The transcript below is an approximation of the podcast.
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, MPH: 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.
Cyrus Khambatta, PhD: In the world of diabetes, actually in the world of nutrition as a whole, there's a lot of confusion about what to eat, what not to eat, how much to eat, when to eat, when not to eat, how much exercise to do, how much exercise not to do, what type of exercise to do. It's almost endless.
Every time you go to Google, every time you go to YouTube, and you look for some nutrition related information, there's some nutrition expert giving you their opinion on what they believe is the right thing for you. And, you know, we are no different. We are one of those voices, and we are one of the opinions of experts tried to educate you as to what you can do to specifically improve your diabetes health.
Now, some of these experts have phenomenal approaches and have information that can truly transform your life, and some of the experts don't. Some of the experts don't really have the evidence basis, or the research focus, and so it's difficult to know, from your perspective, what to listen to, especially when it comes to talking about dietary fat.
Now we spend an inordinate amount of time talking about how the consumption of excess fat can lead to the deposition, or the accumulation of too much excess fat inside of your liver and muscle, and how that can impair the ability of insulin to do its job. And when that happens, you increase the risk for the development of insulin resistance, and prediabetes, and type 2 diabetes.
And all of that is a true statement, and we're going to do a deep dive today into different types of fat inside of your diet, because the truth is that all fat is not created equal.
Some of the fat that you eat comes in the form of trans fat. Some of the fat that you eat comes in the form of saturated fat, and some of the fat that you eat in your diet comes in the form of unsaturated fat, and they all play diverse roles in your body, and can either promote chronic diseases or help reverse chronic diseases.
So, just lumping all fat into one category and saying, “Oh, fat is bad for you, don't eat fat. Fat is what makes you fat”, or “Fat is what makes you diabetic” is technically speaking not a true statement at all.
In the world of nutrition, it's becoming increasingly important to be very, very specific in your language. And the reason I say that is because health experts make a lot of claims, and if these claims are not made with very specific language, so that it's very easy to understand exactly what the claim is intending to communicate, that is what leads to a lot of problems.
So a perfect example is to say, “Oh, you know, sugar is bad for you. If you consume fruit, fruit turns into sugar, and then sugar will make you fat. So, don't eat fruit.” It's really frustrating when we hear things like this because the first thing that happens is that you equate sugar with fruit, or fruit with sugar, which is a fallacy.
Secondly, the term sugar is a misnomer in this particular context. Instead of using the word sugar, the right word to use would be carbohydrate, in fact, the right word would be “whole carbohydrate energy”, and if you make these vocabulary substitutions, then you end up with a statement that is more research-based, that is more factually accurate, and the statement would read something like, “When you consume fruit, you are eating a carbohydrate-rich food, which is rich in whole carbohydrate energy.” And when you say something like that, you can then go into greater detail about whether or not that is truly beneficial, or truly not beneficial, but saying something like fruit contains sugar, don't eat fruit because sugar is bad for you, is just overly simplified, way too simplified, and it just causes problems.
So like I said, today we're going to be talking about different types of fats. Trans fats, saturated fat and unsaturated fat in particular, and it will give you some insight here into how they behave in your body, where you can find them in food, and why it's necessary to differentiate between them because they all do very, very different things in your body.
Now, when it comes to managing your blood glucose and controlling insulin resistance, it’s very important to understand that all fat is not created equal. There's very specific differences, and very important differences in how trans-fat, saturated fat, and unsaturated fat affect your metabolic health, and either increase or decrease your risk not only for diabetes, but for cardiovascular disease, for hypertension, high cholesterol, for Alzheimer's disease, for chronic kidney disease, for peripheral neuropathy. All of these conditions that are sort of satellite conditions of diabetes are very important to think about when considering, you know, when understanding a little bit more about the role of dietary fat in your diet.
Now, another thing that I want to establish just at the beginning, before we dive into detail here, is that a lot of people think about the Mastering Diabetes Method as being a no fat diet. You see this all over the place. You say, “Well, I can't eliminate fat. I don't want to eliminate fat. I thought fat was good for me, fat is necessary. What about fats for hormonal balance?” I want to back up here.
It is impossible, it is impossible to consume a diet that has no fat in it. We are not recommending that you eliminate your fat intake, it’s not even possible to do it. The only way that you could actually eliminate your fat intake, is if you were to eat a refined sweetener, if you were to eat something like table sugar, or high fructose corn syrup, or honey all day long, every day. And last time I checked, I'm pretty sure you weren't doing that. Nobody does that. And that's the only true way that you could get to a zero fat diet. But that is not what we recommend. That is not what the World Health Organization recommends. That's not what the Food and Agriculture Association recommends. And so that would be irresponsible to say that.
In reality, what we do recommend for improved diabetes health, for improved insulin action, for improved glucose tolerance is to reduce your fat intake to between about approximately 10% and 15% of your total calories. And in the process to move towards more plant-based foods, because plant-based foods have a different type of fat. They have a more unsaturated version of fat. And when you drop your fat intake, and move towards more plant-based fats, then you can dramatically improve your diabetes health.
So, that's the first thing that I want to establish in this whole game of talking about fat. Now, there are three types of fatty acids, again, trans fatty acids, saturated fatty acids, and unsaturated fatty acids. Let's do a deep dive into each one of these, so that it's very obvious as to how they actually behave inside of your body.
The first type of fatty acid that we're going to go into details about is trans fatty acids. Now, trans fatty acids are a type of fat that actually occur naturally in very small quantities in foods like beef, in pork, in lamb, in butter, and in milk. And you can find these naturally occurring because they are present in nature, and they usually contain somewhere between about 1% and 10% of the total fat content of that food.
So, even though they're present naturally, the overwhelming majority of the trans fat that you get in your diet, or that I would get in my diet, originates from a process known as hydrogenation. And hydrogenation is nothing more than a fancy chemical manufacturing process that food manufacturers invented many years ago with explicit intent of converting a liquid at room temperature into a solid. That is the whole purpose. Because if you can take a liquid fat rich substance like oil, let's say, and you can do something to it so that it turns into a spreadable solid, the spreadable solid is going to have a longer shelf life likely, and the spreadable solid is something that consumers are going to like, and they're going to buy it, and then they're going to use it to put on top of a bread, or thought of a potato, or they're going to put it into different dishes.
And so, food manufacturers invented this process known as hydrogenation, so they could turn a liquid into a solid and then they would it would increase consumer appeal. Now, margarine is a perfect example of this. A margarine has hydrogenated oil inside of it, and as a result of that, you get this block of yellow material that you can easily cut, spread and enjoy.
Now, when you go shopping at the grocery store, you see it all over the place. If you read product packages carefully, you'll see the term “partially hydrogenated vegetable oil” printed on many products. This used to be more true about 10 years ago, until food manufacturers got a smack down from the FDA, but partially hydrogenated vegetable oils still exist in the foods that you eat today. And you can find them all over the place, including foods like cakes, pies, cookies, biscuits, breakfast sandwiches, and some margarine, crackers, microwave popcorn, cream filled candies, donuts, you know those ready to use dough that you just literally take out of the package and stick in the oven. And then you also find them in both dairy creamers, as well as non-dairy coffee creamers. They're also found in both unprocessed as well as processed meats.
Now processed meat, are the ones that are associated… They're considered the class one carcinogens, and they contain significantly more trans fats than the unprocessed counterparts from which they originated. And this includes, you know, deli cold cuts, meats, salami, Bologna, sausages, bacon. Meats that have basically been processed from their original form. Sometimes they're cured, sometimes they are packed with nitrites and nitrates, and these are deleterious compounds that can increase your chronic disease risk, and they can do so very quickly.
Now, food manufacturers used to actually celebrate the fact that there were partially hydrogenated vegetable oils in their food, because they were considered, you know, heart healthy. And so, food manufacturers used this back in the 80s, back in the 90s, and they tricked consumers into believing that things like, you know, anything that said hydrogenated, partially hydrogenated vegetable oil, was actually better for you, so consumers bought it, and they listened to that message, and they did it. And that was a complete fallacy.
The reason is because trans fatty acids are associated with an increasing list of cardiovascular complications in particular. And food manufacturers have, again, deceived many consumers into believing they’re healthy, but there's plenty of studies now to show that the more trans fatty acid you consume, the higher your risk for congestive heart disease, for stroke, for atherosclerosis, which is the hardening of blood vessels, for high cholesterol, as well as high blood pressure.
Now, this is very unfortunate because, again, so many people have gotten tricked into believing that partially hydrogenated vegetable oils are good for you, first of all. And second of all, they're everywhere, they're really hard to eliminate.
A simple way to try and remove trans fatty acids from your diet is to not purchase packaged and processed foods. It's just that simple, because that's where they're found predominantly. So, if you just eliminate those from your diet, and you eat more whole-food, you shop more in the produce section, you buy stuff that does not come in a bottle, a package, a box, or a can, then right there, that's one of the most powerful things you can do to reduce your intake of trans fatty acids.
Now, these trans fatty acids are really nasty, because they can directly elevate your LDL cholesterol, they can reduce your HDL cholesterol. So, in other words, your LDL cholesterol is your bad cholesterol, so they can cause elevations in your bad cholesterol, they can suppress or reduce your good cholesterol. They can cause vascular inflammation, which is inflammation at the level of your blood vessels. And they can accelerate the development of what are called atherosclerotic plaque. So, these are plaques that form on the inside of blood vessels that harden the blood vessels, and increase your blood pressure, and can eventually rip off and increase your risk for a stroke, or some type of cardiac event. And this happens both in your heart as well as in peripheral blood vessels that are located in your brain, in your liver, in your kidneys, in your toes, in your fingers.
Now, trans fats have also been implicated in Alzheimer's disease and dementia. Okay, so add it to the list of things that the research world is now finding out. It can increase your risk for Alzheimer's disease and dementia, otherwise known as cognitive decline.
In addition to that, trans fats have also been linked with depression. Are they causative? Not necessarily. But they're associated with increased risks of many different brain or neurological defects. And this is a problem because, again, when you consume trans fatty acids, they may taste good at the time, and they may be palatable, they may give you a dopamine release in your brain. But as you eat more of them, they increase your risk for the development of many brain conditions in the long term, and that's a problem.
Now, when it comes to the connection between trans fats and insulin resistance, there's plenty of evidence that shows the trans fats can directly impair the ability of beta cells in your pancreas to respond to glucose. And, you know, these studies have actually been done in animals and in cell culture, so they're not directly translatable to human beings.
In other words, just because you show in a laboratory setting, either in an animal or in a cell culture model, that trans fatty acids can impair beta cell function, does not mean that it's actually going to happen in human beings. I get that, and hopefully that that's pretty clear. But this is pretty strong evidence that it could happen in human beings, and so there are studies now to, you know, underway, to try and determine if this is actually true in humans as well.
The Nurses’ Health Study, which was published by researchers from the Harvard School of Public Health, they actually did an analysis on more than 200,000 individuals over the course of 19 years. This is called the Nurses’ Health Study. And they showed that a higher intake of trans fatty acids was associated with a higher risk of type 2 diabetes over the course of 14 years.
Now, is that gospel, does that mean that that's the only piece of evidence that we have? The answer's no, of course not. However, this is what's called epidemiological evidence, that's performed in large numbers of people over long periods of time. And, there's pros and cons of these types of articles, but this is a good indicator that people who consume more trans fat may be increasing their risk for insulin resistance and diabetes.
Now, when it comes to saturated fat, this is the second type of fatty acid molecule that I want to talk about, and that's actually… Saturated fat has a long story, and is actually one of the more problematic types of fatty acids in general. Trans fatty acids are without question the worst type of fatty acids, so if you can try and eliminate them from, again, eliminating packaged and processed foods, you're doing yourself a huge favor. So, continue with that because that's the most important thing that you can do. But it's also very important to pay attention to your saturated fatty acid intake, because saturated fatty acids are also implicated in cardiovascular disease and insulin resistance as well, and we're also going to see many other conditions.
Now, where do you find saturated fatty acids? Well, they're also naturally occurring, and they are found in practically all foods, but they're just more abundant in foods like meat, poultry, fish, shellfish, dairy products, including things like butter, cheese, milk, yogurt, sour cream, ice cream, and whipped cream. Now, trust me, I know these are all very tasty foods, but in addition to those foods, you also find saturated fat in eggs.
And so, those are the foods from the animal world. But then when it comes to the plant-based world, you also find saturated fat in vegetable oils, in coconut oils, in palm oil, in palm kernel oil, in cocoa butter, in avocados, in coconuts, in nuts and in seeds.
So, saturated fat to say it plainly, they’re found everywhere. It's all over the place. And the foods that I listed are the ones that it happens to be higher in saturated fat, than you would find in something like a potato, or a banana, or some cherries. Does a potato, does a banana, do cherries have saturated fat? The answer is absolutely, they certainly do. It's just in such small quantities, that it doesn't make a sort of quantitative and physiological... It's so low that it's not relevant.
Now, in the ketogenic world, if you start reading ketogenic blogs, or if you listen to what the ketogenic world likes to say, they would argue that diets that are high in saturated fat are actually protective of chronic disease, and that they actually promote optimal metabolic health, and in particular, they improve your diabetes health. But then there's people like us, and there's other people in the plant-based world, there's Dr. Fuhrman, there's Dr. Greger, there's Dr. Neal Barnard, there's Dr. Garth Davis, there's Dr. Michelle McMacken, and the list goes on, that say the opposite. That increasing quantity of saturated fat, increases insulin resistance. That promotes atherosclerosis, and increases your risk for coronary artery disease, for high cholesterol, and for cancer.
So who do you believe, the people in the ketogenic world or the people from the plant-based world? And why, most importantly, why are the two sides so diametrically opposed to each other? How could that possibly be? Aren't you both consulting the same, quote unquote, medical literature? And if so, how is it that you can come to two completely opposite conclusions, and argue about those conclusions to the end of time?
The question really becomes this: Is an increasing intake of saturated fat from your diet associated with increased longevity, or is it associated with an increased risk for premature death? Or do we not know the answer?
Now, one thing that's very important to understand is that diets that are high in saturated fat are very effective short term treatments to lose weight, and normalize blood glucose. But in the long term, there's plenty of data, and plenty of evidence to show that they can actually significantly increase your level of insulin resistance, which in turn, increases your risk for many chronic diseases, and may reduce your longevity at the same time.
How do we know this? Well, when I was first in doing my PhD back at UC Berkeley in 2007, I was given the task of trying to induce insulin resistance in laboratory animals, both in mice and rats, and the goal was to induce insulin resistance in them, and then perform some type of intervention whether it was intermittent fasting, or exercise, or calorie restriction to try and rescue that insulin sensitivity, and make them normal animals once again.
So, you would induce insulin resistance using diet and then you would try and reverse that. Then you would learn about what methods you could use to reverse it, and then study those methods even deeper.
When I first started studying this, I thought, “Okay, well, I got to induce insulin resistance in mice, I'm going to go feed them a high sugar diet, or a high fructose diet.” Wrong, that is not the case. I started reading paper after paper, after paper, to try and find out how do you induce insulin resistance in a mouse? How do you induce insulin resistance in a rat? And the answer was very obvious. Every single paper that I had read, used a diet that was high in saturated fat. They said, “We fed animals a diet containing 70% saturated fat. We fed animals a diet containing 60% saturated fat, plus isolated fructose.” And everywhere I read, it said “diet high in saturated fat”, “diet high in saturated fat.” And I thought to myself, “Why would you feed a diet that's high in saturated fat to animals in order to induce insulin resistance? I thought insulin resistance had something to do with sugar.” And that was the first light bulb that went off in my head that said, “Oh, wait a minute. I wonder if diabetes is actually a fat metabolism disorder not a sugar metabolism disorder, as the public wants to believe.”
So I started diving deeper and deeper, and deeper, and found out that in fact, yes, there's a strong association, and a strong causative impact of saturated fatty acids in inducing insulin resistance. In fact, saturated fatty acids can directly interfere with insulin signaling, and this can happen within hours of eating a single high fat meal. And this blocks the ability of both your liver and muscle to absorb, or uptake glucose from your blood.
Now, when I first learned this, this was mainly in animal studies, but since that time there have been other studies that have been published that in people living with type 1 diabetes, that show the exact same thing.
Now, people with type 1 diabetes are actually excellent test subjects, we’re like walking laboratories, because we don't manufacture our own insulin. And so, what you can do in an individual living with type 1 is you can perform an experiment on them, and then you can determine whether or not your experiment increased or decreased their insulin requirements, because you are the one that controls exactly how much insulin goes into their body.
And so, effectively by having a broken insulin production facility, this allows us to become very, very good test subjects, and in fact better test subjects than people who are able to manufacture their own insulin.
Now, there are two studies that I want to draw your attention to. The first study was performed in 2013, in the journal Diabetes Care, and the name of the paper, it’s called “Dietary fat acutely increases glucose concentrations and insulin requirements in patients with type 1 diabetes.” And what they show in this paper is actually phenomenal. They effectively compare a single dinner meal containing either 10 grams of dietary fat, or 60 grams of dietary fat, and they try and determine whether feeding a low fat, or a high fat diet, affects insulin requirements over the course of the next 12 hours. And what they found was that, in fact, yes, when feeding a diet that is high in fat, a high fat dinner required more insulin than low fat dinner. In fact, a required almost 33% more insulin, and despite the extra insulin that they had to infuse in order to try and control the glucose of these type 1 diabetic patients, there was actually higher blood glucose value.
So, effectively what this means is that when you eat a high fat dinner, you're going to need a minimum of 33% more insulin to create control your blood glucose in the post meal state. And 33% is the minimum because even at 33%, your blood glucose is still likely to get elevated.
There's another study that was published in 2016, again in the same journal, Diabetes Care, and this one is called “Optimized mealtime, insulin dosing for fat and protein in type 1 diabetes.” And in this paper, what the researchers found was that, in fact, the number 33% was too low. They fed individuals with type 1 diabetes, either a low fat, low protein, or high fat, high protein meal, and found that the high fat, high protein meal required 65% more insulin than the low fat, low protein meal.
Now the two meals that they fed these patients with type 1 diabetes with were basically a pizza base that had marinara sauce. Now, I am not recommending that you eat pizza with marinara sauce by any stretch of imagination, but the reason they did that in this study is because this is a typical food eaten by people living with type 1 diabetes in a free living situation. And so, the two meals were matched for their carbohydrate content, meaning that they both contain 50 grams of carbohydrate. The low fat meal contain 4 grams of total fat, and the high fat meal contained 44 grams of total fat. And again, having 44 grams of fat increases your insulin requirements by 65% over the meal containing only 4 grams of fat.
So, this is interesting information because we see that this mechanism of saturated fat increasing insulin requirements holds true, not only for mice and rats, but also in human beings as well. Now, it also holds true in people that are not living with type 1 diabetes, again, we're just good test subjects, but this same pattern evolves in people who actually can manufacture their own insulin. It's just that it's easier to study in people with type 1, than it is in people who don't have type 1.
Now, inside your muscle and liver cells, what happens is that when you consume saturated fat in your diet, the saturated fatty acids can migrate into your adipose tissue, your fat tissue, they can also get inside of your liver, they can also get inside of your muscle. When they get inside of your liver and muscle, especially when they get there in excess, they do a number of things that are not beneficial, including, number one, they reduce the number of insulin receptors that appear on the cell surface. And number two, they impair the function of insulin receptors by modifying the structure on the inside of the cell membrane.
Number three, they reduce the ability of these glucose transport vesicles, or these GLUT vesicles. You can think of these as little spaceships inside of cells, that migrate to the cell surface to say “Hey glucose, come inside.” And when you eat saturated fat, you actually have a reduced ability of these GLUT vesicles to get to the surface, so that they can import glucose from your blood.
And in addition to that, studies have shown that an increased intake of saturated fat can actually induce inflammation, or free radical production, at the level of the mitochondria. So, this is a kind of a quadruple whammy because you have less insulin receptors, more defective insulin receptors, less glucose transporters going to the surface, and more inflammation at the level of the mitochondria. In other words, this is not great.
Now, we also have another problem that emerges inside of your adipose tissue, and that is when you over accumulate saturated fatty acids inside of your adipose tissue, even though that's where they're supposed to be, you can end up developing inflammation in the adipose tissue, the fat tissue. And this inflammation then starts to attract these other cells in your blood called macrophages. These macrophages are like the biological Pac-Man that get inside of your adipose tissue, and start to clean up cellular debris from cells that have split open. So, your adipose tissue becomes inflamed and that contributes to whole body insulin resistance.
So, within a short period of time eating a single high fat meal, especially if that high fat meal is repeated over and over, and over, and over again, can dramatically increase a number of insulin signaling problems in your muscle and liver, and that can reduce their ability to uptake glucose. So, what that means is that this sort of saturated fat… An increase in the amount of saturated fat you eat causes a traffic jam that then blocks glucose from being able to transport inside of muscle and liver, leaving it trapped in your blood, causing high blood glucose.
Now in addition to saturated fat causing problems with insulin signaling, saturated fat can also raise your LDL cholesterol, or your bad cholesterol. Well, how the heck do we know that this is true? There's plenty of research to investigate whether or not saturated fatty acid can alter your LDL cholesterol, because it's a very hot topic. It's a very important topic of research, and researchers are always on the hunt for things that can negatively impair your cholesterol level, and ways that you can reduce your cholesterol level. And what researchers have found over the course of time, is that the connection between the amount of saturated fat in your diet, and your LDL cholesterol is so strong, in fact, is so strong that they've actually developed a mathematical equation that can predict how much your LDL cholesterol is likely to go up based off of how much saturated fat is in your diet.
Now, this equation was written many years ago. I don't even remember the exact year, but I want to say it was in the, either the 70s or the 80s, and it was referred to as the hegsted equation. And the hegsted equation, again, it predicts how much your cholesterol level is likely to rise, your LDL cholesterol is likely to rise given the amount of saturated fat in your diet.
Now, this… It does not bode well for the people in the low carbohydrate community. They don't like hearing this message, and there's in fact a huge backlash about this idea that the hegsted equation is actually a useful equation. And you'll hear over and over again from people in the low carbohydrate community that saturated fat does not increase your risk for heart disease, it does not raise your cholesterol level, it does not impair the ability of blood vessels to do their job, and there's this huge controversy over it.
So, if you're privy to that controversy, if you've seen it, then you might be listening to what I'm saying right now, and you might be like, “Well, Cyrus, you know, I want to believe you, but the other side is saying the exact opposite thing as you. How is that possible?” Well, if you dive a little bit deeper into the research, you'll see that data from more than 1 million, yes, I said 1 million, participants enrolled in more than 100 studies over the course of time, have demonstrated a very strong positive relationship between your total LDL cholesterol level and your risk for coronary artery disease.
So, what that means is that we know conclusively that if your LDL cholesterol level increases, then your risk for coronary artery disease increases. I will read you the quote from the paper. The paper was published in 2013, and the name of the paper is “The role of early LDL lowering to prevent the onset of atherosclerotic disease.” And the quote is this: “Numerous prospective epidemiological cohort studies.” That's a mouthful. “In two large meta-analysis of individual patient data from over 1 million participants, enrolled in more than 100 prospective studies, have demonstrated a continuous, graded and approximately log linear relationship between increasing plasma LDL-C, and the risk of coronary heart disease. In addition, a meta-analysis of individual level data from 170,000 participants, enrolled in 27 statin trials, conducted by the Cholesterol Treatment Trialists’ Collaboration demonstrated that the risk of coronary heart disease is reduced by approximately 21% for every 38 milligrams per deciliter reduction in LDL-C.”
So, what that means is that if you can just focus on doing something on eating, such that your LDL cholesterol drops by 40 milligrams per deciliter, which is not necessarily that easy to do, but every time your LDL cholesterol drops by 40 milligrams per deciliter, then your risk for coronary heart disease drops by 20%. That's a big drop.
So the question really becomes, well, how can you eat to actually lower your LDL cholesterol? Is that possible? And is it true that eating a saturated fat diet actually increases your LDL cholesterol?
Now, if you believe hegsted equation, which if you read the details of it, you will likely find that the correlation is so strong, in fact, the mathematical correlation is so strong that it's very, very hard to refute. And there's a number of studies that actually show, “Well listen, if you just feed people eggs, and you try and determine whether or not the amount of triglyceride in their blood increases, or their LDL increases after a meal, what you'll find is that that's not always true.” And the answer is you're right, that's not always true. Here's why: Because those studies are done in people who already have a high fat intake in their diet.
So if you're performing the study on people who already are eating a significant amount of saturated fat, and you add one or two eggs to their diet, you're not going to see much of a change in their cholesterol level. But if you perform a study in people who have low saturated fat in their diet, and then you feed them a couple of eggs, what you will find is that their cholesterol level goes up, and it goes up pretty darn quickly.
So, the research can be very misleading, and again, it causes a lot of arguments. And the truth is that there's a lot of methodological errors that happen in the research that the general public just doesn't aware of, and as a result of that, people get confused.
Now, one other thing to take into account here is that the low carbohydrate world always likes to say this thing, they say “Listen, the type of LDL particle is more important than the total amount of LDL in your blood.” So in other words, “I don't really care if your LDL cholesterol is going up, it doesn't really matter. What I care about is that the type of LDL particle in your blood is large and fluffy, because that's a good thing, and not small and dense. So if we see a migration of your LDL particle size towards large, fluffy, and away from small dense, that's a good thing, that means you're actually protected against heart disease.”
So, I used to believe this and I said, “Okay, well, that's a kind of an interesting concept.” So then I dug for more information. And what I found was actually that this is not a true statement, once again.
Now, Dr. Greger, Dr. Michael Greger has some videos about this, and I think it's actually phenomenal. What he shows in his videos is that in the research, you can actually see that all LDL particles, regardless of whether they're small and dense, or whether they're large and fluffy, increase your risk for heart disease, period, end of story. It doesn't matter whether they're small or whether they're large. More LDL equals an increased risk for heart disease.
It turns out that large, fluffy LDL particles increase your risk for heart disease by about 31% versus the small, dense LDL particles that increase your risk for heart disease by 44%. Okay, so the researchers that wrote this paper found out that both large, fluffy, as well small, dense, both increase your risk for heart disease. But what did they say? What was their conclusion? They said, “Oh, the large fluffy LDL particles are atheroprotective”, they use the word protective to insinuate that large, fluffy was less damaging, right? Which is technically a true statement, but also factually inaccurate, because they both increase your risk for heart disease. So, you cannot refer to either one of them as being protective. In fact, one of them is just less bad than the other. But using the word protective is horrendously misleading.
So, the takeaway message from this is that the most effective way to reduce your LDL cholesterol is simply to reduce your saturated fat intake. I'm going to say it one more time. The most effective thing that you can do to reduce your LDL concentration in your blood, is to reduce your saturated fat intake.
In addition, if you reduce or eliminate your cholesterol intake, that will also contribute to reduce LDL cholesterol. Both of those are very powerful things that you can do, and they're very easy to accomplish, and they're at your disposal at all times.
The third type of fatty acid that I want to discuss today are unsaturated fatty acids. And unsaturated fatty acids are actually a very important topic in the world of health today, because you see it written all over the internet. People say, “Oh, you know, I'm eating healthy fats. Healthy Fats are good for me, right? I should be eating plant fats, because those are good for me. I want to make sure that I'm increasing my intake of healthy fats, because I need them for my hormonal development. I need them for my brain, right?”
And so, the question really becomes, well, part of that story could be true, but part of that story might also not be true. So, let's do a little deep dive and try and figure it out.
If you go into the research and you, you know, dig and dig, and dig, to try and find out what the heck are healthy fats, and is that just a pop science term, or is that actually a medical definition? It turns out that the term healthy fat is actually just a pop science term. There's no such thing as a healthy fat in my mind. There are healthier fats, there are fats that are less damaging, there are fats that are actually required, that are essential for brain health, for eye health, for liver health, for kidney health, you name it, but then also, labeling them as “healthy fats” is, again, it's a vocabulary problem. It's a misleading analysis that then leads you to believe that it's important to eat a lot of these, quote unquote, healthy fats.
In the literature, there's a comprehensive review conducted on this topic, and this paper shows that substituting higher quality unsaturated fatty acids, okay, which mainly are derived from the plant world, for lower quality saturated fatty acids and trans fatty acids, dramatically improves your insulin sensitivity, in particular, within weeks, and it can help reduce your LDL cholesterol, and it can help you lose body fat.
So, what this means is that if you were to make no other changes to your diet, but simply start eating more foods that are rich in unsaturated fatty acids, and foods that are less rich in saturated fatty acids, then you would improve your insulin sensitivity, and this can happen in a short period of time.
In 2011, the Nurses’ Health Study discovered that diets that were higher in what's called PUFA, polyunsaturated fatty acids, are correlated with less type 2 diabetes, than are diets that are higher in MUFA, monounsaturated fatty acids.
These two types of fatty acids, the polyunsaturated and the monounsaturated, are both considered unsaturated fatty acids. And the monounsaturated fatty acids are the ones that your body can manufacture. The polyunsaturated fatty acids are the ones that you cannot manufacture, they are essential.
So, what this study discovered was that diets that are higher in the polyunsaturated fatty acids, the essential ones that you cannot manufacture, are correlated with less type 2 diabetes, than are the ones with monounsaturated fatty acids. So, what that leads you to indicate is that, okay, trying to find PUFAs in your diet, as opposed to MUFAs, might be a beneficial strategy.
There's another study called the Iowa Women's Health Study, and they found that, again, substituting PUFAs for saturated fatty acids also decreased type 2 diabetes risk, which is a good thing as well.
Now, studies also consistently show that when you replace foods in your diet that are high in saturated fat, with those that are higher in unsaturated fat, this can not only improve your insulin sensitivity, but it can lower your LDL cholesterol, it can raise your HDL cholesterol, and it can protect you against a future cardiac event.
Now, one of my favorite collections of studies that I've ever come across was brought to my attention by Dr. Joel Khan, in a debate that he did against Dr. Chris Kresser on the Joe Rogan Podcast. Dr. Joel Khan talked about a very specific study that was published in the British Medical Journal, and it was basically an elegantly designed collection of studies involving more than 395 metabolic ward experiments.
And what they found in this collection of studies was that replacing 10% of your calories from saturated fat, with equal amounts of either poly or monounsaturated fat, can reduce your total cholesterol by approximately 25 milligrams per deciliter. Let me let me restate that. If you replace approximately 10% of your calories from saturated fatty acids, to unsaturated fatty acids, if you do nothing else, just that, your total cholesterol is likely to drop by about 25 points.
This same collection of studies also showed that replacing 10% of your calories from saturated fat, with carbohydrate-rich whole-foods, like potatoes and fruits, and legumes, and whole grains, can reduce your cholesterol by about 20 milligrams per deciliter, and your LDL by about 15. Okay so, regardless, whether or not you're going to replace saturated fat with more unsaturated fat, or if you're gonna replace saturated fat with more carbohydrate, it literally doesn't matter, all that matters is that you reduce your saturated fat intake, because like we talked about earlier, the hegsted equation, very elegantly describes how increasing intake of saturated fat increases your LDL concentration in your blood.
Now, one thing that is very important understand, is that all whole foods contain unsaturated fat, without exception. There's no whole foods that don't contain any amount of fat, especially unsaturated fat. So, whether you're gravitating towards bananas, carrots, lettuce, potatoes, beans, quinoa, rice, apricot, it doesn't matter. All of these foods contain small amounts of saturated fat, small amounts of unsaturated fat. It turns out that the unsaturated fat tends to be more abundant in the plant-based world, and the saturated fat tends to be more abundant in the animal based world.
So, a simple thing that you can do is eat a diet that contains mostly plants, and eat a diet that contains, you know, 80% to 90% plants or more, and by doing so you can derive all these benefits, improved insulin sensitivity, reduced LDL cholesterol, reduce risk for atherosclerosis, and acute cardiac event.
When it comes to nuts and seeds, like walnuts, almonds, cashews, you know, hemp seeds, chia seeds, flax seeds, these foods contain a significant amount of unsaturated fat as well, okay? And they have extremely high nutrient density, and they're rich and protective compounds that are called phytochemicals. And these phytochemicals include compounds like lignans, and sterols and antioxidants, and polyphenols and bioflavonoids. These are all just big scientific words to describe the types of chemicals that the scientific world has identified as having anti-chronic disease properties.
So, anytime you can eat foods that are rich in phytochemicals, then you're doing yourself a huge favor, and it turns out that nuts and seeds are very rich and phytochemicals, as are fruits, whole grains, legumes, and starchy vegetables.
So, even though you may be tempted to just say, “Okay, well, Cyrus told me that all I have to do is eat less saturated fat and more unsaturated fat, then problem solved, right? That's all I have to do.” So, you might be tempted to say, “Okay, well, I'm just going to eat less salami and bacon”, or “I'm going to eat less olive oil. And I'm just going to substitute that for more nuts and more seeds, and more avocados.” And the truth is that yes, that will improve your insulin sensitivity, that will decrease your risk for cardiac disease. However, that's only the tip, of the tip, of the tip, of the tip of the iceberg.
What we recommend doing here at Mastering Diabetes is actually a number of things. These are your take home messages from today's Podcast. The most effective way to increase your insulin sensitivity is to, number one, reduce your total fat intake to a maximum of 15% of total calories. Please get out a pen and paper and write this down. Okay? The most important thing that you can do to increase your insulin sensitivity is to reduce your total fat intake to about 15% of total calories. If you want to go as low as 10%, you're welcome to do that as well.
How do you know how much fat you're eating in your diet? You go to the Internet and you download an app on your phone. It's either called My Fitness Pal or Chronometer. We prefer Chronometer, it's a much more elegant platform. Go download that. You can get it on your iPhone, you can get on Android, and use that to log your diet. Do it for like 3 to 4 days and just input all the food you're eating, and then it'll tell you. It'll say, “Hey, john… Hey, Cynthia… Hey, Mandy, this is how much fat, and carbohydrate, and protein you're eating.” You also get a readout on your micronutrients. We don't really care about those right now.
What we're concerned about is how much carbohydrate, how much fat, and how much protein is going into your body. If you can log your diet and then manipulate your diet so that it's down closer to 15% of total calories as fat, then you're doing yourself a huge favor.
The second most effective way to increase your insulin sensitivity is to replace foods that are rich in saturated fat, and trans fat, again, these are things like meat, and poultry, and fish, and dairy, and eggs, and oils, and processed meats, and substitute those foods with carbohydrate rich whole foods that are low in saturated fat, and trans fat. And those carbohydrate rich whole foods include fruits, starchy vegetables from the ground, whole grains, and beans, peas and lentils. You make that change, that's going to be a very dramatic improvement in your insulin sensitivity as well.
Now, when it comes to high fat plants like nuts, seeds, avocados, coconuts, and olives, these foods are definitely, they have a place in the Mastering Diabetes Method, and they have a place in your diet, no question, but I want you to understand that if you eating those foods in excess, meaning, that if you're eating those foods and they are increasing your total fat intake to be on 15% of your total calorie intake, then that's going to hampers your insulin sensitivity. It's going to impair the action of insulin in your body.
So, do your best. Include those foods, absolutely have them. Again, they're very nutrient dense and they contain a huge phytochemical density. But again, just make sure that you're not overeating on those foods, especially living with any form of diabetes. It's important to keep your total fat intake relatively low.
Now, the final thing that I'll say is that, again, all whole-foods contain fat, even if the food has a sweet flavor. So, a banana has got a sweet flavor, a mango has got a sweet flavor, papaya, I just had one for breakfast, sweet flavor. All of these foods do contain fat. I don't want you to think of those as just being, you know, sugar bombs, or carbohydrates only, that is not a true statement. All of these foods contain small amounts of fat. Plant foods contain more unsaturated fat, animal foods contain more saturated fat, but a tiny amount of fat that you're getting from each one of these foods adds up to a much larger total, and when you put the whole thing together, using food logging software, you can get the data that you are interested in, and that'll tell you exactly how much fat is in your diet.
So, hopefully these tips are helpful for you. Hopefully, these tips give you an idea that there's actually a dramatic difference here between trans-fat, and saturated fat, and unsaturated fat, they do not behave the same way in your body. And it's important to understand that, yes, fat has a role in your body, there's a necessity of having fat in your diet, but understanding which type of fat you're consuming, and where that fat is coming from, is very important and understanding the bigger picture.
Your blood glucose control is certainly important, your A1c value is certainly important, but your total body health goes way beyond that. Those are just two minor, tiny, little things that people with diabetes care about. But the bigger picture here is what's going to happen to your heart health, what's going to happen to your kidney, what's going to happen to your liver, how is your brain functioning, and what's going to happen to your ability to live a long, healthy life. Are the foods that you're eating compromising your longevity, or the foods that you're eating are actually maximizing your longevity? The two of those are fundamentally different scenarios.
So, at all points along this way, I want you to think about the foods that are going into your mouth as being an opportunity for you to increase your longevity, and an opportunity for you to increase your total body health. Pay attention to your blood glucose, and pay attention to your A1c, but also pay attention to all these other biomarkers, because they're very important, and they tell you a much more important, much larger story.
I hope this was helpful. Go at it. Have yourself a really tasty, low-fat, plant-based, whole-food meal at your next opportunity. And I will catch you on the flip side.
Cyrus Khambatta, PhD: Thanks for listening to the Mastering Diabetes Audio Experience. We're very happy that you're making the commitment to learn more, and open your mind to a world of diabetes management and reversal that has truly taken the world by storm.
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If you're looking for more information, visit our website at www.MasteringDiabetes.org to learn evidence-based science and get free recipes, and listen to free Podcast episodes. And you can also register for our free Mastering Diabetes Online Summit, which is our premier online event of the year which attracts between 40,000 and 60,000 people every year.
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Cyrus Khambatta, PhD earned a Bachelor of Science in Mechanical Engineering from Stanford University in 2003, then earned a PhD in Nutritional Biochemistry from the University of California at Berkeley in 2012. He is the co-founder of Mastering Diabetes and Amla Green, and is an internationally recognized nutrition and fitness coach who has been living with type 1 diabetes since 2002. He is the co-host of the annual Mastering Diabetes Online Summit, a featured speaker at the Plant-Based Nutrition and Healthcare Conference (PBNHC), the American College of Lifestyle Medicine Conference (ACLM), Plant Stock, the Torrance Memorial Medical Center, and has been featured on NPR, KQED, Forks Over Knives, Healthline, Fast Company, Diet Fiction, and the wildly popular podcasts Plant Proof and Nutrition Rounds. He is a co-author of the upcoming book Mastering Diabetes with Robby Barbaro, MPH.
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