MDAE E53 – How to Reverse Neuropathic Pain and Chronic Pain Naturally – with Evan Queler, MD

Article written and reviewed by Cyrus Khambatta, PhD and Robby Barbaro, MPH
Published January 19, 2019

Podcast Transcript

Evan Queler, MD: Animal products, processed food, feed that cascade. That is the fuel to the fire. So, if you want to turn out the fire, stop putting gasoline on it, and smother it. So, it's a matter of eating more nutrient dense, plant-based foods that are rich in omega-3 fatty acids, and you're consuming, you know, healthy water.

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, also known as the Mastering Diabetes Podcast. It's all the same thing. Thank you for joining us today. We have a great episode. So, there's a lot of people living with neuropathic pain. I mean, millions, and millions of people, and for a lot of people, it can just be stabbing pain in the middle of the night. It can be chronic prickling, or tingling, or burning all throughout the day. It's really, really awful for the people who are experiencing neuropathic pain. So, if you're one of those people, today's episode is definitely for you. If you are curious to learn more about this, you're going to learn a lot in today’s episode.

So, we interviewed Dr. Evan Queler, who is in the trenches on this topic. He's really working with people who are going through this. He's doing all the conventional therapies. He's done, been there, done that. And now he has learned about lifestyle medicine. So, he's going to share his journey, deciding to use lifestyle medicine as often as possible, but also the knowledge he has about the medications, the treatments that are being used, and why you really, really want to avoid them at all costs.

So, it's a great episode. He really goes in depth on this topic. Cyrus and I are really proud and excited to bring you guys experts on their topic. So, you know, Cyrus and I, we've helped people reverse neuropathy in a lot of situations, but we're not experts on all the treatment that's being done, the medications being used, and a lot of the nuances. So, really excited to bring you Dr. Evan Queler today.

Now, before we get into the episode I would like to announce a contest. So, you guys sharing this Podcast, telling more people about it, helps us change lives. That's how we're going to get the word out, is having you guys share it. So, if you take a screenshot and share it on Instagram stories, you will have officially entered yourself in the contest to win one month of small group coaching, in our Small Group Coaching Program. So, all you got to do is take a screenshot, tag @masteringdiabetes in the screenshot, and tell people, you know, “This Podcast is amazing. Check it out”, or just say “Hey, look, I'm listening to this Podcast and I learned some interesting information. I highly suggest you guys check it out”, anything like that. Anything that shares it with your audience, whether it's in your story, whether it's a main feed post, it doesn't matter. This is an exclusively Instagram contest, that's where we're going to pick the winner. So, go ahead, do that, and I can't wait to have somebody win and join our Small Group Coaching Program.

I should probably explain exactly how amazing our Small Group Coaching Program is, just for some extra motivation to enter this contest. So, our Small Group Coaching Program is basically our premier coaching program in the sense that you work with a small number of people, and you get direct access to our coaches every single week. We do live Zoom video conferences, so you can have that week by week check in with our coaches, and the small group of people who you'll get to know, and become friends with. So, we have them on Tuesday nights and Wednesday’s nights, and so you'll always be with the group of people who are living with the same type of diabetes you're living with. So, Tuesday’s night is not insulin dependent, Wednesday’s night is people who are insulin dependent, and you get to connect, and really understand what everybody's going through. You get help from the coaches, but the community aspect of being on a call with, it's usually no more than 10 to 12 people, so you really get to know each other well. And that's the major benefit of our Small Group Coaching Program.

Then, of course, you also get to access our Online Course which teaches you everything. You get instant access to that once you're signed up, and the course goes in a step by step manner, giving you guidance on how to transition, one step at a time. The whole point is to not make the process overwhelming. We're all about long term success. So, you just make one change at a time. It's manageable, it's doable, and when you're ready, you move on to the next one. And then we also have our private online community that's on Facebook, that's also inside the Online Course If you're not a Facebook user. And that allows you to ask our coaches and other members of the Program any question, anytime, and you will always get an answer within 24 hours from one of our coaches, and you also get responses from other members, who may have been through the same experience, can add some value, can answer your question themselves. So it's really great. It's a fun, fun community. We really, really are proud of our Coaching Program, what we're offering, and the results we’re getting, and the experience our members are currently having.

So we'd love to have you join us. I hope you, yes, you, the person listening, I hope you win. Just go ahead, and post a screenshot on Instagram stories, or post it on your main feed and tag @masteringdiabetes. We will see it, and we will pick a winner, and announce it next week. All right, enjoy the show.

Cyrus Khambatta, PhD: So, we're super excited to be here today with you, Evan. I know that you’ve got a lot of experience in helping people overcome chronic pain, and you know, your insights are going to be very valuable to audience. So, thank you so much.

Evan Queler, MD: I'm excited to be here. You guys are doing great work, and I’m glad to be collaborating with you guys.

Cyrus Khambatta, PhD: Fantastic. So, maybe let's start at the top here. Let's go a little bit into your background in medicine, because you're classically trained, but you are now practicing lifestyle medicine, and teaching people how to adopt a plant-based diet. So, give us a little insight here into how you went from a traditional approach, to a more sort of alternative lifestyle medicine approach.

Evan Queler, MD: Well, I think essentially, you know, I was getting back to the original reason as to why went into medicine, which was to help people, and to try and find the best way to do that. Originally I went into medicine with the idea of practicing integrative medicine. I was influenced by Andrew Weil’s book, Health and Healing, where he talked about the whole landscape of how there isn't necessarily one best treatment for helping people, whether it was conventional medicine, to shamanism, to chiropractic, to naturopathic medicine That idea of integrative medicine of combining the best of both worlds, of both conventional and alternative therapies, was a way to have a powerful impact on people's health.

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So, when I got into medicine, I slowly became disenchanted with that, and after practicing medicine for about 10 years as an Interventional Spine Podiatrist, I felt that there was a better way, I knew that there was a better way. My health was suffering because of just the cognitive dissonance of all that, and felt that I needed to try and improve my own health, and came across plant-based nutrition as a way to do that. If I couldn't take care of my own health, how was I supposed to help others in doing so?

And so, I just kind of got fed up with the revolving door of the current medical model. People were frustrated, they want to get better, and a lot of chronic ailments aren't effectively treated with conventional therapies.

Robby Barbaro: Yeah, I mean, I want to commend you on making that transition, because I know there's a lot of people that would be scared to do that, and you have just dove right into it. So, one thing we want to learn about today is, can you give us some insight into what is the conventional, typical Western approach to addressing people who are struggling with diabetic neuropathy, or any type of nerve pain?

Evan Queler, MD: Well, you know, it's funny it's there's a similar mentality, just like with the cardiologist with treating heart disease. It's like, “Well, you should eat well, and you should quit smoking, but, you know, we don't have the time for that, so here's this pill, you know, here's this procedure.” And it continues to enable people to continue the same deleterious lifestyle behaviors. And what's, you know, good for your heart, it is also good for your bones, and your muscles, and your tendons.

So, the conventional treatment is typically physical therapy, anti-inflammatories, different non-opioid medications to opioid medications. And they have side effects, and they are a Band-Aid, they don't necessarily cure the problem. And the metaphor of that Dr. Greger so pointedly does in some of his presentations, where he talks about hitting your shin with a hammer, and you know, you could go to the doctor, and you could continue to hit your head with a hammer, and he could prescribe you pain pills, or you can stop. And he uses that analogy, and that metaphor for every day we're eating food, three times a day, and we're damaging, and banging our endothelial cells that help keep ourselves open, and our tissues well profuse, where you can stop that deleterious lifestyle behavior. So, the current medical model is just that revolving door, a pill for every ill.

Cyrus Khambatta, PhD: Yeah. Okay, so let's go in a little bit more detail about this, because peripheral neuropathy, and neuropathic pain is no joke, at all. I hear stories from people living with all forms of diabetes, about just how uncomfortable it is to have tingling in your fingers, tingling in your toes, lightning bolts going through your legs at night. And it can be really obtrusive in your sort of normal daily lifestyle. So, when somebody starts to experience neuropathic pain, they go to their doctor, and their doctor basically says, “Okay, I have a solution for you. The solution is this little pill in a bottle. And this thing is going to help you reduce your symptomology.” So, what are the names of some of these medications, and is there sort of a prescribed protocol? First try this one, then move to this one, then move to this one. Or is it a whole laundry list of medications that maybe work?

Evan Queler, MD: So, the most powerful one, the most powerful intervention is someone's diet. But again, most physicians don't even have that diet adopted and intertwined in their own personal lifestyle. But that's the most effective treatment, is a whole-food, plant-based diet. And that's oftentimes overlooked, and certain things aren't implemented to kind of help enable the patient to adopt those types of lifestyle behaviors.

But that being said there's medications, like Lyrica and Gabapentin that are first line treatments that are in a class of anti-seizure medications, but they also call it a cell membrane stabilizers. So, they're working on the tiny calcium channel, you know, membrane calcium channel ion receptors and calming them down. So, these small pain fibers, they're called the C-fibers, and Alpha and Delta pain fibers that transmit that signal to our brain, that we're feeling lancinating pain, or burning pain, or these abnormal sensations called paresthesia, where, you know, when your foot falls asleep, and you have like those pins and needles sensations, and sometimes it cannot be painful, but oftentimes it can be painful.

And so, we give these different medications that kind of work on pain in different ways, and oftentimes it comes to opioids, you know, which also has, you know, is riddled with side effects as well. So, the conventional medicine treatment it's oftentimes anti-inflammatory medications, like non-steroidal anti-inflammatory drugs that are over the counter like Advil, also known as ibuprofen, or Aleve, also known as an naproxen. And then, those cause GI side effects, where you take a proton pump inhibitor affecting your microbiome, increasing risk of Alzheimer's, and having so many other deleterious effects to try and compensate for the side effects of the NSAIDs, the non-steroidal anti-inflammatory drugs.

And then you have cell membrane stabilizers. I was talking about Gabapentin, also known as Neurontin, but you don't get it sold as Neurontin anymore because now it's just generic as Gabapentin. And then there's Lyrica that might have a slider better efficacy, but for quite some time, there wasn't a generic form of Lyrica, so you had to try Gabapentin first, and then if they fail Gabapentin you have to try Lyrica. And then you're spent, you know, you're spending the limited time resource that you have during the day trying to get their approval for this medication, when it isn't all that effective. So, then you might try an antidepressant, but antidepressants called SNRI, Serotonin-norepinephrine reuptake inhibitor. So, it's not just working on serotonin, it's also working on norepinephrine, and these neurotransmitters that are secreted from the cells to help communicate painful signals to get muted.

And so, there's medicines like Cymbalta and Savella. So, you have these medicines that are often used for peripheral neuropathy, diabetic peripheral neuropathy, that are also used for chronic pain in my myofascial pain syndromes, like fibromyalgia. Where there's this diffuse neuropathic or myofascial type of pain syndrome. So, you've gone down this cascade of non-steroidal anti-inflammatories, and a class of anti-seizure medicines like Gabapentin and Lyrica, and other medications like SNRIs, like the Cymbalta and Savella. And then you could put these medicines in topical pain creams, which also have limited efficacy, but is a way to try and bypass some of the systemic side effects because of less systemic absorption is just getting absorbed locally to that area.

But then you just have this chronic pain, this chronic neuropathic pain, and you can't be constantly applying Lidocaine, a numbing medicine that we use, which is like Novocaine for our teeth, like onto our skin all the time. And there's even some limitations into what we really know of the efficacy of like, well, if we take the Gabapentin and we take it systemically, and it gets into our system, is that the same as applying topically? Is it really going to get through to the skin to make a significant difference? But we do it in theory, and for some people it helps, but the outcomes are limited in regards to its efficacy. People look at conventional medicine as being this great cure, but it is limited, and the medications are not...It was few and far between that I was seeing patients and they were getting better. And that they were like, “Wow, this is a great drug!”

Cyrus Khambatta, PhD: Yeah, that doesn't really happen that often.

Evan Queler, MD: It was few and far between that they're like, “This Gabapentin! Wow! My pain was at 10, now it’s 0 out of 10. Thanks.”

Cyrus Khambatta, PhD: Right.

Evan Queler, MD: You know, “Now I can go run and exercise, and I can sleep better, and I can move more.”

Cyrus Khambatta, PhD: So, I think you're actually panting a really good picture here, because there's sort of, there's a hierarchy of medications, you know, you first start out like you said with the NSAIDs, if those don't work you move to the anti-seizure medications, if those don’t work you move to the SNRIs, if those don't work you go to the topical and opioids, and you go to the topical creams. And then, as a result of any combination of those medications, there could be other gastrointestinal problems, that then results in the need for proton-pump inhibitors, and the list goes on.

So, people with diabetes also fall subject to the same cascade of medications specifically to treat high blood glucose, independent of chronic pain and neuropathic pain.

Evan Queler, MD: Right. And they're also complex to dose. So Gabapentin, for example, it needs to be titrated, it can cause people to feel sleepy, there's a black box warning for increased risk of suicidal thoughts and depression. There are some times where it could affect our ability to produce white blood cells. So, you have this, what they call aponeurotic ptosis that could sometimes happen. You could have increased risk of falls, you know, so you have the medical complexity that can sometimes be associated and correlated with diabetes, and heart disease, and how they're all intertwined in obesity, and the neuropathy, where you have poor proprioception. And then, you're placing people on medications that make them drowsy, and increase the risk of falls, which leads to other medical problems, which is why you see the top third cause of death being the healthcare system.

Robby Barbaro: Okay so, this is fascinating, and soon we're going to get into some better solutions. But before we get to that, can you give us some information on what is spinal cord stimulation, and how it’s used for people experiencing neuropathic pain?

Evan Queler, MD: Okay, well, spinal cord stimulation, I guess, you know… Someone is maybe a candidate for that, that's kind of like, basically same way that we implant a pacemaker for someone's heart. People could kind of correlate, could understand that, and that’s kind of mainstream common knowledge where you place this battery, sometimes you see it up in the upper part of the chest wall, this battery, and that has a wire connected to it, and there's this wire that sends an electrical impulse to the heart, so you can control the rhythm of the heart.

Well, there's that gate theory mechanism of pain, where you bang your shin, you're having this painful stimulus, and so you rub it, you stimulate different nerve endings that are able to appreciate light, vibratory sensation, you know, or soft touch. So the brain, or that sensation is then translated over to the spinal cord up to the brain that says, “Oh, I'm not feeling a painful signal. I'm feeling rubbing.” So the idea is that you could stimulate a part of the spinal cord, called the dorsal columns that appreciate a vibratory sensation. And when you place a thin wire over that spinal cord, usually the mid portion of like, there's 12 thoracic vertebrae, or the mid back, there's usually around T8 is that sweet spot that gives you sensation to the low back. It's not like the lumbar vertebrae Ls, 1 through 5, that's not where you place the stimulator. You place it up at T8, and that's where in the body you perceive the pain in the low back, and down the legs.

So, you have this algorithm where people have failed conservative treatments. They failed this algorithmic approach of maybe a lumbar sympathetic nerve block. They've failed the different nerve agents that you would treat for their neuropathic pain, and have them undergo psychological clearance, before proceeding with a spinal cord stimulator trial, where under X-ray guidance, I'm able to place a wire through a needle into the epidural space. So, instead of me injecting corticosteroid for that herniated disc, and injecting a fluid there, I'm threading a thin wire through that needle, and under extra guidance, placing it in that specific spot, and testing that wire, stimulating that wire stimulate the spinal cord so people get a pleasant sensation.

And so, people will be on the table, “You feel it in the areas that you have pain? You feel it across your back and down your legs? Where are you feeling the stimulation?” And so, when the patients are on the operating table, they're able to tell us where they're feeling it, “Well, it's wrapping around my chest, I don't want it there.” So I manipulate the wire to get it set just right. And for 7 days, they have that wire implanted. They have to take bird baths, they can't get it wet. And there's a risk of infection, they have to be in prophylactic antibiotics, wiping out their microbiome, because the risks outweigh the benefits. And again, you're literally masking the symptoms.

And so then, the spinal cord stimulator provides at least 50% relief, so there's improvement in their function, so they come back to the office, and just like… And so I take off the tape and undo the suturing and I pull the wire out, just like I would maybe pull out a catheter, or something that was in their vein, right. So, I pull it out, put a Band-Aid over it, and then I asked them, you know, “How did you do this week? Did you find the stimulator improve the quality of your life? Did it relieve your pain? Did you use less medications? What are some measurable functional outcome measures?” And if they did indeed have significant relief of their symptoms, and they felt that it was improved function, improved quality of their life, they would then go see a spine surgeon, or there are some physicians like anesthesiologists, or a physiatrist like myself that might do the implementation itself, where you create a pocket in the buttock area for that battery, as opposed as up in the chest, and you thread the wire, you know, I guess there's no point in getting into the fine details of how the surgery has taken place, but it's implanted. This wire is implanted and people have this pacemaker, that's essentially stimulating their spinal cord to create a pleasant sensation down their legs, and blocks that pain signal.

Robby Barbaro: I really hope the people hearing this are getting some motivation to not get to this point.

Evan Queler, MD: Again, all that is not a cure, you know? It's all bypass surgery, right? So, for me, since I kind of got into this in 2016, when I would hear people like Caldwell Esselstyn, you know, state well, you know, coronary artery bypass graft is… What if they say a whole-food, plant-based diet is extreme, well, so is bypass surgery, you know, that's a little more extreme. And so, things like that really resonated with me, in the sense of the treatment that I was providing for patients where it was just, it's like bypass surgery, you're bypassing the problem and you're not getting at the root cause of the problem.

There's the the healing model and the pain relief model. And I literally was working in the pain relief model, where we were alleviating people symptoms, and we associate feeling better with getting better. But it was a perfect example of falling into the pleasure trap where we're continuing to do the same deleterious behavior. So, I felt like it was my mandate, like I was compelled that, you know, people are dying, people are suffering. I went into medicine to try and help with that very problem, and I have a solution. And so that's kind of what I'm doing.

Cyrus Khambatta, PhD: Okay. So, this is awesome, because I want to get to the solution now, because what you're pointing at, and what Robby was just hinting at here is, this is very, very, very, very important, which is that if you show up, you have neuropathic pain, you have some form of chronic pain in some point in your body, you start with an oral medication cascade. If that doesn't work, you can then go to what are invasive surgical interventions, that are designed, you know, they're sort of the equivalent of a coronary artery bypass graft, but they're doing it specifically on peripheral nerves. And if that doesn't work, then “Oh, I'm sorry. You just have to live with neuropathic pain the rest of your life.”

However, what you're pointing out is the fact that there is a solution. And the solution is very simple, and it's very straightforward. And that solution is a plant-based diet. Most don't want to believe that this is true. I didn't believe that it was true for a long time. Now, I'm a firm believer. So, the question to you is this, what is it about a plant-based diet that is actually truly a full solution, not just a treatment method, not just a Band-Aid, but a solution to living with neuropathy, neuropathic pain and chronic pain?

Evan Queler, MD: There's pretty impressive research showing the reversal of peripheral neuropathy within just several days, within 4 to 16 days. They did an In-Ward study, where they put people at a residence lifestyle program for 25 days. And 17 out of the 21 of them had complete relief within 4 to 16 days. So, that 75% of the patients who were able to reverse their symptoms of paresthesia, and numbness. And they were also able to lose weight, improve other measures of chronic disease like their blood sugar, their triglycerides, and even improving their high blood pressure.

Now, there's an osmotic effect of the glucose getting into the cells and then bringing the water into the cell, into that nerve cell, and causing physical damage from the osmolality or the high concentration of sugar in the body. And when it gets absorbed into the cells, that brings the water in there, and there's and damage in the inflammatory process that takes place. But there's also free radical damage that takes place when consuming animal based products that have heme iron, Neu5GC, that are interfering with these inflammatory pathways, the NF-κB pathway that turns on these genes of Alzheimer's, and colitis, and autoimmune disease, an aging pathways, and asthma, and diabetes, and cancer, and atherosclerosis.

And so, phytochemicals that are found in nutrient dense foods like fruits, vegetables, whole grains, berries, they turn off this NF-κB pathway. So, it's like what Dean Ornish was able to show, that within these simple lifestyle interventions, we’re able to up-regulate the good genes, and down-regulate the bad genes. And they were able to, with some very fancy high tech measures, show how you could affect over 500 genes. So, in the same way, you know, diabetes and neuropathy is due to an inflammatory process of these perpetual, chronic inflammation that takes place, where the healing process never gets a chance to heal itself.

Cyrus Khambatta, PhD: Okay, this is actually really cool. Are there specific components of a plant-based diet which are more effective than others? In other words, is it the antioxidants that are more effective than the fiber, that's more effective than the water, that's more effective than the vitamins or minerals? Or is it not even worth going down that road and instead looking at the bigger picture and saying “No. The more plant-based foods you put into your diet, the less animal based processed, and refined products you will be eating. Don't worry about the details, just eat this food and you'll see dramatic improvements”?

Evan Queler, MD: Right. Well, I think it's very easy to get caught up in the minutiae, and to fall into the trap of like, that reductionist type of mentality. And maybe there are certain foods that seemed to have a little bit more of a positive effect, like berries that have less of a glycemic load and that are more nutrient dense, and the more nutrient dense food that you have, you're providing your body with the nourishment that it needs to try and help repair itself. And certainly, there is like a spectrum of how one approaches a whole-food, plant-based diet, and the more nutrient dense that it is, the better the results, right. The dietary recommendations and interventions only work when you do them. You can't necessarily eat a vegan diet and just be plant-based without taking a look at the quality of the food that it consists of. And there's a lot of research supporting the fact that you could be on a plant-based diet, but not be very well nourished, and fall into the trap of having a lot of chronic diseases.

But, I think generally speaking when trying to fight inflammation, it's a matter of like cutting... It's kind of spinning it in a similar way of just emphasizing a whole-food, plant-based diet, which is, you know, cutting out processed foods. Cutting processed foods happen to have oil, and added sugar, and added salt. So, you're cutting out processed foods, you're cutting out added oils, you're cutting out sugars, you're cutting out animal products that are laden with the heme iron, the advanced glycation end-products, the Neu5GC. And then, you're adding in more nutrient dense plant-based foods, foods that are higher in omega-3 fatty acids. A lot of the processed foods are high in omega sixes, which also consists of arachidonic acid and that whole pathway and cascade that leads to inflammation, and inflammatory mediators that we take anti-inflammatory drugs for, and Naprosyn, and Advil, and Aleve for to block.

Animal products, processed foods feed that cascade, that is the fuel to the fire, so if you want to turn out the fire, stop putting gasoline on it and smother it. So, it's a matter of eating more nutrient dense, plant-based foods that are rich in omega-3 fatty acids, and you're consuming, you know, healthy water.

Robby Barbaro: This all makes perfect sense, in 100% alignment with everything we teach here. And, you know, before we go, I just want to bring up one issue on this, one topic about this, which is celery juice. Have you heard of people using celery juice that Anthony Williams has been teaching people? We've heard him talk about it in our Summit interviews in the past. And I mean, there's no science, Anthony is the first person to say there's not scientific research on this, but there's a lot of anecdotal evidence of people using straight celery juice in the morning, first thing in the morning, just celery juice, not eating anything afterwards. And this having a big impact on neuropathic pain. So, I don't know if you've heard of that or not?

Evan Queler, MD: I haven't specifically heard about it. I will look into it. I think that some things like that are great, but then you're also, you know, but then we forget about, and I think that it's great if you want to try and juice some celery, but we also have to think about all the fiber and the prebiotics that we're feeding for that healthy gut bacteria that seems to play such an important role in our health that, you know, we're made up of more genetic material from our microbiome, that we are from human cells. And so, we have to feed that gut bacteria. And celery is great, it has a lot of fiber and a lot of water, you know, so you get some nourishment, you get some minerals, it's not high in sugar, and I'm sure that there's probably something healthy in it that might be helping to alleviate some of the inflammation.

But again, as humans that is the way that we are hardwired, we're looking for that simple fix, that easy fix, that pill, that juice, that supplement, and if it's good news about our bad habits then we're all for it, right. But I don't know, you know, I haven't read anything specifically about the celery juice. I will tune in if I come across anything.

Cyrus Khambatta, PhD: Okay, so let's put it this way. Somebody, let's pretend like somebody listened to a part of this Podcast, maybe they didn't listen to the entire thing. And they want to know sort of the take home message from Dr. Evan Queler. So, you run into somebody in the elevator, you have 30 seconds to explain to them how they can modify their lifestyle to improve, or get rid of neuropathic pain. What do you tell them?

Evan Queler, MD: Eat a whole-food, plant-based diet. That's going to reverse the problem, that's going to get at the root cause of the problem. There are some medications that you could try to help alleviate the symptoms, if you feel that it's too overwhelming. And there are more advanced procedures, like spinal cord stimulation, that could be very effective in alleviating the symptoms but not getting at the root cause of the problem.

Cyrus Khambatta, PhD: That's everything we wanted to hear. You know, it's funny, actually, like, I'll be the first person to admit this. We interview a lot of people for our Summit interviews. We interview a lot of people for our Podcast, and no matter what specific topic we're talking about, whether it's gastrointestinal discomfort, whether it's reducing your risk for Alzheimer's disease, whether it's neuropathic pain, whether it's improving your performance in recovery as an athlete, whether it's reducing your blood glucose, you name it, any one of these topics, the answer is the same. It's the same every single time. And it's almost, the people that get the most benefit, are the people that keep it the simplest, rather than over complicating it, like you said, not getting involved in the minutious, “Well, I want to eat this one food over this food”, but just migrating towards a plant-based diet, and minimizing, or eliminating animal based foods, and packaged and processed foods. I mean, that's the answer, right?

Evan Queler, MD: Yeah. I mean, if you want to take care of anything, you have to give it the right nourishment, right? If you want something to grow, you have to feed it. And again, just like when, in the beginning of the conversation, when you asked me, I was trying to explain how I got involved in plant-based nutrition, was my original interest in that book by Andrew Weil, Health and Healing, and the underlying message was that the body has an innate ability to heal itself. It wasn't the homeopathy, it wasn't the chiropractic, it wasn't the surgery, or the naturopathy. It was the body's innate ability to heal itself. And if we're… You can't poison a sick man well, you know, you can be putting diesel into a... We were eating synthetic-like food, we're overfed and undernourished. So, if a lot of these chronic ailments are just tips of the iceberg, and it's all the same underlying cause of malnourishment.

Cyrus Khambatta, PhD: 100%. Yeah, so if you're listening to this Podcast, and you're experiencing some element of peripheral neuropathy or chronic pain, just ask yourself a simple question. What proportion of your diet comes from whole-food, plant-based, low-fat foods? Is it that you're eating 50% of your diet as low-fat, plant-based, whole-foods? Is it 75%? Is it 90%? Is at 100%?

The message that Dr. Queler has is the same message that Robby and I have, which is that as you move from a lower percentage to a higher percentage, and a higher percentage, and a higher percentage, you're likely, highly likely to start to feel better start, to see dramatic improvements in your blood glucose, and you can alleviate, if not get rid of, a lot of the symptomatology that comes along for the ride, peripheral neuropathy being one of them.

So, have a good look at your diet and ask yourself, are there packaged and processed foods? Even something as simple as a few bites of some potato chips can make a big difference. And how many animal based products do you have? Even eating one or two eggs per week can make a big difference. So, if you're in this situation, take Dr. Queler’s advice, there's no joke about the fact that moving towards a whole-food, plant-based diet, it's not a fully plant-based, whole-food diet, is such a tremendous and powerful solution to peripheral neuropathy, it can alleviate and get rid of neuropathic pain completely. And that's something that is worth considering, for sure.

Evan Queler, MD: And then, as physiatrist I don't want to overlook the idea of the importance of exercise, and how it also ties in in a holistic way to how we feed our bodies, and also how we stimulate them. I commonly would get asked, “What is the best type of exercise that I could do for back pain?”, and there's so much variability out there, and there isn't one specific thing. But one type of exercise that I think is, that might be very helpful for your listeners, it’s not something that I'm affiliated with, it’s just something I practice and would recommend for a patient, is Foundation Training.

So, they could go to the website foundationtraining.com and they could learn about some effective yoga-esque, physical therapy-esque type exercises that change their movement patterns, and stop that deleterious movement pattern, just like banging your shin with a hammer, or just like moving wrong repeatedly, day in and day out. This is a type of exercise that helps strengthen those muscles that support the back, and change the way that we move and carry our bodies.

Cyrus Khambatta, PhD: This is great. And you know, when we talk about exercise, we could have an entire separate discussion. And I think we will have a completely separate Podcast discussion here about how you can utilize movement patterns to start to rewire peripheral nerves, and rewire pain sensations. Something we don't have the time to get into right now. But I think it's very important. Even if you're not experiencing chronic pain, neuropathic pain, you know, exercise is something that's tremendously powerful for improving your insulin sensitivity, dropping your blood glucose and improving your overall health.

So anyway, here's what I want to say, Evan. Thank you so much for being here with us today. You have a lot of experience, a lot of insight, and I love your message, I really do. It's super simple. It's just so blatantly obvious. And there's so much research backing it up that it's really powerful to hear you talk about it from your experience, as a physiatrist, and as somebody who's been dealing with chronic pain management for so many years. So thanks for doing what you do, and we’ll continue to learn from you in the future.

Evan Queler, MD: Thank you.

Cyrus Khambatta, PhD: We hope you enjoyed this episode, and can apply some of these principles to your personal life. Now, we have an Online Group Coaching Program that has helped thousands of people living with all forms of diabetes, reverse insulin resistance, drop their A1c, lose weight, and gain tons of energy. And also reduce their need for oral medication and insulin using, their food as medicine.

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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.