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I have the best job in the world.

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I'm a doctor.

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No! Believe me that's not why.

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I'm an obesity doctor.

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I have the honor of working
with the group of people

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subject to the last widely
accepted prejudice: being fat.

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These people have suffered a lot
by the time they see me:

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shame, guilt, blame
and outright discrimination.

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The attitude that many take,
including those in healthcare,

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is that these people
are to blame for their situation.

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If they could just control themselves,
they wouldn't be overweight,

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and they are not motivated to change.

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Please let me tell you
this is not the case.

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The blame, if we've got
to extend some here,

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has been with our advice.

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And it's time we change that.

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Obesity is a disease, it's not something
created by lack of character.

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It's a hormonal disease,
and there are many hormones involved.

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And one of the main ones
is a hormone called insulin.

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Most obese individuals
are resistant to this hormone, insulin.

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So, what does that mean exactly,
to be resistant to insulin?

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Well, insulin resistance is essentially
a state of pre-pre-type 2 diabetes.

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Insulin's job is to drive glucose,
or blood sugar,

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into the cells where it can be used.

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In a nutshell, when someone
is insulin resistant,

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they are having trouble
getting blood sugar where it needs to go,

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into those cells.

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And it just can't hang out
in the blood after we eat

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or we would all have a diabetic crisis
after every meal!

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So, when someone is resistant to insulin,

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the body's response to this
is to just make more of it.

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And insulin levels will rise and rise,

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and for a while, years even,
this is going to keep up,

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and blood sugar levels can remain normal.

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However, usually it can't keep up forever,

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and even those elevated levels of insulin

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are not enough to keep blood sugar
in the normal range.

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So it starts to rise.

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That's diabetes.

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It probably won't surprise you to hear

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that most of my patients
have insulin resistance or diabetes.

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And if you are sitting there thinking,
"Phew, that's not me,"

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you actually might want to think again,

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because almost 50% of adult Americans
now have diabetes or prediabetes.

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That is almost 120 million of us.

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But that's hardly everyone
who has issues with insulin.

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Because as I was saying,

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people have elevated insulin levels
due to insulin resistance

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for years, even decades,

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before the diagnosis
of even prediabetes is made.

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Plus it's been shown that 16-25%
of normal-weight adults

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are also insulin resistant.

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So, in case you're keeping track,
this is a heck of a lot of us.

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So, the trouble
with insulin resistance is:

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If it goes up, we are at great risk
for developing type 2 diabetes.

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But also, insulin makes us hungry,

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and the food we eat
much more likely to be stored as fat.

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Insulin is our fat storage hormone.

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So we can start to see
how it's going to be a problem

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for diseases like obesity
and metabolic issues like diabetes.

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But what if we traced this problem
back to the beginning,

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and we just didn't have
so much glucose around

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that insulin needed to deal with?

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Let's take a look at how that could be.

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Everything you eat

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is either a carbohydrate,
a protein or a fat,

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and they all have very different effect
on glucose and therefore insulin levels,

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as you can see on the graph.

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So when we eat carbohydrates,

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our insulin and glucose
are going to spike up fast.

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And with proteins it looks a lot better.

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But take a look at what happens
when we eat fat.

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Essentially nothing, a flat line.

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And, this is going to wind up
being very important.

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So, now I want to translate
that graph for you

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into a real-world situation.

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I want you to go back

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and think about the last time you ate
an American version of Chinese food.

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We all know there's rules
associated with this, right?

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And the first rule is:
You're going to overeat.

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Because the stop signal doesn't get sent

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until you are literally
busting at the seams.

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Rule number two is:
In an hour you're starving.

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Why?

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Well, because the rice in that meal
caused glucose and insulin to skyrocket,

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which triggered hunger,
fat storage and cravings.

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So, if you are insulin
resistant to begin with,

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and your insulin levels
are already higher,

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you really are hungrier all the time.

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And we have this setup:

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Eat carbs, your glucose goes up,
your insulin goes up,

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and you have hunger and fat storage.

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So, how do we recommend
to these people to eat,

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because it seems like that would be
really important, and it is.

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Let's focus just on type 2 diabetes,

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because the general recommendations
are to tell patients with type 2 diabetes

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to consume 40 to 65 grams
of carbohydrates per meal,

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plus more at snacks.

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Trust me on this, that's a lot of carbs.

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And remember what's going to happen
to glucose and insulin,

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blood sugar and insulin,

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when we eat them?

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Yes, we are essentially recommending

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that they eat exactly
what's causing their problem.

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Sound crazy?

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It really, really is.

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Because, at its root, diabetes
is a state of carbohydrate toxicity.

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We can't get the blood sugar
into the cells,

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and that causes a problem
in the short term.

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But the long-term consequences
are even greater.

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And insulin resistance is essentially
a state of carbohydrate intolerance.

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So why, oh why, do we want to continue
to recommend to people to eat them?

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The American Diabetes
Association guidelines

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specifically state that there is
inconclusive evidence

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to recommend
a specific carbohydrate limit.

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But those guidelines go right on
to say what we all know:

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Our carbohydrate intake is the single,
biggest factor in blood sugar levels,

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and therefore need for medication.

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These guidelines then go on to say:

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Hey look, if you are taking
certain diabetic medications,

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you actually have to eat carbs,
otherwise your blood sugar can go too low.

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Okay, so let's take a look

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at the vicious cycle
that that advice just set up.

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So it's: Eat carbs so you have
to take medicine,

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then you have to eat more carbs

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so you avoid the side-effect
of those medications,

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and around and around we go.

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Even worse is that nowhere
in the ADA guidelines

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is the goal of reversing type 2 diabetes.

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This needs to be changed,

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because type 2 diabetes can be reversed,
in many, if not most, situations,

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especially if we start early.

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Not only do we need
to let people know this,

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but we have to start giving them
the practical advice so they can do this.

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Consider carbs.

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First, here's a shocker for you:
We don't need them.

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Seriously! Our minimum daily requirement
for carbohydrates is zero.

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We have essential amino acids,
those are proteins,

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essential fatty acids,

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but, nope, no essential carb.

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A nutrient is essential

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if we have to have it to function,
and we can't make it from something else.

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We make glucose,
plenty of it, all the time,

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it's called gluconeogenesis.

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So, we don't need them,

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the overconsumption of them
is making us very sick,

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yet we are continuing
to recommend to patients

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to consume close to, if not more than,

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half of their total energy intake
every day from them.

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It doesn't make sense.

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Let's talk about what does.

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Cutting carbs, a lot.

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Yes, in my clinic we teach patients

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to eat with carbs
as the minority of their intake,

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not the majority.

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So, how does that work?

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Well, when our patients
decrease their carbs

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their glucose goes down,
and they don't need as much insulin.

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So those insulin levels drop, and fast.

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And this is very important,

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because a study

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looking at our National Health
and Nutrition Examination Survey data,

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better known as NHANES,

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showed that the single,
biggest risk factor

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for coronary artery disease

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is insulin resistance.

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It is responsible
for a whopping 42% of heart attacks.

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Low-carb intervention works so fast

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that we can literally pull people off
of hundreds of units of insulin

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in days to weeks.

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One of my favorite stories
is a very recent one.

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A young gal, but who had an almost
20-year history of type 2 diabetes,

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came in when a physician from another
clinic told her she was just sick,

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and she'd probably get used to it.

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Her diabetes was way out of control.

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This despite the fact that she
was on multiple medications,

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including almost 300 units of insulin,

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that was being injected into her
continuously every day via a pump.

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All of this, remember,
blood sugar still out of control.

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So we put her on a low-carb diet,
and now let's fast-forward four months.

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She lost weight, yes,
but, better than that, sick no more.

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Her blood sugar levels
were now normal all of the time.

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This on, get this, no diabetes medication.

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Gone was the 300 units of insulin,

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no more insulin pump,

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no more pricking her finger
multiple times each day,

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gone, all of it, no more diabetes.

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One of the greatest joys of my job
is to be able to tell a patient like this

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that they no longer have diabetes,

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and we ceremoniously take it off
their problem list together.

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So, are they cured, is this a miracle?

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We'll leave that grandstanding
to Doctor Oz.

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Cured would imply that it can't come back.

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And if they start eating
excessive carbs again, it will.

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So no not cured, but they don't have
diabetes any longer.

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It's resolved, and it can stay that way
as long as we keep away the cause.

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So, what does this look like then?
How does somebody eat this way?

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Well, first, let me tell you
what it's not.

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Low-carb is not zero carb,
and it is not high protein.

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These are common criticism
that are so frustrating

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because they are not true.

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Next, if we take the carbs out,
what are we going to put in?

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Because, remember,
there's only three macronutrients:

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if one goes down, one has to go up.

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My patients eat fat, and a lot of it.

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"What!?" you say. What's going
to happen when you eat fat?

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Well, let me tell you, you're
going to be happy,

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because fat tastes great,
and it is incredibly satisfying.

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(Applause)

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(Laughter)

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But, remember, fat
is the only macronutrient

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that's going to keep our glucose -
blood sugar - and insulin levels low,

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and that is so important.

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So, I want you to now hear
my simple rules for eating.

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These rules, you have to remember,
are even going to be more important

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00:12:04,333 --> 00:12:07,505
if you are one of the tens
of millions of Americans

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who have trouble with insulin levels.

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Rule number one: If it says light, low fat
or fat-free, stays in grocery store.

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because they took the fat out,
they put carbs and chemicals in.

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Rule number two: Eat food.

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The most important rule
in low-carb nutrition:

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Real food does not come in a box,

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and no-one should have to tell you
real food is natural.

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You should know that when you look at it.

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Don't eat anything you don't like.

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And eat when you're hungry;
don't eat when you're not,

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no matter what the clock says.

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And number five is a simple way
to remember what we want to avoid.

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No GPS: no grains,
no potatoes and no sugar.

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That last one is a biggie,
right, no grains?

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Na, no grains.

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But we have to have them.

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Nope, they're a carb.

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But whole grains are so good for us.

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Well, first of all, there are actually
very few foods out there

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that are truly whole grain
even when they say they are.

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Most foods that purport themselves
to be wholegrain

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are highly processed
and the fiber benefit ruined.

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Or they're coming
with highly refined flour,

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usually both of these things.

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So if you are one of the truly
insulin-sensitive people,

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00:13:13,513 --> 00:13:15,811
you can eat real, whole grain.

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But if you're in the enormous slice
of our population with insulin issues,

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it's making things worse.

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So what if you are one
of the real insulin-sensitive people?

246
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Can you still eat this way?

247
00:13:27,736 --> 00:13:30,203
Yes! I am a great example.

248
00:13:30,221 --> 00:13:33,163
Over a year ago I decided
I would cut my carbs

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as low as I recommend
to my diabetic patients.

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Now, it's not mandatory for my health
like it is for theirs;

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I'm not insulin resistant,
so would this be a problem?

252
00:13:42,290 --> 00:13:44,384
No! That's just the thing.

253
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Unless you have
an exceedingly rare syndrome,

254
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then cutting carbs
is going to be good for you,

255
00:13:49,132 --> 00:13:51,770
even if it's not necessary.

256
00:13:51,780 --> 00:13:55,881
I want to show you a couple of pictures
of my radical food.

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So, this is a common breakfast
in my house.

258
00:13:58,517 --> 00:14:00,795
So does it look like
I just broke my own rule?

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00:14:00,815 --> 00:14:04,822
I didn't because this muffin
is made with coconut flour.

260
00:14:04,822 --> 00:14:06,812
I bake all the time still.

261
00:14:06,814 --> 00:14:11,529
I just use non-grain-based flours:
coconut, almond, hazelnut, flax.

262
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They make delicious things.

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00:14:13,356 --> 00:14:16,898
And this is a typical dinner in my house
with a typical starch.

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That would be the sautéed mushrooms.

265
00:14:19,566 --> 00:14:25,012
No, my patients and I eat delightful food
all of the time and enjoy it.

266
00:14:25,012 --> 00:14:27,011
But what about the research on this?

267
00:14:27,024 --> 00:14:29,953
I mean is this just anecdotal
evidence now from my clinic?

268
00:14:29,960 --> 00:14:31,033
No!

269
00:14:31,040 --> 00:14:33,657
There are dozens of
randomized controlled trials

270
00:14:33,665 --> 00:14:35,410
looking at low-carb intervention

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00:14:35,421 --> 00:14:39,722
for things like diabetes,
cardiovascular risk factors, obesity.

272
00:14:39,748 --> 00:14:41,952
They're consistent. It works!

273
00:14:41,995 --> 00:14:45,229
There are even a large number
of studies showing

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00:14:45,240 --> 00:14:48,896
that low-carb nutrition
decreases inflammatory markers,

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which is making it really exciting
for diseases like cancer.

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00:14:53,240 --> 00:14:56,326
We just finished a study in our clinic.

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And what we did is,

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we took 50 type 2 diabetic patients

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00:15:00,295 --> 00:15:03,686
that were treated with
our low-carb-high-fat-based program,

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00:15:03,689 --> 00:15:05,670
and we compared them to 50 patients

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00:15:05,681 --> 00:15:08,172
who were treated with the ADA guidelines.

282
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And after six months,

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00:15:09,390 --> 00:15:12,673
not only did we find
a significant metabolic advantage

284
00:15:12,683 --> 00:15:13,967
for the low-carb group,

285
00:15:13,988 --> 00:15:18,891
but, and let's face it, this is important,
a huge cost savings.

286
00:15:18,906 --> 00:15:24,273
Our analysis showed that our patients
could save over $2,000 a year

287
00:15:24,303 --> 00:15:28,127
just on the diabetes meds
they were no longer taking.

288
00:15:28,162 --> 00:15:30,215
Just think how fast that adds up.

289
00:15:30,246 --> 00:15:32,023
We are in a diabetes epidemic now

290
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that we are spending
$250 billion a year on in this country.

291
00:15:36,831 --> 00:15:38,492
So, I want to show you a slide now

292
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that demonstrates where
those savings are coming from.

293
00:15:42,463 --> 00:15:45,632
So this is looking
just at the insulin difference

294
00:15:45,653 --> 00:15:47,755
in the two groups after six months.

295
00:15:47,760 --> 00:15:49,280
And what we can see is

296
00:15:49,299 --> 00:15:52,568
that the low-carb group
was able to decrease their insulin

297
00:15:52,577 --> 00:15:55,481
by almost 500 units a day.

298
00:15:55,507 --> 00:15:57,520
Whereas in the ADA treated group,

299
00:15:57,534 --> 00:16:01,990
they had to increase their insulin
by almost 350 units a day.

300
00:16:01,995 --> 00:16:03,307
Two important things.

301
00:16:03,313 --> 00:16:06,511
Number one: Insulin is expensive.

302
00:16:06,533 --> 00:16:12,171
And number two: Not all the people
in this study were even on insulin,

303
00:16:12,198 --> 00:16:15,396
which makes these results
even more impressive.

304
00:16:15,412 --> 00:16:18,630
But what I would say is
that this graph really represents

305
00:16:18,654 --> 00:16:21,821
two different approaches
to treating this disease.

306
00:16:21,841 --> 00:16:25,732
The first, our group,
with the goal of reversing disease,

307
00:16:25,746 --> 00:16:27,738
meaning they need less medicine.

308
00:16:27,742 --> 00:16:32,129
And the second group, which very clearly
aligns with the ADA guidelines,

309
00:16:32,144 --> 00:16:35,778
which state that diabetes
is a progressive disease,

310
00:16:35,783 --> 00:16:38,365
requiring more medicine over time.

311
00:16:38,380 --> 00:16:42,220
Progressive unless we take away the cause.

312
00:16:42,247 --> 00:16:43,771
So, what's the problem then?

313
00:16:43,771 --> 00:16:47,009
Why is this not everywhere?
Why isn't low carb the norm?

314
00:16:47,029 --> 00:16:48,450
There's two big reasons.

315
00:16:48,480 --> 00:16:53,005
Number one: status quo.
It is hard to break.

316
00:16:53,042 --> 00:16:55,286
There are many agendas involved.

317
00:16:55,318 --> 00:16:59,564
We got this notion that low fat
was the way to go decades ago.

318
00:16:59,593 --> 00:17:01,317
But a recent study just came out

319
00:17:01,325 --> 00:17:04,667
showing that there was
zero randomized control evidence

320
00:17:04,675 --> 00:17:08,329
to recommend to Americans
to remove the fat from our diet.

321
00:17:08,342 --> 00:17:10,928
And that's how the carbs got added in.

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00:17:10,943 --> 00:17:16,132
It was essentially a huge experiment
on millions of people,

323
00:17:16,160 --> 00:17:18,632
and it failed miserably.

324
00:17:18,648 --> 00:17:21,493
The second reason we don't
see it everywhere is money.

325
00:17:21,511 --> 00:17:25,743
Don't be fooled, there's a lot of money
to be made from keeping you sick.

326
00:17:25,759 --> 00:17:28,925
And what we see is,
with these specialty guideline panels,

327
00:17:28,940 --> 00:17:32,679
they are stacked
with conflict of interest.

328
00:17:32,687 --> 00:17:38,957
So, the solution to the diabetes epidemic
in my clinic is exceedingly clear:

329
00:17:38,978 --> 00:17:43,847
Stop using medicine to treat food.

330
00:17:43,862 --> 00:17:48,188
And for a disease
whose root cause is carbohydrates,

331
00:17:48,193 --> 00:17:51,422
take away the carbohydrates,
or at least cut them,

332
00:17:51,436 --> 00:17:54,829
so we can remember
what we used to know.

333
00:17:54,829 --> 00:17:56,439
We knew it a long time ago,

334
00:17:56,445 --> 00:17:58,636
this was said thousands of years ago,

335
00:17:58,651 --> 00:18:02,713
and we need, in this day and age,
to get back to that notion.

336
00:18:02,740 --> 00:18:04,215
Thank you.

337
00:18:04,228 --> 00:18:06,927
(Applause)