MDAE E35 – Can You Get Diabetes From Eating Too Much Sugar?

Article written and reviewed by Cyrus Khambatta, PhD and Robby Barbaro, MPH
Published September 6, 2018

Podcast Transcript

Neal Barnard, MD: You can't control your genes. You can't control the passage of time. But you can control what's on your plate. And if avoiding those foods is going to protect the brain, in the same way that protects the heart, then that's golden. So, that's where we're really going with this.

Cyrus Khambatta, PhD: Welcome to the Mastering Diabetes Audio Experience, where we teach you how to sit in the driver's seat of your diabetes health for the rest of your life. We’ll teach you how to reverse insulin resistance, achieve your ideal body weight, gain energy and get your best A1c following more than 85 years of evidence-based research in the Mastering Diabetes Program.

Robby Barbaro: Our program teaches you how to reverse prediabetes and type 2 diabetes, and how to simplify your life with type 1 diabetes by maximizing your insulin sensitivity, using food as medicine.

Cyrus Khambatta, PhD: We're on a bold mission to reverse insulin resistance in 1 million people. We're glad to have you joining us.

Robby Barbaro: Welcome back to the Mastering Diabetes Audio Experience. Today, we have a truly epic, epic episode. So, this is another interview from our 2018 Online Summit. And if you have not checked that out yet, I highly suggest going to our website www.masteringdiabetes.org, just click Summit in the navigation bar, and you're definitely going to want to register for that.

But today we are sharing one of the best interviews. It's hard to pick and say, oh, you know, because there's so many amazing interviews. But we got to be honest here. There are some people that just stand above the rest. I mean, that's the truth here. And this is Dr. Neal Barnard, the legend himself. The work he has done for the diabetes community with the book he wrote, diabetes and reversing type 2 diabetes with the work he's doing at the Physicians Committee for Responsible Medicine. He just truly, truly is a legend. So we're super honored to have him in our 2018 Online Summit, and to be able to share this interview with you. He is just a true gem.

So in today's episode, you're going to hear Dr. Neal Barnard explain insulin resistance in a very easy to understand way. And he's going to talk about why it's important, and how it applies to people living with all forms of diabetes, including type 1 diabetes. He's also going to talk about the controversy around sugar causing diabetes. So, he's an expert on that. And he's sort of been in the media a lot about that, in relation to the movie “What The Health”. So, that's a fascinating topic that he covers in this interview.

We also go into some of the details about low-carb nutrition versus high-carb nutrition. And that's fascinating. He wrote a book about cheese recently, and he goes into detail about the psychological effects, and why it's so difficult to stop eating cheese. It's very, very addicting, and he explains why.

Dr. Barnard also the talks about type 3 diabetes. You're not gonna want to miss that, very interesting topic. And he covers tips for communicating with your doctor. And at the end of the interview, he also talks about how much fat is allowed, if you want to truly reverse insulin resistance. So you're going to hear it straight from the legend himself. This is a great, great episode. Let's get right into it. I hope you guys enjoy it.

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Cyrus Khambatta, PhD: Alright, we are pleased to be in the presence of a true pioneer in the plant based nutrition world for diabetes. Dr. Neal Barnard is with us today and Dr. Neal Barnard wears many hats. He's a New York Times bestselling author, he's a physician, and a clinical researcher who runs an organization called PCRM, the Physicians Committee for Responsible Medicine, a non-profit organization in Washington D.C. that promotes preventive medicine and higher standards for ethics in research. Dr. Barnard has written 18 books, including Dr. Neal Barnard's Program for Reversing Diabetes, in which he clearly lays out a program that’s designed to target and reverse the root cause of diabetes using a low-fat, plant-based, whole-food nutrition approach. In short, there's nothing that Dr. Neal Barnard cannot do. We're pleased to have you on the Summit today, thanks so much for being here.

Neal Barnard, MD: Well thank you, it's great to be with you. Thanks for that very nice introduction.

Cyrus Khambatta, PhD: Absolutely. So, for many people, the term insulin resistance is vague, it's something people may have heard before, but most people living with diabetes can't necessarily fully describe it. So, you are a master biological story teller. What is insulin resistance?

Neal Barnard, MD: Okay, well let me see if I can make it clear and obviously why this is important is that when a person goes to the doctor's office and they get their diagnosis of type 2 diabetes, the diabetes didn't start that day. It started long before that with insulin resistance. It really starts in the muscle cells and the liver cells. Normally, sugar, glucose, can go into the muscles and it powers them, it gives you the ability to move. It can go into the liver cells as well and the glucose is powering your liver cells. And some glucose is going into the other cells of the body, but actually, the biggest place it goes is the muscles.

Now, to get into the muscles, it can't just get into the cell, you need insulin, which acts like a key to open little channels to allow the glucose to go into the cell. And insulin of course is made in the pancreas, it goes through the blood, it attaches to receptors right on the surface of a cell, just like a key in a lock, opens it up, in goes the glucose into the cell. That's normal. However, for some folks, that's not working very well. They've got insulin. The insulin is in the blood, and in fact, the insulin is attaching to those receptors with no problem, just like a key in a lock, no problem at all.

But, somehow that receptor is not turning on the process by which the glucose can get inside. It's like a key that just can't open your front door lock, for some reason. And you look at your key and there's nothing wrong with it, but you look in the lock, that's where the problems are. Now, when I was a kid growing up in North Dakota, there was a trick that sometimes other kids would play, which is to put chewing gum in their neighbor's locks, and then they would hide in the bushes and watch, you know, as the person's keys couldn't work and they would get frustrated. If that were to happen to you, you've got just one choice, that's clean out the darn lock.

You don't have chewing gum in your cells, but if that insulin key isn't working, the problem is you have fat building up in your cells. I don't mean layers of fat around my stomach; what I'm talking about is inside the cells, tiny fat particles that are making that insulin key not work anymore. And so, when the cells build up with fat, which, by the way, the technical term is intramyocellular lipid, but that just means fat. When the fat is build up, then we need to have a diet that clears it out, and so a vegan diet means no animal products, ergo, no animal fat. If I keep the oils low then the fat inside the cells should start to dissipate. And so that's why we've been using this kind of diet for people, because it can improve the insulin resistance, which is the first step for diabetes.

Robby Barbaro: Does insulin resistance affect only people with prediabetes and type 2 diabetes? Or is it a more generalized biological phenomenon?

Neal Barnard, MD: Oh, it can affect anybody. It can affect a 15 year old kid. They haven't been diagnosed with prediabetes or diabetes, but the reason we know this is with MR spectroscopy, which is, for anybody who's had a MRI for a torn cartilage in your knee or whatever, a similar technique is used to look inside the muscles or inside the liver. And you can take a 15 year old kid and you can look inside their muscles and their liver and you'll see the buildup of fat, depending on what they've been eating, and you can predict that that person will develop insulin resistance, that they will develop prediabetes, that they'll ultimately got to diabetes.

And you can see this way, way, way ahead of the diagnosis. So, yeah, great question, it can happen to anybody. And it can also happen to a person that's got type 1. So type 1 diabetes means that the pancreas isn't making any insulin anymore, but that doesn't mean you can't also develop insulin resistance on top of that.

Robby Barbaro: Right. It's very important, it's something we talk about a lot in our Coaching Program. Cyrus and I are both living with type 1, as well. So, as a leader in the whole-food, plant-based world, you receive a lot of push back about your views on sugar and you do a great job of addressing the opposition with respect. So many people don't love to hear the message that sugar does not cause diabetes. Can you go into more detail about what you mean when you say that?

Neal Barnard, MD: Yes, well first of all, I do mean to say that I'm not suggesting that sugar is health food and you should just be throwing sugar in every recipe, and having sodas all the time. Sodas are not healthy, even if they're called "Dr. Pepper", it's not healthy for you. So, but what's the deal? Here's why I'm concerned about this, and this is why it came out in the movie “What the Health", which I think, by the way, is a really inspiring movie to many people.

A lot of folks have had the idea that diabetes means there’s too much sugar in my blood, so therefore, it must have been that I ate sugar and that's putting the sugar in my blood. And if I just stop drinking soda, I wouldn't have diabetes or it would go away. And that's just way too simplistic. And a couple other things are problematic with it. The first is that soda consumption peaked in 1999, and in fact sweeteners in general. I'm talking about sugar and high fructose corn syrup, and you add it all together, it peaked in 1999 and in that year, that's when bottled water started having such a large market share that soda consumption started going down and sugar overall went down.

So it's been going down, and down, for about 20 years now, but where's diabetes going? It's going up, and up, and up. If sugar was the whole issue then it's hard to make sense of this. So, the other piece of this, and this is really disquieting for researchers to see, if you look at sugar sweetened beverages in cohort studies. By a cohort study, I mean you gather a group of people and you follow that same group year, after year, after year, and you track what they eat. You do see a correlation, that those that have the most sweetened beverages, I'm talking about soda or sweetened juices, and things like that, they do have slightly higher risk of developing diabetes, so the lesson there is maybe sugar is playing a causative role or at least you don't want to be having sugar in your life.

But, it turns out that, if you look at people who are having sodas that don't have sugar in them, I'm talking about the artificially sweetened ones, they get diabetes, too. Same as the ones with sugar. So that lead people to think, well maybe it's not the sugar, or maybe sugar is bad, and the artificial sweeteners are bad, maybe they're both bad. Then, a meta analysis came out earlier this year, that looked at sugar overall, not just the sugar in sodas, but sugar overall, and they found something very surprising, that it wasn't linked to diabetes. In fact, some of them, like sucrose, were actually linked to reduced risk of developing diabetes.

Now, once again, I'm not trying to say that sugar is healthy, or that it doesn't have health risks, it does. But, this lead people to hypothesize that maybe a big part of the reason that sodas were linked with diabetes, but sugar overall was not, is that sodas come with cheeseburgers, and sodas come with chicken nuggets, and sodas come with pizza. And when you're having soda, you're having all these other unhealthy foods, too. So anyhow, the other thing is that if we're focusing only on sugar and making that our culprit for everything, then we're missing the real cause of insulin resistance, which is the buildup of fat inside the cells. Ok, now, one more thing, and forgive me for this belabored answer, you've opened up a big can of worms by talking about sugar. Here's the other thing that has to be said. I do think sugar can be harmful and here's part of why.

Let's say I am insulin resistant, let's say my cells are filled with that. Then anything you eat is going to raise your blood sugar, and so what I need to do is get the fat out of my diet, go on a vegan diet so that I can fix the problem, which is in my cells. But in the meanwhile, sugars that you eat will make your blood sugar rise to a great degree. And I am prepared to believe also that when your blood sugar goes way up, even for a short period of time, I think it can do damage to fine nerve function, to fine blood vessels, maybe the blood vessels of your eyes. They don't like having a big tsunami of sugar hitting them all at one time.

So, bottom line, the idea that sugar causes diabetes is really simplistic, it's the buildup of fat inside the cell that causes insulin resistance, and then the beta cells wear out because they can't make enough insulin to keep up. But sugar is not health food and it can contribute to these problems.

One last thing. A lot of people think, well I'm overweight because of sodas. Maybe, but you've really gotta work at it, because sugar is only 4 calories per gram, but fats have 9 calories per gram, so if you want to get fat quickly, eat a lot of cheese. Or eat foods that are laden with fat, and the pounds come on much more easily than they ever will with sugar. Long answer, but that's kind of the deal with sugar.

Cyrus Khambatta, PhD: No, this is great, actually, we're gonna be talking about dietary fat and cheese in a little bit here, but before we get there, I want to continue on this sugar trend because I understand it's a can of worms. We get it. We see in the world of diabetes your typical individual who's living with either prediabetes, type 2 diabetes, type 1 diabetes, we're sort of told over, and over, and over again that sugar is the enemy, carbohydrate-rich foods are the enemy. Bananas are the enemy. Potatoes are the enemy. Don't eat those foods.

Right, so, what we see, and what is happening is that, there are millions of people around the planet adopting low carbohydrate diets. Low carbohydrate diets, ketogenic diets. And as a result of that, what they do, is they limit their total carbohydrate intake, of sugar-sweetened beverages, of fruits, of starchy vegetables, you name it. They get lower blood glucose, their A1c drops, they start losing weight, and so their conclusion is like, “Hey look, the carbohydrate-rich foods were the problem, and now I feel a lot better, and my doctor is happy”. So, what's happening here and why is it that when they limit their intake of carbohydrate-rich foods they do end up getting good results?

Neal Barnard, MD: Well, they don't get good results over the long run typically, they get good results over the short run and sometimes not even then. Let's say I am insulin resistant. My cells are filled with fat. And if I suddenly leave out all the carbohydrate, then there's not much glucose going into my body, so my blood sugar will fall. The same way muscle cells run on glucose, my car runs on gasoline, and somebody's put a rag in my fuel tank so the gasoline can't get in there anymore and I'm trying to get the gas in, it's spilling all over the ground. If I just stop giving it gasoline, it stops spilling. But my car's not gonna run very well. So if you stop giving your cells glucose, yeah, your blood glucose can fall if you stop eating it, but your body's not gonna run as well because that's the main fuel the cells need.

The other thing, and perhaps more importantly, is if you look at a person's diet, carbohydrate is most of the calories, or half or more of the calories in the average person's diet. In a low-carb diet, you're taking out the fruit, the beans, the pasta, the bread, all that stuff. You're taking out a lot of calories. And when people reduce their calories in anyway, they will typically lose weight, and their blood sugars will fall, and hopefully their cholesterol will fall a little bit, too. So that's not really rocket science.

If you make up for it with the same number of calories from meat or cheese, which don't have the sugars, then you don't lose weight at all. Studies have found that the only low-carbers to lose weight are the ones where their calories are falling. More worrisome though, is what really happens when you look in their blood. If you lose weight, typically your cholesterol will drop about one pound per point. In other words, if I lose five pounds, my total cholesterol would’ve drop about 5 points, just average, everyone's different, but that's a good average. Not so for low-carb diets. Yes, if you lose a lot of weight your cholesterol will fall, but about 1 in 3 low-carbers has their cholesterol go up, I'm talking about their LDL going up, sometimes to a shocking degree and then they realize, “Wait a minute, you told me I could eat pork chops and I was gonna get healthy”, but their cholesterol's through the roof.

The other thing is, there was big study a couple years ago, that looked at mortality in low-carb dieters. And those who ate the least carbohydrate had the highest mortality, 30 plus, between a 30-40% increase risk of dying. And what are you dying of? You're dying of cardiovascular diseases and cancers and other things. So, I have to say, we do a lot of clinical trials here and people come in, and the ones who do the worst are the ones who are worried about carbs and they are trying to minimize their carbs, and think “This should accelerate my weight loss”. And when we put them on the scale, week after week, you know, everyone will kind of lose weight in one way or another, but the ones who really lose weight are the ones who do a low-fat vegan diet. They just go “Bam!” their weight goes down. The ones who worry about carbohydrate are the ones who really struggle. They might be doing better than they were doing before, but they're not really successful. At least not what we've seen.

Robby Barbaro: Okay, let's talk a little about cheese. So, over the past year, you wrote your 18th book and this one is called “The Cheese Trap”. And no, this is not a recipe book for cheesy recipes. In that book, you document the negative physical and psychological effects of eating cheese. So for people who haven't read that book, tell us exactly what happens when you eat cheese.

Neal Barnard, MD: You know, the reason that I wrote this is, in our studies, we have people who do great, you know, they had diabetes and high blood pressure, high cholesterol, weight problems, and they go on a vegan diet and they do great. But I kept hearing, not from a lot of people, but from enough that it got my attention, they would say “The one food I really miss is cheese”, or “Yes, doc, I'd love to do your vegan diet, I could be vegan except for cheese.” And people would describe it, the way an alcoholic would describe their last drink. It's like a drug for people and I thought what is that about? So I started looking into it and I found a number of really interesting things. First of all, it is surprisingly fattening, surprisingly unhealthy and surprisingly addicting. And those were the three things that made me decide to write this book. To guide them to understanding it and then also how we can replace it.

Robby Barbaro: So how can people get away from their addiction to cheese?

Neal Barnard, MD: Well I think the first thing is they have to understand what it's doing to them. And the pretty easy things are calories, this'll surprise you, the average American eats 65,000 calories of cheese every year. That's the number of calories that the average American has just from cheese. That's before you've got down to the burger or the bun or anything. 65,000. Back in 1909, the average American ate less than 4 pounds of cheese in a year, today we're at about 35 pounds of cheese per person per year. So what is that doing? It promotes weight gain.

If you look at two vegetarians, One is an ovo-lacto, cheese-eating vegetarian and the other is vegan, the difference in weight on average is close to 15 pounds between those two, and I'm going to attribute that mostly to cheese. The other thing is it's extremely high in sodium. 2 ounces of potato chips, a high sodium food, 330 mg of sodium. 2 ounces of cheddar, 350. 2 ounces of Velveeta, 800 mg of sodium. Hold on to your blood pressure. One of the things that's really grabbed people is the hormonal aspect, which is a surprise to people. If you don't mind, can I lay out the hormonal issues in cheese?

Robby Barbaro: Please do, please.

Neal Barnard, MD: Okay, milk comes from a cow. The cow has been pregnant and gave birth. A lot of people think, well I'll just have a cow and the cow gives milk. To make milk, any animal has to have been pregnant and has to have given birth. And so that means that dairy farmers, to keep milk production high, impregnate the cows, not personally, but they have the cows impregnated annually. A cow's pregnancy is about 9 months, similar to that of a human. And if they are impregnated every year, that means 9 out of every 12 months, they are pregnant and pregnant animals make estrogens, female sex hormones, they get into the blood plasma, they get into the milk. Not much, it's just a trace.

However, researchers a couple years ago, started looking at men's fertility. And they published a fascinating study. Those men that consumed the most cheese had the lowest sperm count, the worst sperm morphology, meaning the shape of the sperm. And the worst sperm motility, meaning their sperms are kind of like dead in the water, not moving like they should be. And those who tended to avoid cheese tended to do better. And this lead them to speculate that maybe those tiny little traces of estrogens, female sex hormones, that are in milk and get concentrated as milk is turned into cheese, even though it's only a trace, maybe it's enough to affect a man's fertility. Well, maybe. I don't know.

But researchers in California did another study, much more worrisome. They looked at women who had had breast cancer. These were women who had their cancer diagnosis, they were treated, hopefully successfully, and they got one thing on their mind, which is “Is my cancer ever gonna come back? Is it gonna kill me?”. And what happened was that those women who consumed one or more servings a day of high fat dairy, I'm talking about cheese, butter, whole milk. They had a 49% higher risk of dying of their cancer compared to women who ate less than half a serving a day. Let me say that again: a 49% higher risk of dying of your cancer, if you have at least one high fat dairy serving a day, cheese for example.

So again the researchers said, “Wait a minute, it's only a trace of estrogen in a slice of cheese. Could this really affect me?” And a lot of people would say, “No, how could it?” But we're starting to see signs that it does. And so, in the same way as if I've got a glass of water, my glass of water is absolutely full, no problem until I start taking a medicine dropper, and put one more drop in, and another, and another, and another, and it starts dripping down the sides and all over the table. Your body has all the hormones that nature wanted you to have.

If I start dribbling in a little bit more, and a little bit more of these estrogens, and particularly if you consume 35 pounds of cheese every year, which is what Americans do. This year, next year, next year, next year. Could some people have hormonal effects of it? I don't know, but it's more than enough reason, if you've got a 6 year old daughter, a 12 year old son, a spouse you care about, yourself, maybe these are reasons not to have this hormonal cocktail that we call cheese.

Cyrus Khambatta, PhD: It's absolutely brilliant. I think, also, when you read on the internet and when you're looking at blogs and you're picking up some of this pop-science books, it's very easy, it's believable, to also believe that not only are foods like cheese not necessarily harmful in the long term, but that there's no link between the cholesterol found in animal products, and the cholesterol inside of our blood. Despite this, though, there's an overwhelming body of research that actually shows there's a very strong connection between the amount of cholesterol we consume and our LDL cholesterol, and therefore risk for heart disease. So, can you go into this a little bit, and try to give our listeners a little bit of understanding here. Is there truly a link between the cholesterol in your food and the cholesterol in your blood?

Neal Barnard, MD: There sure is. And what you're speaking about is the tragedy of 2015. Here's what happened. The US government in 2015 was working on the dietary guidelines for Americans. And every food industry has their eyes trained on that, because if the dietary guidelines for Americans say eggs, which are the highest cholesterol food, in fact contributes cholesterol to your blood, then schools are going to limit them. And people are told don't have too many eggs, maybe one a day, no more than that, or heart patients don't have them, or whatever.

So every food industry targets the dietary guidelines, and the egg industry specifically set about to try to do studies to show the effect of cholesterol, in general, and eggs in particular, on your blood cholesterol level was minimal or non-existent. And in 2013 a study came out from Tufts University, where they looked at this question and they said, “Well, the effect of dietary cholesterol on your blood cholesterol is pretty small, and it's only maybe certain people”. If you look into this study in more detail, it was a review of 12 prior studies, 11 of the 12 were industry funded, 10 of them were egg industry, and the other was a different animal agriculture industry.

But, what I'm saying here is that, back in the 50s and 60s and 70s, when this was all getting sorted out, studies were funded largely by government. They were just passionate about it. They didn't have an investment in a particular outcome and it was clear beyond measure that cholesterol you eat, would raise your blood cholesterol. About half of the cholesterol in an egg or in anything else you eat, about half the cholesterol goes into your blood. Same way does the sugar you eat raise your blood sugar? Yes. Does the cholesterol you eat raise your blood cholesterol? Yes. And you can see this really clearly in a crossover trial. Crossover means I bring a group of patients in, some of them are gonna eat 2 eggs a day and some of them are going to eat none.

The people eating the eggs, their cholesterol goes up. The people not, their cholesterol goes down. Four weeks later, crossover. So, if you've been eating eggs, stop, and we see the cholesterol goes down. If you haven't been eating eggs, start, and their cholesterol goes up. This has been done, the results are extremely clear. So industry decided, “Wait a minute, I can make that go away. Here's how I can make it go away: I'm going to take a whole bunch of research participants, and I make sure that they're eating a standard American diet now, where you're having an omelette for breakfast and some bacon and some sausage. And now I'm gonna ask you, in my research study to have one more egg a day. And we find it doesn't really make much difference”.

Because they are awash in cholesterol. It's like asking a 3-pack a day smoker to have 4 more cigarettes a day. You can't really detect a difference. Where you see the difference is in a person who's not eating it and a person who does. That's where the difference is really obvious. So anyway, 2015, the dietary guidelines advisory committee came out saying “I guess, based on the recent studies, industry-funded studies, the effect of cholesterol is really small and we shouldn't worry about it”. We went to work and we met with people over at the USDA and we brought the studies to their attention, and to their credit, they reversed that. When the dietary guidelines came out, they said very clearly, you don't need any dietary cholesterol at all and you should eat as little as possible. Which means the best is none. So I’m going to give them credit. They were able to push back on the egg industry.

But unfortunately, everyone remembers the headlines that came out, that said, back in 2015, I guess cholesterol doesn't matter, scientists were wrong, and bloggers all picked this up. Anyway, bottom line, yes, dietary cholesterol is a problem. Now, it's not as big a problem as the fat, the bad fat, saturated fat. Bacon, grease, cheese fat. Those will really raise your cholesterol, but the cholesterol you eat adds to that problem.

Cyrus Khambatta, PhD: Brillant, brillant, brillant. So, you know, there's a lot of confusion as well about dietary fat, you know, how much is okay to eat, how much is not okay to eat. There's also a growing body of evidence now that shows Alzheimer's disease is now being classified as either diabetes of the brain or type 3 diabetes. So can you explain to us, what is the connection between dietary fat and/or cerebrovascular disease?

Neal Barnard, MD: Yeah, it's an amazing area, and I have to say it's one of the most frightening areas, because to think that what you're eating could just destroy brain function. But, I have to say that the reverse side of it, is it's the most empowering thing. Because when I grew up, my father's mother started to become forgetful and pretty soon, she couldn't remember her grandkids' names, then she couldn't remember her kids' names, then she couldn't remember her husband's name, and you would think, “Good heavens, I don't want to get old. Alzheimer's is terrible. It takes away everything you ever cared about”.

So up until now, people have thought it's old age and it's genes. Because there are genes that greatly increase the risk. However, 1993 a big study got started in Chicago called the Chicago Health and Aging Project and it showed that those people eating the most saturated fat, I'm talking about especially dairy fat, but also meat is the second biggest source. The people eating the most saturated fat had 2-3 times or more the risk of developing Alzheimer's disease compared to those eating the least.

And then they looked at trans fats, you know, the partially hydrogenated oils that are used in some snack foods. That was just as bad, maybe even worse. And they found many other parts of the diet that were linked to Alzheimer's. And then other research teams in New York, one in Europe, started finding the same thing. And I have to say, it was the most exciting thing, because suddenly, you can't control your genes, you can't control the passage of time, but you can sure control what's on your plate. And if avoiding those foods is going to protect the brain in the same way it protects the heart then that's golden. So that's where we're really going with this.

I should say, we do need more research, I want to really nail this down, because, for example, people with genetic risk are also being studied and it looks like it helps them too. So, we do need more research in this area, but we know more than enough now to change our diets. That's why I wrote the book "Power Foods For the Brain" because I thought, “Good heavens, I don't want another 10 or 20 years to go by, before people start changing their diet”.

One other real quick thing, there were researchers at Kaiser who were looking at the onset of incidence of Alzheimer's disease and it correlated with high cholesterol. The higher your cholesterol, the higher your risk of Alzheimer's. And so that goes along with the same direction, but the cholesterol levels they were associating it with were cholesterols drawn at age 40. So if you're eating a rotten diet at age 40, you may very well be paying for it later. So now is the time to be on a healthy diet.

Robby Barbaro: Let's talk a little bit about communicating with people's doctors. Many people with diabetes get really frustrated when their doctors tells them either: A, they can't support them unless they eat a low carbohydrate diet, or B, eating a high carbohydrate diet is actually unsafe. So, at Mastering Diabetes, we love doctors, we do our best to partner with them, but what suggestions do you have when people are getting conflicting advice and how can they work with their doctor?

Neal Barnard, MD: Well, your doctor, almost all doctors are pretty good with diagnosis and they're good with monitoring. And that's what you should be really relying on your doctor for. If your doctor doesn't know anything about nutrition, or if the nutrition knowledge that your doctor imparts to you is something you read in a magazine at the swimming pool one day, don't use your doctor for that. But on the other hand, don't fire your doctor. Your doctor can tell you what your A1c is, and if you need medication, which some people will, then your doctor is hopefully good at that. And your doctor can monitor you, if there are other problems that happen to you, the body is a fragile thing, things go wrong, so your doctor is good with those things. But most doctors are not well-trained, nor are they comfortable, talking about diet.

And so, some doctors and some dietitians have been lured into this low-carb thinking, which is carbs have sugar, and the sugar gets into the blood, so if you have diabetes, don't eat that. And they have to be reminded that the skinniest, healthiest people on the planet lived in Japan in the 1950s, and they were eating rice like crazy. And it wasn't until meat and cheese, a Western diet came in and pushed the rice off their plate, that diabetes came roaring in. We're seeing that now in China, which has had a starch-based diet that is now giving way toward a meatier diet and diabetes is through the roof in China right now.

So, doctors, hopefully are paying attention. We've been publishing our research for years in top journals, Diabetes Care for the American Diabetes Association published one of our pieces on diabetes in 2006. The American Journal for Clinical Nutrition published the follow-up in 2009. It's not like this is all new. We've been pushing this for a long time, so I think doctors are kind of running out of excuses. But I will say this, if the doctor has a really good dietitian who can prescribe a healthy vegan diet for patients, the doctor just needs to spend a little time going over your labs and then let the dietitian work with you as your food coach.

Cyrus Khambatta, PhD: Yeah, I think you bring up a really good point here, you know, and doctors unfortunately didn't receive, or don't receive very much nutrition training in medical school. Some doctors report that they receive zero hours, some that they get as much as 10, 15, 20 hours. So what needs to change in our medical school system, in order for doctors to actually become well-versed in evidence-based nutrition? Is that something that's happening in medical schools now, or is that something that's going to take a really long time to get implemented properly?

Neal Barnard, MD: It's happening at a glacial pace. It's just really, really, really slow. And I think the neglect of nutrition was defensible a century ago, when we had infective disease being the big issue and we started studying antibiotics and you could knock out the things that were killing people, the pneumonias and other infections, early on.

The role of nutrition hadn't really been well-studied. But then, in 1990, Dean Ornish shows that a plant-based diet, along with other healthy lifestyle factors opens up arteries again. So we have been showing that a plant-based diet is really, really powerful for helping people with type 2 diabetes, as well as weight issues and so forth.

So I think it's much less defensible that doctors aren’t aware of these thing. And you know, if a new drug came on the market, in 6 months, every doctor knows about it. Invokana, it's on the market, great, suddenly it's all over the television and it's making diabetes look like fun, so we ask the doctor for Invokana. The people who are promoting medications are just way ahead of the people who have been promoting food and I think it's because their budgets just eclipse everything else. They've been a dominating force in continuing medical education and in medical school funding and everything else.

Here's the good news, I have to tell you, we have so many doctors and especially medical students, who want a better way, and they know that nobody ever hugged them for giving them a prescription. But if your patient has diabetes improve dramatically and the weight comes off, those patients are so happy and they're so grateful, and the doctors want to partner with patients for what they can do together, which is the food side of it. Because that's really the cause of the issue in most cases.

Robby Barbaro: Let's talk a little bit about the logistics of implementing this approach. So how much fat is allowed or appropriate when somebody is looking to reverse prediabetes or type 2 diabetes?

Neal Barnard, MD: Well, I'll give you numbers, but before I do that, let me describe how I mention this to people, because we try to make it super simple with as few numbers as possible. So if I have a group of people here in my office, first of all, I'll draw my cellular diagram and I'll show them the bits of fat inside their cell and suddenly, they understand what insulin resistance is and they'll also understand why we want to get away from all that excess dietary fat. But then what we'll say is a vegan diet means, four healthy food groups, vegetables, fruits, whole grains, beans. And then we teach them how to cook without added fat. So if I've been sauteing my garlic in oil, can I saute it in water or broth or even in a dry pan? So we test out these things. And if you added it up, it's not a no-fat diet. A no added fat diet has all the natural oils that are in these foods to start with.

So, let's say I'm eating a serving or two of broccoli and I send some of that broccoli to the laboratory, they'll tell me between 8-10% of it's calories are natural oils. And that's good because your body needs Alpha-Linolenic acid, Linolenic acid, these are the essential oils that you need and they're in plants. If I send a fruit or a bean to the laboratory, they'll tell me something similar. There are, you know, 4, 5, 6% of their calories come from healthy fats. So it's not zero fat. So if a person is really saying, “Doc, you gotta tell me how much fat I'm gonna eat”, the way it works out, the way we do the diet, it might be about 10% of their calories from fat, give or take a little bit. If you're eating a lot of rice, it might be lower than that.

On the other hand, if a person is adding nuts or seeds, it'll go a little higher than that. But your average American now is starring around 30-35, some 40%, it depends on where they are. And so it's a big drop, but it's not zero. And apart from the quantity, the quality of the fat is dramatically better. Because there's not a lot of fat in green leafy vegetables, but what there is, is relatively rich in Omega-3, so you're getting all the junk out of there and you're getting the natural oils that your body really needs.

Robby Barbaro: That's great. So at PCRM, your organization has worked with countless people being able to adjust their diet through the 21-day kickstart and your work. What do you think, what do you see is the biggest pitfall that people run into and how can they overcome that when making this lifestyle change?

Neal Barnard, MD: Wow, that's a great one. Yeah, it's true, we've had, our online Kickstarter has had almost 600,000 people go through it, which is really cool. We've had hundreds and hundreds in our clinical trials, where we're actually measuring them carefully. Well, first of all, for some reason for some people there aren't a lot of pitfalls.

Many people describe it as really easy. In fact, I just got off the phone, a little while ago with a guy who had to change his diet, and he said, you know, I thought it was going to be hard, but he pretty soon discovered a vegan diet doesn't mean you're wearing tie-dye or that you like folk music or you know, that kind of stuff. It just means you're not, you know, here's my spaghetti, instead of the meatsauce, I'm going to have the tomato sauce with wild mushrooms and artichoke hearts, how hard is that? Okay, we're at the taco restaurant, skip the meat taco and give me the bean burrito, hold the cheese. How hard is that? It's easy. We're at the sushi bar, you have the fish sushi, because you're probably well-insured, with everything that's going to happen to you. But give me the cucumber sushi, the asparagus sushi, whatever. Have the miso soups, have the salads, and we don’t limit calories.

You know, so suddenly, our patients say, “Wait a minute, I don't have to count calories? I don't have to be hungry? I don't have to count carb grams and all that stuff?” There are some people who will have to, if they're calibrating their insulin dose to count carbs, but for most people, they don't have to do any of that. And so, it's super easy and without hunger, they're just fine. But you asked about pitfalls. One pitfall is industry. Industry is dangling things in front of you all the time. Half the commercials on TV are for unhealthy foods. Of course, the other half are for medications to undo the effects of the food. But then, they put their food everywhere.

Food used to be in a food store; now you pump your gas and you go into pay and there's food all over the gas station. Last time I was in a bookstore and I was at the checkout, or go to an IT store, you're buying a hard drive, there's candy and stuff all over the cash register. So they're very good at dangling seductions in front of us. But the biggest issue, I really think, is just sort of our culture. Logic plays very little role in human decision making. I'm getting out of bed for breakfast, how many grams of fiber should I have? No, people don't think that. They think, “I'm gonna eat what my parents ate”, or “What I ate yesterday”, or “What other people eat”, and that's a big determiner. And people naturally resist a change in culture. And rightly so.

If we ate any wacky thing we found in the forest, we could be in trouble. It's much safer to do what's tried and true, what your herd has been doing. That’s what we do. And even if your herd, your people, have been doing unhealthy things, we tend to stick with that and we are suspicious of changes.

That said, the research favoring the approach we use is overwhelming now, and the successes that so many people have had are so convincing. I think that's a reason why culture is giving way. That's why health food stores are huge. They're crowded with people who want a better way. And that's why a movie like "What the Health" or "Forks Over Knives", these are inspiring people to say, alright, enough of where my parent's diet has let me down, I want to stop that. I want to try something new. And so people are willing to change and I am completely optimistic about the future. I see, every day, people who say, I'm going on a better path and they in turn are inspiring other people. The world is indeed changing, and in a really good way.

Cyrus Khambatta, PhD: I love it. I actually had an idea here for a new toy. We could make a miniature pocket Dr. Barnard and you just put it right here, and it's like, “Hey Dr. Barnard, what should I eat?” And then you tell them.

Neal Barnard, MD: Pull my string and I'll talk to you.

Cyrus Khambatta, PhD: Okay, great.

Neal Barnard, MD: I'm in.

Cyrus Khambatta, PhD: But thanks so much for your time here today. You're always a wealth of knowledge, and one of the things I love about speaking with you is that, you always have a very optimistic message. We can easily focus on all the ills that are present in society, and all the roadblocks that are preventing people from actually making intelligent lifestyle decisions. But rather than pointing a finger at those, you know, it's like, what can we do together? And I sincerely personally appreciate your positivity and thank you so much for doing what you do.

Neal Barnard, MD: Well, let me give you two more things to think about if you don't mind. The first is, when you think about the food industry themselves, we can think of them as the devil and in many ways they behave that way. You know, my dad grew up on a cattle ranch and so did his father and his father. And I've got cousins in that business and they're good folks and I don't think of them as our enemy, I think of them sort of as the pre-vegans, the people who are gonna get there eventually.

So our job is not to necessarily fight them. Our job is to lure people away, so they end up having to diversify. And they are doing it. You know, it started 10, 15 years ago, you'd go into the grocery store, and you'd look at the dairy case and there started to be things that weren't dairy in. First there's soy milk, then there's rice milk, then there's almond milk, then there's hemp milk. And nowadays you go into a grocery store and it's amazing the other products that are there. And the dairy industry saw the writing on the wall, and they're investing in these things, too. The meat industry, as problematic as they have been on every front, is now starting to say, wait a minute, meat intake in the US has drop by 20 pounds per person per year since 2004. They're starting to look at how they can diversify into other things, too. And that’s all to the good.

The last thing I just want to mention real quickly, is that some people will get down, they had a friend who went vegan and then they got lured back to, you know, a bacon cheeseburger or whatever it was. Don't worry about that. There is nobody who has ever broken away from an addictive situation without a little bit of recidivism here and there. They kind of stutter into it. When I quit smoking back in 1980. Yes, I was a smoker. I stuttered into it and I failed so many times, but sooner or later you succeed.

Same with people who've given up alcohol or drugs. They have problems, but they get with it. And so when people do a vegan diet, if they goof up, just love 'em back. They dust themselves off, they get back into where they want to be, and we see great success and it really, really will change people's lives. So we never worry about the negativity part of it. We just power ahead and see the changes.

Cyrus Khambatta, PhD: Beautiful. Thank you so much for being here today. We really appreciate it. And I know there’s a lot of our viewers, thousands of our viewers, love your message. So keep doing it. Keep writing more books. And we'll see you next time.

Neal Barnard, MD: Well, thanks to the two of you for all the great stuff you're doing. You're pumping people up and giving them life-saving information. So right back at you, thanks for the great work that you do.

Robby Barbaro: We really hope you enjoyed that episode, you've learned a lot and you're going to now take this information and put it into action. If you are living with diabetes, or you want to make sure you don't develop diabetes, you may want to consider joining our coaching program.

So we have an incredibly robust coaching program at an incredibly affordable price. At the time of this recording, we have a waitlist, so if you want to get into our coaching program, you have to go to www.masteringdiabetes.org, click Coaching in the top navigation bar and get your name on the waitlist.

We offer a lot in this coaching program, the price ends up being less than $0.70 cents a day. And we offer an online course that gives you everything you need to know about how to transition to a low-fat, plant-based, whole-food lifestyle one step at a time. And it's only the pertinent information, only exactly what you need. The whole point is to not make it overwhelming. So that's the way we've designed this online course in a step by step manner.

Start with goal setting, you learn some of the science, you start changing breakfast, when you're ready, you start changing lunch, and when you're ready, you start changing dinner, and there's lessons about intermittent fasting all along the way, all the nuances about your blood glucose and what to expect and medications, and all that is covered in the online course.

The second tool we offer in our coaching program is a private community where our coaches answer questions within 24 hours. So every time you make an original post, sharing something or asking a question, one of our amazing coaches is going to reply within 24 hours. This community is on Facebook and outside of Facebook, for those who don't want to use Facebook.

So it's an incredible, incredible resource to get your questions answered every step of the way. We have two people in that group that have completely reversed type two diabetes as our coaches. That's Adam Sud, and Marc Ramirez. And we also have Kylie Buckner, RN, who's a registered nurse as one of our lead coaches in the coaching program. And you also have Cyrus and me chiming in when necessary. So we have you covered on all fronts, no matter what type of diabetes you're living with, we're there for you every step of the way.

People are also sharing lots of food pictures and recipes in the community. We're sharing meal planning tips, our team, we're sharing new recipes, we do challenges together. So the community is a really robust aspect of this program. And really, really important for people to have long term success on our program.

The third tool in our coaching program is twice monthly live Q&A calls. And these are fantastic with the first and third Sunday of every month, we use Zoom Video Conference so you can see us and we can see you if you choose to turn on your camera. Or you could just call in with your phone and we answer questions until everybody's questions are answered. And it's really fun. It's great to have that back and forth communication, and we can cover a lot in a short period of time.

The online community is obviously very helpful, you should get any urgent questions answered right away through the community. But it's also nice to have that dialogue and go back and forth on a video conference call. So that's the other tool we offer. And that's the Coaching Program.

So we have amazing results. I'm sure you've heard them on our podcast, seen our testimonials on YouTube and on our website, we want you to experience the same success, okay, our incentives are so aligned it's not even funny. We want you to have the best health ever so we can show the diabetes community how successfully a low-fat, plant-based, whole-food diet reverses insulin resistance. It's a win-finity situation, we want you to succeed so, so much. We all benefit and we work very hard as a team to make sure that you get the results you're looking for. That's our point with the coaching program. So again, make sure to get on our waitlist, go to www.masteringdiabetes.org, click coaching and I can't wait to work with you soon.

Have a great day!

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About the author 

Cyrus Khambatta, PhD and Robby Barbaro, MPH

Cyrus Khambatta, PhD, and Robby Barbaro, MPH are the coauthors of the New York Times bestselling book Mastering Diabetes: The Revolutionary Method to Reverse Insulin Resistance Permanently in Type 1, Type 1.5, Type 2, Prediabetes, and Gestational Diabetes. They are the cofounders of Mastering Diabetes, a coaching platform that teaches people how to reverse insulin resistance via low-fat, plant-based, whole-food nutrition. Cyrus has been living with type 1 diabetes since 2002, and has an undergraduate degree from Stanford University and a PhD in Nutritional Biochemistry from UC Berkeley. Robby was diagnosed with type 1 diabetes in 2000, and has been living a plant-based lifestyle since 2006. He worked at Forks Over Knives for 6 years, and earned a Master’s in Public Health in 2019.