Reversing Type 2 diabetes starts with ignoring the guidelines | Sarah Hallberg | TEDxPurdueU
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0:12 - 0:15I have the best job in the world.
-
0:15 - 0:16I'm a doctor.
-
0:16 - 0:18No! Believe me that's not why.
-
0:18 - 0:20I'm an obesity doctor.
-
0:20 - 0:23I have the honor of working
with the group of people -
0:23 - 0:27subject to the last widely
accepted prejudice: being fat. -
0:28 - 0:31These people have suffered a lot
by the time they see me: -
0:31 - 0:36shame, guilt, blame
and outright discrimination. -
0:36 - 0:39The attitude that many take,
including those in healthcare, -
0:39 - 0:43is that these people
are to blame for their situation. -
0:43 - 0:47If they could just control themselves,
they wouldn't be overweight, -
0:47 - 0:49and they are not motivated to change.
-
0:49 - 0:52Please let me tell you
this is not the case. -
0:52 - 0:55The blame, if we've got
to extend some here, -
0:55 - 0:57has been with our advice.
-
0:57 - 0:59And it's time we change that.
-
0:59 - 1:04Obesity is a disease, it's not something
created by lack of character. -
1:04 - 1:09It's a hormonal disease,
and there are many hormones involved. -
1:09 - 1:12And one of the main ones
is a hormone called insulin. -
1:12 - 1:17Most obese individuals
are resistant to this hormone, insulin. -
1:17 - 1:21So, what does that mean exactly,
to be resistant to insulin? -
1:21 - 1:27Well, insulin resistance is essentially
a state of pre-pre-type 2 diabetes. -
1:27 - 1:31Insulin's job is to drive glucose,
or blood sugar, -
1:31 - 1:34into the cells where it can be used.
-
1:34 - 1:37In a nutshell, when someone
is insulin resistant, -
1:37 - 1:41they are having trouble
getting blood sugar where it needs to go, -
1:41 - 1:42into those cells.
-
1:42 - 1:45And it just can't hang out
in the blood after we eat -
1:45 - 1:50or we would all have a diabetic crisis
after every meal! -
1:50 - 1:52So, when someone is resistant to insulin,
-
1:52 - 1:56the body's response to this
is to just make more of it. -
1:56 - 1:59And insulin levels will rise and rise,
-
1:59 - 2:02and for a while, years even,
this is going to keep up, -
2:02 - 2:05and blood sugar levels can remain normal.
-
2:05 - 2:09However, usually it can't keep up forever,
-
2:09 - 2:12and even those elevated levels of insulin
-
2:12 - 2:16are not enough to keep blood sugar
in the normal range. -
2:16 - 2:18So it starts to rise.
-
2:18 - 2:20That's diabetes.
-
2:20 - 2:22It probably won't surprise you to hear
-
2:22 - 2:26that most of my patients
have insulin resistance or diabetes. -
2:26 - 2:29And if you are sitting there thinking,
"Phew, that's not me," -
2:29 - 2:32you actually might want to think again,
-
2:32 - 2:38because almost 50% of adult Americans
now have diabetes or prediabetes. -
2:38 - 2:42That is almost 120 million of us.
-
2:42 - 2:46But that's hardly everyone
who has issues with insulin. -
2:46 - 2:47Because as I was saying,
-
2:47 - 2:52people have elevated insulin levels
due to insulin resistance -
2:52 - 2:54for years, even decades,
-
2:54 - 2:58before the diagnosis
of even prediabetes is made. -
2:58 - 3:03Plus it's been shown that 16-25%
of normal-weight adults -
3:03 - 3:06are also insulin resistant.
-
3:06 - 3:11So, in case you're keeping track,
this is a heck of a lot of us. -
3:11 - 3:14So, the trouble
with insulin resistance is: -
3:14 - 3:20If it goes up, we are at great risk
for developing type 2 diabetes. -
3:20 - 3:25But also, insulin makes us hungry,
-
3:25 - 3:29and the food we eat
much more likely to be stored as fat. -
3:29 - 3:33Insulin is our fat storage hormone.
-
3:33 - 3:37So we can start to see
how it's going to be a problem -
3:37 - 3:42for diseases like obesity
and metabolic issues like diabetes. -
3:42 - 3:45But what if we traced this problem
back to the beginning, -
3:45 - 3:49and we just didn't have
so much glucose around -
3:49 - 3:51that insulin needed to deal with?
-
3:51 - 3:53Let's take a look at how that could be.
-
3:53 - 3:55Everything you eat
-
3:55 - 3:58is either a carbohydrate,
a protein or a fat, -
3:58 - 4:03and they all have very different effect
on glucose and therefore insulin levels, -
4:03 - 4:05as you can see on the graph.
-
4:05 - 4:06So when we eat carbohydrates,
-
4:06 - 4:10our insulin and glucose
are going to spike up fast. -
4:10 - 4:13And with proteins it looks a lot better.
-
4:13 - 4:16But take a look at what happens
when we eat fat. -
4:16 - 4:20Essentially nothing, a flat line.
-
4:20 - 4:24And, this is going to wind up
being very important. -
4:24 - 4:27So, now I want to translate
that graph for you -
4:27 - 4:30into a real-world situation.
-
4:30 - 4:31I want you to go back
-
4:31 - 4:37and think about the last time you ate
an American version of Chinese food. -
4:37 - 4:40We all know there's rules
associated with this, right? -
4:40 - 4:43And the first rule is:
You're going to overeat. -
4:43 - 4:45Because the stop signal doesn't get sent
-
4:45 - 4:48until you are literally
busting at the seams. -
4:48 - 4:52Rule number two is:
In an hour you're starving. -
4:52 - 4:53Why?
-
4:53 - 4:57Well, because the rice in that meal
caused glucose and insulin to skyrocket, -
4:57 - 5:02which triggered hunger,
fat storage and cravings. -
5:02 - 5:05So, if you are insulin
resistant to begin with, -
5:05 - 5:08and your insulin levels
are already higher, -
5:08 - 5:11you really are hungrier all the time.
-
5:11 - 5:13And we have this setup:
-
5:13 - 5:16Eat carbs, your glucose goes up,
your insulin goes up, -
5:16 - 5:19and you have hunger and fat storage.
-
5:19 - 5:23So, how do we recommend
to these people to eat, -
5:23 - 5:27because it seems like that would be
really important, and it is. -
5:27 - 5:30Let's focus just on type 2 diabetes,
-
5:30 - 5:35because the general recommendations
are to tell patients with type 2 diabetes -
5:35 - 5:40to consume 40 to 65 grams
of carbohydrates per meal, -
5:40 - 5:42plus more at snacks.
-
5:42 - 5:45Trust me on this, that's a lot of carbs.
-
5:45 - 5:48And remember what's going to happen
to glucose and insulin, -
5:48 - 5:49blood sugar and insulin,
-
5:49 - 5:50when we eat them?
-
5:50 - 5:54Yes, we are essentially recommending
-
5:54 - 5:58that they eat exactly
what's causing their problem. -
5:58 - 5:59Sound crazy?
-
5:59 - 6:02It really, really is.
-
6:02 - 6:07Because, at its root, diabetes
is a state of carbohydrate toxicity. -
6:07 - 6:10We can't get the blood sugar
into the cells, -
6:10 - 6:13and that causes a problem
in the short term. -
6:13 - 6:17But the long-term consequences
are even greater. -
6:17 - 6:22And insulin resistance is essentially
a state of carbohydrate intolerance. -
6:22 - 6:28So why, oh why, do we want to continue
to recommend to people to eat them? -
6:28 - 6:31The American Diabetes
Association guidelines -
6:31 - 6:34specifically state that there is
inconclusive evidence -
6:34 - 6:38to recommend
a specific carbohydrate limit. -
6:38 - 6:41But those guidelines go right on
to say what we all know: -
6:41 - 6:47Our carbohydrate intake is the single,
biggest factor in blood sugar levels, -
6:47 - 6:51and therefore need for medication.
-
6:51 - 6:53These guidelines then go on to say:
-
6:53 - 6:57Hey look, if you are taking
certain diabetic medications, -
6:57 - 7:02you actually have to eat carbs,
otherwise your blood sugar can go too low. -
7:02 - 7:04Okay, so let's take a look
-
7:04 - 7:07at the vicious cycle
that that advice just set up. -
7:07 - 7:11So it's: Eat carbs so you have
to take medicine, -
7:11 - 7:13then you have to eat more carbs
-
7:13 - 7:15so you avoid the side-effect
of those medications, -
7:15 - 7:19and around and around we go.
-
7:19 - 7:23Even worse is that nowhere
in the ADA guidelines -
7:23 - 7:27is the goal of reversing type 2 diabetes.
-
7:27 - 7:28This needs to be changed,
-
7:28 - 7:35because type 2 diabetes can be reversed,
in many, if not most, situations, -
7:35 - 7:38especially if we start early.
-
7:38 - 7:41Not only do we need
to let people know this, -
7:41 - 7:47but we have to start giving them
the practical advice so they can do this. -
7:47 - 7:49Consider carbs.
-
7:49 - 7:53First, here's a shocker for you:
We don't need them. -
7:53 - 7:58Seriously! Our minimum daily requirement
for carbohydrates is zero. -
7:58 - 8:02We have essential amino acids,
those are proteins, -
8:02 - 8:03essential fatty acids,
-
8:03 - 8:06but, nope, no essential carb.
-
8:06 - 8:07A nutrient is essential
-
8:07 - 8:13if we have to have it to function,
and we can't make it from something else. -
8:13 - 8:16We make glucose,
plenty of it, all the time, -
8:16 - 8:19it's called gluconeogenesis.
-
8:19 - 8:21So, we don't need them,
-
8:21 - 8:24the overconsumption of them
is making us very sick, -
8:24 - 8:26yet we are continuing
to recommend to patients -
8:26 - 8:29to consume close to, if not more than,
-
8:29 - 8:34half of their total energy intake
every day from them. -
8:34 - 8:36It doesn't make sense.
-
8:36 - 8:37Let's talk about what does.
-
8:37 - 8:40Cutting carbs, a lot.
-
8:40 - 8:42Yes, in my clinic we teach patients
-
8:42 - 8:46to eat with carbs
as the minority of their intake, -
8:46 - 8:47not the majority.
-
8:47 - 8:49So, how does that work?
-
8:49 - 8:52Well, when our patients
decrease their carbs -
8:52 - 8:56their glucose goes down,
and they don't need as much insulin. -
8:56 - 8:59So those insulin levels drop, and fast.
-
8:59 - 9:01And this is very important,
-
9:01 - 9:02because a study
-
9:02 - 9:06looking at our National Health
and Nutrition Examination Survey data, -
9:06 - 9:08better known as NHANES,
-
9:08 - 9:11showed that the single,
biggest risk factor -
9:11 - 9:13for coronary artery disease
-
9:13 - 9:15is insulin resistance.
-
9:15 - 9:20It is responsible
for a whopping 42% of heart attacks. -
9:20 - 9:23Low-carb intervention works so fast
-
9:24 - 9:28that we can literally pull people off
of hundreds of units of insulin -
9:28 - 9:30in days to weeks.
-
9:30 - 9:33One of my favorite stories
is a very recent one. -
9:33 - 9:38A young gal, but who had an almost
20-year history of type 2 diabetes, -
9:38 - 9:41came in when a physician from another
clinic told her she was just sick, -
9:41 - 9:43and she'd probably get used to it.
-
9:43 - 9:46Her diabetes was way out of control.
-
9:46 - 9:50This despite the fact that she
was on multiple medications, -
9:50 - 9:54including almost 300 units of insulin,
-
9:54 - 10:00that was being injected into her
continuously every day via a pump. -
10:00 - 10:03All of this, remember,
blood sugar still out of control. -
10:03 - 10:07So we put her on a low-carb diet,
and now let's fast-forward four months. -
10:07 - 10:12She lost weight, yes,
but, better than that, sick no more. -
10:12 - 10:16Her blood sugar levels
were now normal all of the time. -
10:16 - 10:21This on, get this, no diabetes medication.
-
10:21 - 10:23Gone was the 300 units of insulin,
-
10:23 - 10:25no more insulin pump,
-
10:25 - 10:28no more pricking her finger
multiple times each day, -
10:28 - 10:32gone, all of it, no more diabetes.
-
10:32 - 10:37One of the greatest joys of my job
is to be able to tell a patient like this -
10:37 - 10:39that they no longer have diabetes,
-
10:39 - 10:42and we ceremoniously take it off
their problem list together. -
10:42 - 10:45So, are they cured, is this a miracle?
-
10:45 - 10:48We'll leave that grandstanding
to Doctor Oz. -
10:48 - 10:50Cured would imply that it can't come back.
-
10:51 - 10:54And if they start eating
excessive carbs again, it will. -
10:54 - 10:59So no not cured, but they don't have
diabetes any longer. -
10:59 - 11:05It's resolved, and it can stay that way
as long as we keep away the cause. -
11:05 - 11:08So, what does this look like then?
How does somebody eat this way? -
11:08 - 11:10Well, first, let me tell you
what it's not. -
11:10 - 11:15Low-carb is not zero carb,
and it is not high protein. -
11:15 - 11:18These are common criticism
that are so frustrating -
11:18 - 11:20because they are not true.
-
11:20 - 11:23Next, if we take the carbs out,
what are we going to put in? -
11:23 - 11:26Because, remember,
there's only three macronutrients: -
11:26 - 11:28if one goes down, one has to go up.
-
11:28 - 11:32My patients eat fat, and a lot of it.
-
11:32 - 11:35"What!?" you say. What's going
to happen when you eat fat? -
11:36 - 11:38Well, let me tell you, you're
going to be happy, -
11:38 - 11:42because fat tastes great,
and it is incredibly satisfying. -
11:42 - 11:44(Applause)
-
11:44 - 11:46(Laughter)
-
11:46 - 11:49But, remember, fat
is the only macronutrient -
11:49 - 11:53that's going to keep our glucose -
blood sugar - and insulin levels low, -
11:53 - 11:56and that is so important.
-
11:57 - 12:01So, I want you to now hear
my simple rules for eating. -
12:01 - 12:04These rules, you have to remember,
are even going to be more important -
12:04 - 12:08if you are one of the tens
of millions of Americans -
12:08 - 12:10who have trouble with insulin levels.
-
12:10 - 12:14Rule number one: If it says light, low fat
or fat-free, stays in grocery store. -
12:14 - 12:17because they took the fat out,
they put carbs and chemicals in. -
12:17 - 12:19Rule number two: Eat food.
-
12:19 - 12:22The most important rule
in low-carb nutrition: -
12:22 - 12:24Real food does not come in a box,
-
12:24 - 12:27and no-one should have to tell you
real food is natural. -
12:27 - 12:29You should know that when you look at it.
-
12:29 - 12:32Don't eat anything you don't like.
-
12:32 - 12:35And eat when you're hungry;
don't eat when you're not, -
12:35 - 12:37no matter what the clock says.
-
12:37 - 12:40And number five is a simple way
to remember what we want to avoid. -
12:41 - 12:45No GPS: no grains,
no potatoes and no sugar. -
12:45 - 12:48That last one is a biggie,
right, no grains? -
12:48 - 12:49Na, no grains.
-
12:49 - 12:50But we have to have them.
-
12:50 - 12:52Nope, they're a carb.
-
12:52 - 12:54But whole grains are so good for us.
-
12:54 - 12:58Well, first of all, there are actually
very few foods out there -
12:58 - 13:01that are truly whole grain
even when they say they are. -
13:01 - 13:03Most foods that purport themselves
to be wholegrain -
13:03 - 13:06are highly processed
and the fiber benefit ruined. -
13:06 - 13:09Or they're coming
with highly refined flour, -
13:09 - 13:11usually both of these things.
-
13:11 - 13:14So if you are one of the truly
insulin-sensitive people, -
13:14 - 13:16you can eat real, whole grain.
-
13:16 - 13:21But if you're in the enormous slice
of our population with insulin issues, -
13:21 - 13:23it's making things worse.
-
13:23 - 13:26So what if you are one
of the real insulin-sensitive people? -
13:26 - 13:28Can you still eat this way?
-
13:28 - 13:30Yes! I am a great example.
-
13:30 - 13:33Over a year ago I decided
I would cut my carbs -
13:33 - 13:36as low as I recommend
to my diabetic patients. -
13:36 - 13:39Now, it's not mandatory for my health
like it is for theirs; -
13:39 - 13:42I'm not insulin resistant,
so would this be a problem? -
13:42 - 13:44No! That's just the thing.
-
13:44 - 13:47Unless you have
an exceedingly rare syndrome, -
13:47 - 13:49then cutting carbs
is going to be good for you, -
13:49 - 13:52even if it's not necessary.
-
13:52 - 13:56I want to show you a couple of pictures
of my radical food. -
13:56 - 13:59So, this is a common breakfast
in my house. -
13:59 - 14:01So does it look like
I just broke my own rule? -
14:01 - 14:05I didn't because this muffin
is made with coconut flour. -
14:05 - 14:07I bake all the time still.
-
14:07 - 14:12I just use non-grain-based flours:
coconut, almond, hazelnut, flax. -
14:12 - 14:13They make delicious things.
-
14:13 - 14:17And this is a typical dinner in my house
with a typical starch. -
14:17 - 14:20That would be the sautéed mushrooms.
-
14:20 - 14:25No, my patients and I eat delightful food
all of the time and enjoy it. -
14:25 - 14:27But what about the research on this?
-
14:27 - 14:30I mean is this just anecdotal
evidence now from my clinic? -
14:30 - 14:31No!
-
14:31 - 14:34There are dozens of
randomized controlled trials -
14:34 - 14:35looking at low-carb intervention
-
14:35 - 14:40for things like diabetes,
cardiovascular risk factors, obesity. -
14:40 - 14:42They're consistent. It works!
-
14:42 - 14:45There are even a large number
of studies showing -
14:45 - 14:49that low-carb nutrition
decreases inflammatory markers, -
14:49 - 14:53which is making it really exciting
for diseases like cancer. -
14:53 - 14:56We just finished a study in our clinic.
-
14:56 - 14:58And what we did is,
-
14:58 - 15:00we took 50 type 2 diabetic patients
-
15:00 - 15:04that were treated with
our low-carb-high-fat-based program, -
15:04 - 15:06and we compared them to 50 patients
-
15:06 - 15:08who were treated with the ADA guidelines.
-
15:08 - 15:09And after six months,
-
15:09 - 15:13not only did we find
a significant metabolic advantage -
15:13 - 15:14for the low-carb group,
-
15:14 - 15:19but, and let's face it, this is important,
a huge cost savings. -
15:19 - 15:24Our analysis showed that our patients
could save over $2,000 a year -
15:24 - 15:28just on the diabetes meds
they were no longer taking. -
15:28 - 15:30Just think how fast that adds up.
-
15:30 - 15:32We are in a diabetes epidemic now
-
15:32 - 15:36that we are spending
$250 billion a year on in this country. -
15:37 - 15:38So, I want to show you a slide now
-
15:38 - 15:42that demonstrates where
those savings are coming from. -
15:42 - 15:46So this is looking
just at the insulin difference -
15:46 - 15:48in the two groups after six months.
-
15:48 - 15:49And what we can see is
-
15:49 - 15:53that the low-carb group
was able to decrease their insulin -
15:53 - 15:55by almost 500 units a day.
-
15:56 - 15:58Whereas in the ADA treated group,
-
15:58 - 16:02they had to increase their insulin
by almost 350 units a day. -
16:02 - 16:03Two important things.
-
16:03 - 16:07Number one: Insulin is expensive.
-
16:07 - 16:12And number two: Not all the people
in this study were even on insulin, -
16:12 - 16:15which makes these results
even more impressive. -
16:15 - 16:19But what I would say is
that this graph really represents -
16:19 - 16:22two different approaches
to treating this disease. -
16:22 - 16:26The first, our group,
with the goal of reversing disease, -
16:26 - 16:28meaning they need less medicine.
-
16:28 - 16:32And the second group, which very clearly
aligns with the ADA guidelines, -
16:32 - 16:36which state that diabetes
is a progressive disease, -
16:36 - 16:38requiring more medicine over time.
-
16:38 - 16:42Progressive unless we take away the cause.
-
16:42 - 16:44So, what's the problem then?
-
16:44 - 16:47Why is this not everywhere?
Why isn't low carb the norm? -
16:47 - 16:48There's two big reasons.
-
16:48 - 16:53Number one: status quo.
It is hard to break. -
16:53 - 16:55There are many agendas involved.
-
16:55 - 17:00We got this notion that low fat
was the way to go decades ago. -
17:00 - 17:01But a recent study just came out
-
17:01 - 17:05showing that there was
zero randomized control evidence -
17:05 - 17:08to recommend to Americans
to remove the fat from our diet. -
17:08 - 17:11And that's how the carbs got added in.
-
17:11 - 17:16It was essentially a huge experiment
on millions of people, -
17:16 - 17:19and it failed miserably.
-
17:19 - 17:21The second reason we don't
see it everywhere is money. -
17:22 - 17:26Don't be fooled, there's a lot of money
to be made from keeping you sick. -
17:26 - 17:29And what we see is,
with these specialty guideline panels, -
17:29 - 17:33they are stacked
with conflict of interest. -
17:33 - 17:39So, the solution to the diabetes epidemic
in my clinic is exceedingly clear: -
17:39 - 17:44Stop using medicine to treat food.
-
17:44 - 17:48And for a disease
whose root cause is carbohydrates, -
17:48 - 17:51take away the carbohydrates,
or at least cut them, -
17:51 - 17:55so we can remember
what we used to know. -
17:55 - 17:56We knew it a long time ago,
-
17:56 - 17:59this was said thousands of years ago,
-
17:59 - 18:03and we need, in this day and age,
to get back to that notion. -
18:03 - 18:04Thank you.
-
18:04 - 18:07(Applause)
- Title:
- Reversing Type 2 diabetes starts with ignoring the guidelines | Sarah Hallberg | TEDxPurdueU
- Description:
-
This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx
Can a person be "cured" of Type 2 Diabetes? Dr. Sarah Hallberg provides compelling evidence that it can, and the solution is simpler than you might think.
- Video Language:
- English
- Team:
- closed TED
- Project:
- TEDxTalks
- Duration:
- 18:12
Davor Skeledzija
This video is great and very important for medical and patient community. Can anyone please give advice how to do something about finishing it for translation?!
Video is sitting here for months and nothing is happening, except these comments are being erased....
Thank you in advance for any help
Anders Björk
Hi Davor!
I posted a request in Facebook group asking for native english speaker to review the transcript https://www.facebook.com/groups/ITranslateTEDTalks/
yesterday! So please comment on that so that other translators see that it is important. Please motivate in the post.
Riaki Ponist
Hi there, there's a typo in the transcript:
4:13 - 4:16
But take look at what happens
when we eat fat.
Suggested:
But take a look at what happens
when we eat fat.
Robert Tucker
4:13 - 4:16 now corrected.
Thank you Riaki.