Latest / NHA Today Podcast / The Science of Preventing and Reversing Type 2 Diabetes w/ Dr. Stephan Esser
Transcript
- Stephan Esser MD: Hello, everybody, and welcome today's edition of the NHA Today podcast. Today I want to speak with you about type 2 diabetes in particular and how five simple strategies have been scientifically proven to radically reduce your risk of this nasty disease or even to prevent it altogether and/or reverse it. So let's get right into the information today. We're gonna share this information so that you and your loved ones can radically improve your health over time. We're gonna call this topic The end of diabetes. You know, we should all start at the beginning, though, and that is what is diabetes itself? At its heart, diabetes is a problem with blood sugar management. There is a dysfunction that is not allowing, right, your body to manage blood sugar in a normal fashion. We normally break these down into two major types of diabetes, either type one, where there's insufficient or non-existent insulin produced, or type two, where there's plenty of insulin, but it's not able to do its job. interestingly enough, 90 to 95% of all cases of diabetes are in fact type 2, as we'll talk about, and the remainder type 1, related to some sort of autoimmune disease, cancer, surgery, something that destroyed the pancreatic cells that are involved with insulin production. In America today, diabetes is a seventh leading cause of death. And if you just look at the stats over the last 20 years, I like to go way back and look at kind of when this all started. And then kind of as it's evolved over time, getting closer and closer to us. And then as we look at more and more data, just the numbers that continue to increase. In large part, this increased rate of diabetes has been related to the weight of individuals, as well as other factors we're going to discuss. But as you probably know, right, it's amazing to think about that 70% of Americans are presently overweight or obese. And as a result of this, the number of projected cases of diabetes just continues to climb and climb and climb. This is a major problem because the cost to our nation is absolutely significant, right? And it's just continued to climb. And I went back to some old data here because I wanted to show this to you that our projections of what this costs are often so far off the mark as to be perilous to us, right? I mean, back in 2007, when I first started talking about this subject. Back then $174 billion being spent managing diabetes. As we said, the majority of being type 2 diabetes. And in 2007, they projected that by 2020 the cost would be 192 billion. And here, by 2012, they were 245 billion. And those numbers have just continued to ratchet up progressively over time, which is absolutely terrifying when you think about one in three children born in 2000 going to have diabetes in their lifetime. Right. And those kids are now full grown adults. Right in their 20s now with this risk very much before them. And so we're spending the amazing amount of healthcare dollars, 12% of the total healthcare spending, just on diabetes itself. And again, the majority of that being spent to manage and treat type two diabetes. And why is it so expensive? Well, because when you have type two diabetes, you increase your risk by 200 to 600% for heart disease, stroke, high blood pressure. And of course. Diabetes is the number one cause of blindness, kidney failure, neuropathies, and amputation in America. Let me say that again. Diabetes is the number one cause of blindness, kidney failure, neuropathy, and amputation. I stress this so much because holy Toledo, right? We're gonna learn today that there are five simple science-based strategies that, for the majority of people, the majority of the time, can make them diabetes-free as far as type 2 diabetes and radically improve their control of type one diabetic numbers. And yet, wow, right? Wow. We will I want you to put your thinking cap on with me. And I want you to walk through this because as you're here to learn, knowledge is power and power is, of course, responsibility. So I want to heat that knowledge into your cup today. And then I want to give you this opportunity and responsibility to impact your own life and the health of those that you love that are around you. So let's start by going to mini medical school. You know, the heart of diabetes is really the pancreas, this beautiful little yellow organ that's wrapped in the arms of the small intestines. And the stomach laying in the left upper quadrant area of your abdomen. This little organ called the pancreas is tightly woven into the small intestines where it dumps through this little duct, right? It dumps fluid into the small intestines to help facilitate digestion. Because one of the primary things that, as an exocrine gland, we call it, as the pancreas, is that it produces digestive enzymes. That help to break down proteins and fats and carbohydrates, as well as to help with neutralizing acid with the production of bicarbonate. And so it dumps this all into the small intestines right as the food is coming out right from the stomach. Now, it also is an endocrine gland, right? It has double duties. And this endocrine function is it produces hormones called insulin, glucagon, somatostatin, these things that are involved controlling your blood sugars as well as influencing neurohormonal control. Now. I want you to memorize this slide with me. Imagine a bunch of houses, they're in a row, and in front of them, they have gates. And those gates, of course, there's a road. Now, this road, of course, is not a road, it's it's meant to be a blood vessel. And this blood vessel carries blood sugar or glucose. This energy of the cell has to get inside the house in order to do its job. And the gatekeeper that opens the gates is insulin. So insulin opens the gate, glucose rushes into the cell. And now the cell can use it for energy. Pretty much all of your cells in your body, from skin cells to hair cells to brain cells to muscle cells, all require blood sugars or glucose. Now, if you're born without any insulin at all, the blood sugar goes crazy, right? And we get major problems and can die prematurely. However, as we talked about, that's not 90 plus percent of diabetes in America. In 90 plus percent of cases in America, this is the problem: visceral fat or belly fat. This belly fat produces molecules we call adipokines with cool names like TNF alpha and interleukin 6 and CRP. And these molecules circulate and they go to the gates of these little cells and they block glucose from doing its job. So as a result, they're blocking insulin from binding in this area, right? Like bouncers blocking a doorway. And so insulin tries to do its job, but it can't. And so what happens? The blood sugars increase in number. Then Pancreas says, Well, I must need more insulin. So it produces more. And it's still not enough. And the blood sugars increase. And the body tries to do more and it keeps producing more insulin until one day, after 10 or 15 years, it goes, I quit, I'm giving up, and boom, you get diagnosed with type 2 diabetes. And now the doctor is offering you drugs and medications to try to treat this problem. Because there is a problem. And the trouble is the fat. The problem is the fat. It is the visceral fat, this belly fat that's deep inside of us. Wrapped up in our organs, what's called the omentum around our intestinal tract. And that fat is the hormonally active fat that impairs function of your insulin and drives your blood sugars up. And so here's where we are, right? We're in this place of things that are in our control and things out of our control, right? Out of your control, genetics, age, and race. Look, if you've got a strong family history, your mother, your father, your uncle Bob, your you know, your Aunt Martha, everybody has diabetes, you have a much higher risk. And in fact, you've got to be that much more serious. As you get older over the age of 35 and 40, right, that increases your risk. But what's in your control? There are a lot. Look at that whole list there. And I want to walk through some of these with you. Because here's the reality, right? All the things that we call treatments for diabetes really are just management options. They don't fix the problem. So what we really want to do is prevent the problem to begin with, not just jump in with all kinds of random drugs that of course have a lot of side effects and costs and all the rest. But when we look at these different medications, right, my gosh, they come with so many other things too, right? Checking your blood sugars, injecting yourself with insulin, getting your A1C and retinal scans and all this. This is why 80 plus percent of people who start on oral diabetic meds end up on insulin within 10 years. The amount of work is just insane. If they don't change what is the stimulant, if they don't change what is causing their problem, they're just gonna progress. And that's exactly what occurs. So You know, let's jump into here. I'm gonna skip some of these slides because what we want to talk about today is impacting diabetes. There are five major diabetic influencers: insulin, exercise, fat, inflammation, and meat. These are five that we're gonna talk about. So insulin doesn't just work with blood sugars. It also is involved with your cholesterol levels, with carbohydrate synthesis, with protein metabolism, a whole host of very important things. Now, what it turns out is though insulin, especially in high doses, Turns out it is adipogenic and atherogenic. What does that mean? It means that it makes you gain weight and it causes heart disease. So those people out there who are taking their insulin and going, what's the big deal, Dr. Esser? I just shoot up a few more insulin, you know, a few more milligons, a little bit more of this, whatever. The problem with that, right, is a few more units of insulin, all that does is drive up your tendency to gain more weight. And the more weight you gain, of course, the more likely you are to make your diabetes worse, right? And the more the worsening of diabetes, right, now your heart disease gets worse. It's a vicious cycle. We want to break this. So you can see the cycle here, right? Weight gain, more insulin resistance. So your blood sugar goes up, and then increased appetite with more insulin and secretion, more weight gain, vicious cycle. And again, we need to break it. Now, exercise. Let's talk about this. Turns out every time you exercise, your body uses energy. Well, what is the energy it's using? Glucose. You guessed it. So it's using glucose. So by exercising innately, you reduce the amount of free blood sugars through your bloodstream. That's good. And In addition, right, you break down stored glycogen, which is the storage form of blood sugars, and you increase how sensitive your insulin is. In other words, you superpower your insulin, you give them muscles. And now that insulin is able to beat up some of the adipocytes, get them out of there, get those adip adipokines out of the way. And as a result, insulin can now do its job. Now, it doesn't matter whether you do strength training or cardiovascular. Both are beneficial. And this is why I say when people say, What should I do? I say, whatever you're willing to do, start. There. Now, what about fat itself? Fat, it turns out, whether it be on your body or that you eat, impairs insulin sensitivity. That's right, that sort of, you know, innocent-looking olive oil that you pour all over your salad turns out actually impairs insulin sensitivity. Why? I like to think about it like putting grease on a door handle. You just can't turn the door handle well, right? You're trying to get through the door, but you can't turn it because it's all greasy. That's the same idea with you having any oils. Right. And high-fat foods, they impair your insulin from binding to the GLUT2 and GLUT4 receptors, and thereby your blood sugars climb. So whether you wear the fat or eat the fat, it increases your risk of type 2 diabetes. And for those of you who are big carnivores, light, here's the problem, right? Turns out that meat consumption impairs insulin sensitivity. And all the studies on meat consumption shows it increases the risk of type 2 diabetes, likely a combination of both the fattiness of the meat, but also some inherent proteins in the meat. That appear to impair blood sugar function. So this is crucial stuff. You and I are aware of this, right? So as a result, right, the populaces that eat the lowest amounts of meat, which we'd have vegans and then vegetarians, et cetera, right? They just kind of level out, you know, the least meat and dairy, the lowest rates of diabetes. and of course, right, even without going 100% plant-based, if you just extract some of the animal protein. And put in instead some vegetable protein sources. You can see here a 5% swap out, and you already get a 23% reduction in type 2 diabetes risk. Beautiful, beautiful. This is what we want, right? So low carbohydrate, high animal-based protein diets long term are not ideal and should be avoided when it comes to our type 2 diabetes risk. So, but interestingly enough, a higher protein diet that's maced from plants does not appear to increase that risk in the same way as animal-based protein does. But as mentioned, the less meat consumed, the lower the risk of type 2 diabetes, as you can see in this large study, and part of the Adventist Health study. And you can just kind of see how it all shakes out. Now, what about inflammation? Same thing here. All of the animal-based foods increase or enhance inflammation in the body, while these minimally processed plant foods reduce inflammation. And inflammation, of course, is part of this whole process of inhibiting insulin from doing its job. Now, let's look at this interview. Let's start with some epidemiologic data. You heard me quote off or quickly rattle off some data saying that people who eat the most plants have the lowest rates of type 2 diabetes. Well, when we look, you can see that as it plays out, whether it be in Finland, California, or other parts of the world, that when we look at tens of thousands of people and look at their rates of type 2 diabetes as related to the highest fruit and vegetable consumption, those who consume the most fruit and vegetable have the lowest rates of type 2 diabetes, right? And in fact, when we look at interventional studies, some of these here you can see three-week intensive dietary modification. 71% of people who are on oral blood sugar medicines get off. 40% who are on insulin get off. Right. Beautiful, right? To kind of see these results. They're able to just kind of quickly get off that medication as little as three weeks. This is huge. And again, these studies have been repeated again and again. These by the Pritikan Institute, some nice studies all the way back in the 1980s. Demonstrating that 26-day inpatient stay, right? Where you had control of what these people ate, almost 80% get off their oral blood sugar meds within 26 days. Amazing, right? So this is what we're talking about: the power of the plate, the power of the personal choices that you and I make. And so the beauty is not only, of course, do your blood sugars come down, but your blood cholesterol levels come down, your blood pressure improves, inflammation and pain improves, everything improves as you enhance your diet. And this was always a very compelling study done at the Weimer Institute. And really, 21 people with type 2 diabetes and nasty peripheral neuropathies. Remember how I said the number one cause of peripheral neuropathy and amputation, right, was type two diabetes. And so amazing to think that 80% of people within a short span of time, as little as four to sixteen days, had complete relief of their peripheral neuropathies by eating what? A bunch of vegetables and fruits and gently exercising. And this worked by improving blood flow, dropping blood sugar numbers, decreasing glycosylation end products that damage the blood vessels. So many different factors involved here, but so beautiful to see the powerful results. We can do a whole talk on that another time. Unlike right reversing your diabetes, if you keep your diabetes, it ages you prematurely and it leads, as we talked about, to a host of different complications. In an effort to reverse, prevent, right, protect, right. We want to look at five science-based prevention strategies. And we're going to use the diabetes prevention program trial, right? This is a seminal study that was done 20 plus years ago, published in the New England Journal of Medicine, in which they took individuals who are overweight, right? Their BMI was 31, so technically obese, right? And they randomized to either just the doctor saying, hey, eat healthy food, it's better for you, or to an individualized lifestyle counseling. And they followed them over multiple years. Now remember how we said if you were obese, you had a nine. 100% higher risk of type 2 diabetes in your lifetime, especially as you aged, right? And so what did they find? They found that people who received the individualized counseling had a 60% reduction of the risk of diabetes over the next three. And then they continue the study actually over multiple more years, and the significant reduction. But that doesn't speak the whole story. I like this slide from the study that looked at what we call success score. And notice they established five specific goals that we're going to talk about for the participants. And if the participants achieved all five of the goals, look at their risk. Look down here. Their risk was essentially zero. That's right. If the participants achieved all five of the goals, I'm going to share with you over the next number of years, the risk of type 2 diabetes was essentially zero. And with each progressive change they made, right, their risk reduction increased. Which is kind of fun, right? Because then you could decide as an individual, right? Hey, I know I don't want diabetes. How serious do I want to be? And how radically do I want to reduce my risk, right? Or as Clint Eastwood said, you know, how lucky do you feel punk or whatever the exact phrase was, right? But why not radically reduce it versus only minimally reduce it? But that's a personal choice. And you can make that choice. So let's walk through here, right? Here are the goals: lose 5% at more of body weight, eat less than 30% of total calories from fat, less than 10% of total calories from saturated fat, eat greater than 15 grams of fiber for a thousand calories, and achieve 150 minutes per week of exercise. Boom, put these on the refrigerator, put them on your mirror, wherever it needs to go, and let's get cooking, right? I want to see you do these every day. So let's start here. Achieving greater than 5% of total weight loss, right? All right, so take a look at your weight, see where you are, and see if you're overweight or obese. Then this needs to be one of your goals. Now, why? Well, not only of course does that weight with the adipode kinds increase the risk of type 2 diabetes, but look at all the other nasty things it increases the risk of. None of which you want, none of which I want you to have, right? So your weight, if you're carrying extra weight, increases the risk of all of these disease processes. And of course, as the data clearly shows, the most powerful, globally healthy for you and the environment way to do this is gonna be by consuming a whole food plant-based diet focused on micronutrient dense, calorie-poor foods. We know this reduces the risk of all primary major diseases and all primary hormonal cancers more than any other approach. And this is what we want to be really be focused in on. Next, fat intake. Total fat less than 30% of daily calories. So well, we know that some of the primary plant-based approaches, right? Whether it be ornish, Esselston, McDougal, Pritican, Rice diet, China, so you can see their average fat intakes are all low as we you know, here less than 30% of total calories. Well, in these, less than 10%, right? They saw radical, powerful results. I encourage people to do a similar program and see those same sort of results. Now, fat intake, you have to decide for yourself. Is your goal pretty good health? Prevention of type 2 diabetes, reversal of type 2 diabetes, excellent health. What does that mean to you, right? And that's a whole another talk. We can have another time. Saturated fat, fewer than 10% of your total calories should come from saturated fat, according to their studies. And again, for you, you should look at, right, myfitnesspal.com or chronometer or one of these apps and track what you're eating and look at what is the saturated fat content that you're getting on a daily basis in your meals. What about fiber intake? Greater than 15 grams per thousand kilocalories. Well, in America today, you know, old data there, but it we're not any better now, unfortunately, from the NA NHANES studies. we were only getting like 15 grams in a given day. We're looking what to get greater than 15 grams per thousand kilocalories. Well, let's look at some examples more importantly, right, from this. Let's look at a simple couple meals. You got oatmeal, you got some salad, rice. You know, this is only about a thousand calories. I get 40 grams. Fiber, right? So pretty intense, right? So they said 15 grams per thousand. Here we're getting 40 grams, right? So we're way above that. Even if you go to Mickey D's Chipotle and like a little Asian place and get this, you're still ending up with 37 grams, right, of fiber per 1500 calories. This is so crucial to remember though, only plant based matter has fiber. It's part of the plants. So nothing meat based and none of the refined foods have any fiber. Next, physical activity more than 30 minutes per day. Doesn't matter again. Yes, you may say I don't have a lot of time. Well, then figure out lifestyle exercise, right? How are you going to incorporate movement into your life on a daily basis? And look, there are multiple types of movement you can do. And the key is to do them all as much as possible and stay vital, stay active by complementing your overall health with always. And again, 150 minutes a week, ideally of some cardiovascular. These are the federal recommendations. Two to three days a week of some resistance training, but making sure that you're getting movement every day. And as a result, as we talked about, your blood sugars reduce and your insulin becomes more sensitive and much stronger over time. Again, whatever you're willing to do, that is the place to start. So let's go back again. My goals for you, based on the science, to make yourself diabetes-free, lose more than 5% of your body weight if you're overweight or obese, eat. Fewer than 30% of total calories from fat, and fewer than 10% of total calories from saturated fat, and more than 15 grams of fiber per thousand calories. These three simple nutritional approaches, you want to track them and see that you're doing them on a daily basis and see where you can improve and enhance. And then getting the movement in on a weekly basis. I mean, the outline's pretty simple, isn't it? Eat more plants, eat less, no animal-based and refined foods, and move. That's the reality. The application into your life is where it becomes challenging. As I say to people, the truth of this science is it's simple, but not always easy. You've got to decide where you are in your personal headspace in life right now and how you want to reduce that risk. And perhaps even more importantly, looking for opportunity to motivate yourself. Are you fearful of death or amputation because you saw your grandmother die of type two diabetes complications? Do you hate the idea of the cost of all of this to you because your insurance isn't ideal and you can see it's gonna cost you a thousand bucks a month? Is it the loss of function, right? Where you get the neuropathies in your feet and you can't feel unless you can't walk safely and move as well? Is it the side effects of the drugs, right? Because we know many of these drugs cause a host of different complications, whether it be metformin with diarrhea, whether it be some of the glyposide and the like that may increase the risk of coronary artery problems. you know, which ones? They all have different side effects. Is it your image and sexual function, right? As we know that people with type 2 diabetes, not only can they get peripheral neuropathies in their limbs, but also in their genital organs, right? Where now we don't have as much feeling, sensitivity, function, etc. So, or is it simply just that you want to maximize your performance and your ability to live life to the best? Whatever it is, I want you to think about what are your motivators and why do you want to change? Thank you again for joining me today and discussing this incredibly important topic. You know, if you or a family member is struggling with type two diabetes, or if you're just nervous about possibly developing it yourself, I want to encourage you to give yourself the gift of four weeks. Do you remember some of those studies I just shared with you that showed that 80% of people could reverse their type two diabetes if they're on oral medicine? Or if you're not even on oral medicine yet, can take you far away from that moment where you might go on meds. The reality is We want to see you healthy. And the personal choices that you make are powerful. So whether it be that you pick up Joel Furman's book on the end of diabetes or PCRM Neil Barnard's books or Mastering Diabetes or My Four Week Program Online or any of the amazing resources that are out there on how whole food plant-based nutrition and exercise can radically and scientifically prevent reverse type 2 diabetes in your life, I want to encourage you. I want to invite you and I want to impress upon you just how powerful you are. So today, your homework after watching this is to make that decision and don't wait. Go get some of those resources, apply them your life, and then share down below how the journey's going. All right, everybody, have a great rest of your day.