually quite excited about this entire class because different from any other current medications you're actually getting rid of the sugar so in this class of course you urinate out the sugar but what's really important is what happens to the insulin so you see this is in combination therapy but as you get rid of the sugar the insulin levels go down right and what happens to the weight the weight goes down why cause as dr. Bhutto said it's all about the insulin right if you give insulin you gain weight if you take away insulin the weight goes down turns out that obesity is also a disease of hyperinsulinemia you know it's not calories that drives obesity it's insulin that drives obesity once you understand that then you say how am I going to lower insulin right because the whole problem we had was that our entire focus was how are you going to lower blood sugar that was the wrong question the question you should have had was how are we going to lower insulin and none of our current drugs do that this is a start and obviously it's not going to be the entire answer but the answer is how you lower insulin so very low very low carbohydrate diets do that fasting does that and bariatric surgery does that you see that all of those eventually lead to the reversal of diabetes right and now you know you see it I mean it's undeniable right yeah yeah

Channel: Jason Fung

Views: 826,284

Rating: 4.8646545 out of 5

Keywords: type 2 diabetes, Diabetes Mellitus (Disease Or Medical Condition), Insulin (Hormone), Fatty Liver (Disease Or Medical Condition), Fasting, Cure for Diabetes, Diabetes Cure, Diabetes reversal, jason fung, dr jason fung, fung, dr fung, insulin resistance, intermittent fasting, type 2 diabetes explained, reverse type 2 diabetes, type 2 diabetes diet, Type 2 diabetes treatment

Id: FcLoaVNQ3rc

Length: 54min 22sec (3262 seconds)

Published: Sun Dec 07 2014

Reddit Comments

[u/bionic_human]

Some of his stuff may have some merit for SOME people with Type 2. It ignores the fact that there are many potential pathways to developing insulin resistance, and is (as most "celebrity" fixes in the diabetes space are), a gross oversimplification. That's not to say he's wrong, but I wouldn't call him 100% right either.

[u/toccobrator]

Following his advice worked for me, a1c 5.0 and off all meds now, healthiest I've ever been in my life

[u/memesterthrowaway]

Hi I just wanted to say, I am very depressed about my diagnosis and I kinda want to try it to see if it works. I know there is no cure, but what is this guy talking about.

[u/[deleted]]

Depends what's wrong. Fasting and weight loss typically help t2 though nothing is guaranteed.

[u/MiddlinOzarker]

Yes, but get his two books. Log everything you consume. Test BG after eating. You will find out what works for you. Plan on achieving a healthy weight and normal BG because it is possible. Many have reported success and you can succeed also. Good luck.