Digestible Facts on Insulin Resistance with Mastering Diabetes Co-Founder Cyrus Khambatta, PhD
By Team Dirty
Jul 15, 2023,
Diabetes affects over 37 million Americans, according to the CDC. That’s about one in 10 people. 🤯However, in the majority of cases, diabetes is reversible with the help of a plant based diet.
If you’re wondering why you’ve never heard that or why so many are prescribed a low-carb, high-fat diet and medication to manage their diabetes, you’re not alone. And how does harnessing the power of plants reverse diabetes, anyway? Our community had the same questions, so our Co-Founder, Molly Patrick, sat down to chat with a passionate expert in the field, Cyrus Khambatta, PhD, of Mastering Diabetes to get all the answers.
Meet Cyrus Khambatta, PhD
Cyrus 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-author of many peer-reviewed scientific publications.
He is the co-founder of Mastering Diabetes and Amla Green, as well as an internationally recognized nutrition and fitness coach who was diagnosed with type 1 diabetes in 2002. He co-created the Mastering Diabetes Method to reverse insulin resistance in all types of diabetes and has helped more than 10,000 people improve their metabolic health using low-fat, plant based, whole-food nutrition, intermittent fasting, and exercise.
Cyrus cuts through the noise and breaks how a low-fat plant based diet can reverse diabetes.
Here’s what we covered:
- The types of diabetes and their differences
- What causes diabetes
- How low-carbohydrate diets often recommended for treatment can actually increase insulin resistance and cause other health issues over time
- How a low-fat plant based diet can lower A1C numbers, reverse diabetes, and often help people lose weight without unintended side effects
Watch the video or read below to get all of his digestible facts about diabetes. Or, tap here to listen to our chat on the podcast.
Molly: Welcome, Cyrus, to our podcast. Thank you for joining us. I’ve got Cyrus here from Mastering Diabetes, and we were chatting a little bit before I hit record. This has been a long time coming. A lot of people in our community are very familiar with you and your work, and you’ve helped so many people. So, welcome to the podcast, and thanks for chatting with me today, Cyrus. Super happy to have you here.
Cyrus: Molly, thank you so much for having me here. This is a pleasure, and I love the fact that you’re providing such high-quality information to allow people to transition to a plant based diet. If you’re helping other people, you’re a friend of mine immediately, so thank you.
Molly: Awesome. So, we’re going to talk about diabetes. We’re going to talk about a lot of things. I have questions from our community that I want to get to towards the end, but the first thing I want to do is get to the basics. Pre-diabetes, type 1 diabetes, and type 2 diabetes. Can you give me a quick recap? What are each of those?
Cyrus: Sure. The way that I like to think about it is there are three different flavors of diabetes. You go to an ice cream shop, and you can get 31 different flavors if you’re in Baskin Robbins. You go to the diabetes store, you can get three different flavors.
- Flavor number one is called autoimmune.
- Flavor number two is called lifestyle.
- Flavor number three is called female.
Flavor number one: Autoimmune
The first one, autoimmune, is type 1 and 1.5 diabetes. These are autoimmune conditions which you don’t necessarily inflict upon yourself. They are induced by any number of lifestyles or by any number of factors from the outside world. They could be a virus that you contracted at some point in your childhood. Researchers have found that mothers who wean their children off of breast milk and towards cow’s milk at a young age, usually before the age of one, end up increasing their risk for type 1 diabetes. So, there are both environmental as well as genetic considerations that factor into it.
Type 1.5 diabetes is also an autoimmune condition, but it affects people over the age of 30, and it is a slow-onset version of type 1 diabetes. So, it’s adult onset, slow-progressing, type 1 diabetes. Those are the two that fall into the autoimmune flavor.
Flavor number two: Lifestyle
Lifestyle is pre-diabetes and type 2 diabetes. This affects 92% of the diabetes population. It’s massive, and those two forms of diabetes are induced by lifestyle. They’re created based on:
- How much alcohol do you consume?
- Do you smoke cigarettes?
- Are you sedentary?
- Are you active?
- Are you overweight?
- What type of food are you eating?
- Are you eating excess calories?
- Do you have a high-fat diet?
- Do you have a low-fat diet?
All of those lifestyle considerations can contribute to the risk of you developing pre-diabetes. If you do develop pre-diabetes and then you do not correct pre-diabetes to go back to the non-diabetic world, you can then progress into type 2 diabetes. But the beauty is that both of them are actually reversible conditions, and we can get into that later.
Flavor number three: Female
Female basically means that it’s a type of diabetes that affects only women called gestational diabetes. Gestational diabetes is effectively the diabetes of pregnancy that some women develop. Usually, women who develop gestational diabetes have actually been living with high blood glucose and/or the underlying condition called insulin resistance. They have actually been living with that for many years, they just didn’t know. So, it’s a pregnancy that induces a very erratic blood glucose control. Then, at the 28-week marker, when they go get an oral glucose tolerance test, their doctor says, “By the way, did you know that your blood glucose is actually quite high?”
That’s the first time that they say, “Wait a minute, diabetes, what are you talking about? I didn’t know anything about this.” Then it’s their opportunity to make some significant changes. Even though it is considered a temporary form of diabetes, having gestational diabetes significantly increases your risk for the development of type 2 diabetes after pregnancy. It also increases the risk for your child to develop type 2 diabetes at some point, even in their adolescent life. So, it’s definitely worth paying attention to.
Molly: Beautiful recap. We’ve got those three flavors covered. I like how you broke that down. So, if I am the average person eating an average Standard American Diet, and I go to my doctor and my doctor says, “Hey, you have diabetes,” what typically will that doctor tell me to do?
Cyrus: Great question. When I was first diagnosed with type 1 diabetes back in 2002, I didn’t know what I could do to try and control my blood glucose. At that time, my medical staff said the only option that you really have to control your blood glucose, and keep it controllable, but then also limit the amount of insulin that you’re using, and prevent yourself from using more and more insulin into the future, is a low-carbohydrate diet.
A low-carbohydrate diet is sort of an umbrella term for any diet that restricts carbohydrate intake, usually to about 150 grams per day or less. So 150, maybe 100 grams per day. Some people go as low as 75, some people go as low as 30, depending on how aggressive you want to be. The idea is that when you’re eating a low-carbohydrate diet, you are eating white meat, red meat, chicken, fish, dairy products, oils, things like turkey burgers, cheese, and lean meats, in general. Then you can also have nut butters, peanut butter, almond butter, and the like, and you’re trying to reduce your intake of all carbohydrate-rich foods, whether they are refined, meaning they come from things like cookies, crackers, chips, pasta, bread, sodas, and sugar-sweetened beverages, or whether they come from whole carbohydrates, like fruits and vegetables and legumes and whole grains.
The world of carbohydrates is unfortunately talked about as though it’s this one-size-fits-all approach, that drinking a soda is the equivalent of eating a banana or having white table sugar is the equivalent of eating a mango.
Unfortunately, that’s just so far from the truth it’s almost embarrassing. But you’re recommended to eat as low-carbohydrate diet as possible, and then in substitution for those carbohydrates that you’re not consuming, eat more protein-rich foods and eat more fat-rich foods, and then continue to adopt this low-carbohydrate methodology into the future.
That’s what I was told in 2002. That’s still pervasive now. It’s gotten even stronger, and there are millions of people around the world who are told to eat a low-carbohydrate diet because living with diabetes effectively means that you’re allergic to carbohydrates. That’s the messaging, and it’s actually a fundamentally incorrect statement.
Molly: If I went to the doctor and the doctor said, “You have diabetes, you’re in the diabetic range, you have to watch your carbs, we’ll put you on this diabetes diet.” That’s a standard issue diabetes diet?
Crushing on carbs and reversing diabetes
Molly: Does it work?
Cyrus: That’s a great question. Let me put it this way. A low-carbohydrate diet, again, is an umbrella term. Underneath the umbrella of low carbohydrates, you have the Atkins diet that was originally invented back in the 1970s and then recreated back in the 1990s, a very low-carbohydrate diet. You also have things like the Zone diet, the South Beach diet, those are all technically considered low-carbohydrate diets. Then you’ve got the paleo diet, that’s a low-carbohydrate diet. You’ve got the ketogenic diet, which is a very low-carbohydrate diet. And then you also have a carnivore diet, which is also a very low-carbohydrate diet. All of those fit underneath that umbrella.
The reason why those eating patterns became popular in the first place is because they are rapid weight loss tools.
That is the number one reason people are attracted to eating a low-carbohydrate diet—because it is a very powerful weight loss tool. What most people discover when they start eating a low-carbohydrate diet is the weight just falls right off of them. When I say falls, in the first month, it’s not uncommon for people to lose something like 12 to 16 pounds in one month. Then by the time they hit month two, month three, month four, before you know it, they have 20 pounds off of them, 25, 30 pounds.
Then a lot of their biomarkers begin to improve because as they lose weight, they find their total cholesterol will drop, their triglyceride value will drop, and their A1C, which is a three-month marker of blood glucose control, drops. Their fasting blood glucose drops. Their blood pressure will drop. They start to see all these biomarkers move in the right direction, and they look at themselves on a piece of paper and they go, Whoa, are you telling me in the last three months I’ve lost 26 pounds and I’ve lowered my cholesterol, my blood pressure, my blood glucose? Clearly, this is working, so I’m going to continue to do this.
So to answer your question, does it work? The answer is absolutely, it works like wildfire in the short term. However, there’s a huge elephant in the room, which is, does it also work in the long term? The long term is vague, but anything longer than a year, two years, three years, or five years into the future.
If you look into scientific research, which is something that I’ve spent way too many hours doing myself, having tried to really answer this question for myself as objectively as possible, you have to take a look at many different types of research studies. There are research studies that are conducted as an example in a metabolic ward that happened over the course of two weeks in a highly controlled environment. Then you have other types of studies that are six-week-long studies with 50 participants where they’re not in a metabolic ward, but they’re actually at home. You have other studies that are randomized control trials that can last anywhere from three to six months, which tells you a slightly different story. Then you have what is called epidemiological studies, which study 5,000/10,000/20,000 people over the course of two to 10 years and try to figure out what happens to people over a long time.
What the research shows is that the short-term studies demonstrate significant positive benefits, just like we talked about. But as you fast forward in time and you get to that one-year time point, the two years, the five years, you see a number of problems.
Number one, adherence is way down. It’s very easy to stick to a very low-carbohydrate diet in the short term because you get all these benefits that come along with it. But usually, somewhere around the six-month marker, nine-month marker, or twelve-month marker, it becomes very hard to follow a very low-carbohydrate diet, and you see a lot of people just stop doing it. So, adherence goes from something like 85% to 90% to south of 20% because it’s just flat-out hard to eat that way.
In addition to that, there are a lot of these adverse side effects that come along for the ride, and these adverse side effects are all symptoms of one root condition. That one root condition is called insulin resistance. So effectively, by eating a low-carbohydrate diet, you eat yourself into a highly, highly insulin-resistant state. I can talk about what that actually means in a second, but let’s just assume that’s a true statement.
You eat yourself into a highly insulin-resistant state, and then a lot of the symptomology of living in an insulin-resistant state starts to manifest itself, including number one: high LDL cholesterol, which is the “bad cholesterol” that predicts your risk for a future cardiac event.
You don’t want that number high, and that tends to creep up pretty quickly. Number two: total cholesterol starts to creep up. Number three: what’s called ApoB, which is a measure of the atherogenic or dangerous cholesterol in your blood, also tends to creep up. Number four: triglycerides tend to creep up. Number five: the A1C value tends to creep up significantly. Number six: fasting blood glucose tends to start creeping up into the pre-diabetic range or sometimes the type 2 diabetes range.
Then the initial weight that people lost either plateaus or people starts to gain that weight back over the course of time. So it does this u-shaped curve where it comes down and then flattens out and then starts to creep up.
Then you have a whole bunch of these ancillary health conditions that come along for the ride. They’re not actual diseases, but they’re symptoms that don’t feel good: gas, bloating, constipation, abdominal pain. Dysbiosis, which is a very painful and very uncomfortable metabolic state that affects your digestive system, happens frequently and intensely.
Molly: That’s as a result of not enough carbohydrates or even a very low-carbohydrate diet.
Cyrus: That’s exactly right. It’s a direct result of eating a low-carbohydrate diet. In addition to that, people end up with very low energy. Sometimes they get brain fog. The energy level is one thing that we’ve heard over and over and over again. People are like maybe I’m just getting old quickly, but I don’t know where my energy is. That’s not a diagnosable condition, but it’s a real thing. It can become fairly problematic over time.
Molly: Really concise and to the point. Love it. Why does eating a very low-carbohydrate diet make people lose so much weight?
Cyrus: Great question. There are actually multiple reasons why weight loss happens in the short term.
First things first, when you consume a diet that’s high in dietary fat and/or dietary protein, which tends to happen in a low-carbohydrate world, the fat and protein basically travel down your esophagus, it goes into your stomach, and it starts to get unfolded or unpackaged.
Then it gets inside of your small intestine where there’s a whole cocktail of digestive enzymes that are secreted by your liver and your small intestine and your pancreas to go start to degrade those nutrients and cut them into the smallest pieces possible, absorb them through the walls of your small intestine and put them in your blood so they can go elsewhere.
In that process, your small intestine has a way of detecting what is inside of it, and it can detect how much carbohydrates are there, how much fat is there, and how much protein is there. When there are fat and protein-rich molecules or nutrients inside of your small intestine, there are actually peptide hormones that are secreted by your digestive system.
Those peptide hormones circulate through your blood, and they can impact the way that your brain functions.
Some of those peptides float up to your brain, and they communicate with your appestat or your feeding centers in your brain, and they basically say, hold on, hold on, hold on. There are a lot of calories in this food. I just took on a lot of calories in a very short period of time. You should stop eating. Your appestat, which is in your hypothalamus, a little pea size gland that’s above the roof of your mouth, that’s basically the thing that controls your appetite, says oh, okay, cool. Hold on. Decrease appetite, decrease appetite.
As a result of that, you end up becoming less hungry, and as a result of becoming less hungry, you end up taking in less food. So you hear this constantly from a lot of people who eat a low-carbohydrate diet. They say, “You know what? I’m not even that hungry anymore. I eat once a day, twice a day, and it’s really not that hard for me to go long periods without food.” And again, the reason for that is because there’s two-way communication between your digestive system and your brain, and your digestive system is picking up the phone and calling your brain and saying, hey, by the way, you should slow down. You should slow down how much you’re eating because there are a lot of calories inside of you already.
As a result of that, you end up decreasing your appetite. When you decrease your appetite, oftentimes, you go into what’s called a negative calorie balance. Negative calorie balance basically means that your appetite is so low that you end up taking on fewer calories than your body is actually metabolizing or burning. Just as simple numbers, let’s pretend you’re burning 2,500 calories per day, and your appestat is turned down, and your appestat basically says okay, cool. I’m not that hungry anymore. I’m trying to protect you from taking on too many calories. You end up taking on 2,100 calories per day, and you now have a 400-calorie negative calorie balance. As a result of that, that 400 calories is then going to translate to weight loss over the course of days, to weeks, to months, to years. That’s sort of how weight loss can begin. That’s number one.
Number two, when you eat a diet that is rich in protein and fat, there is a molecule known as glycogen, and glycogen is basically the storage form of carbohydrates inside of your liver and inside of your muscles.
Glycogen is approximately equal to 2000 calories in the average human being, which means that you can store about 2000 calories worth of glucose inside of your liver and muscle. When you’re eating a low-carbohydrate diet, and there isn’t that much carbohydrate energy coming in your mouth, that means that there’s going to be less glucose getting inside of your liver and muscle, which means that there’s going to be less glycogen inside of your liver and muscle. The reason why we care about glycogen is because glycogen is what’s called hygroscopic. Hygroscopic means it attracts a lot of water. It’s like a sponge. So for every mole of glucose that’s present inside of the glycogen molecule, there are three moles of water to come along with it. It basically has a three-to-one water-to-glycogen ratio. What that means is that glycogen becomes heavy because it attracts water to surround it. So when you lose glycogen, you actually lose three times the molar equivalent of water, and then that translates to a lot of weight loss. So, for a lot of people, within the first month, you can lose something like eight to twelve pounds, and a decent amount of that weight loss is usually not fat tissue, it’s just pure water that left because the glycogen stores have decreased.
So those are the two primary reasons why people end up losing weight. And then again, over the course of time, sometimes that weight loss can stop, or weight loss can plateau, and then it can become problematic.
Molly: Super clear. I want to get back to diabetes, but I have a follow-up question for people out there who might be wondering. Some people might be listening to this and thinking well, I wanna lose weight, so that sounds like a really good plan.
Molly: If that’s effective, then I should definitely try that. Why might somebody want to rethink that?
Cyrus: That’s a very good question. If you’re attracted to the idea of rapid weight loss, join the club.
There are millions of people around the world that have eaten themselves into being anywhere from 10 pounds overweight to 150 pounds overweight, and the weight has been sticking on them for some period of time, and it can be very problematic.
From an inflammatory perspective, it can significantly increase your risk for many metabolic dysfunctions. It can increase your risk for certain types of cancer. It can increase your risk for type 2 diabetes. It can increase your risk for cardiovascular diseases. Having excess weight on you is generally considered a very problematic thing from a metabolic perspective.
People are attracted to this idea of rapid weight loss because why not? I want to get this 40 pounds off of me. You’re telling me that I can lose 40 pounds in the next two months? Awesome. I’m in. Why would I not lose 40 pounds in two months versus losing 40 pounds over eight months? Of course, I’m gonna choose option two because let’s get it off me. Why do I have to wait?
But here’s the problem. Again, the low-carbohydrate diet is a very effective way of losing weight for all the reasons we just described, but I said earlier that low-carbohydrate diets induce insulin resistance.
Insulin resistance is a very important topic in the world of health that we need to, have to, must talk about because if we don’t, we’re pretending like it doesn’t exist.
Insulin resistance is caused by the accumulation of excess saturated fat inside of your liver and muscle, and most people are unaware that this is even the case. But here’s what happens.
When you eat fat and protein-rich foods, things like white meat, red meat, chicken, fish, dairy products, oils of many different types, and even plant based fat-rich foods like nuts, seeds, avocados, olives, coconuts, they all contain a significant amount of triglycerides. Triglycerides, depending on the type of fat, have more saturated fat or less, but saturated fat is mainly found inside the animal world.
Let’s just say I ate a meal that was saturated fat-rich, like I had a cheeseburger with a white bun.
The saturated fat comes from the hamburger itself, plus the cheese on top of it, and then there’s some refined carbohydrate to come along with it in the bun on the top and the bottom. You consume that food, and the saturated fat inside of that burger and inside of that cheese ends up getting distributed to tissues. But before it gets to the tissues, the saturated fat ends up getting absorbed through the walls of your small intestine.
Imagine you have a garden hose outside. I’m sure you’ve probably touched a garden hose before. You’ve got a garden hose, and you turn on the spigot, and then water is flowing through the hose, and then it comes out the other end. That’s like an analogy of what your intestine looks like. But imagine if you took a nail and you popped it through the side of the hose. What would happen is that as soon as you turn the hose on, now you’d have water coming out of that little hole. You could do that hundreds of thousands of times, and then you end up with a leaky hose that’s now spilling water out of every single different hole. Your small intestine is permeable in that same regard. There are billions, trillions of these little holes in them, and that’s okay. That’s fine. The reason that they’re there, the reason that it’s constructed to be permeable in the first place, is because the stuff that’s on the inside of your piping has to be able to transfer through the walls of your piping to get into your blood.
The saturated fat molecules end up getting absorbed through the walls of your small intestine. They get put into what’s called your lymph system. Your lymph system is basically a way of transporting waste products. Your lymph system then dumps the saturated fat molecules into your blood, and inside your blood, they’re put into these little things called chylomicrons. Imagine this is a chylomicron particle in my hand right here. There are trillions of these in your blood at all times. These chylomicron particles are basically little spaceships or little cargo ships that get stuff put inside of them. So I can put cholesterol inside of these chylomicrons, and I can also put saturated fat inside of these things. So, if I have some saturated fat that came from my diet, I can then package them into these chylomicron particles, and then the chylomicron particles end up circulating all throughout your blood so they can eventually distribute the cholesterol and triglyceride elsewhere.
What ends up happening is these chylomicron particles give the saturated fat to your liver, to your muscle, and your adipose tissue. Those are the three primary destinations. In an ideal world, the fatty acids would go directly to your adipose tissue, and that’s because your adipose tissue is a very safe place to store fatty acids. It’s perfectly designed to be able to take it. It’s perfectly designed to be able to hold it for long periods of time, and that’s the right location. What ends up happening is that these chylomicrons distribute these fatty acids to your adipose tissue, and then there’s a spillover effect. The spillover ends up going inside your liver and inside your muscle tissue. And again, that’s okay as long as the amount of fatty acids that get inside of them is very small because their biological design is to have a small amount.
When you’re eating a low-carbohydrate diet, and you consume a cheeseburger for lunch today, then maybe you have some meatloaf for dinner tomorrow, then maybe you have some bulletproof coffee with coconut oil in it tomorrow morning, and then you have some cheese and yogurt for lunch, and then you have another milkshake for dinner and so on and so forth.
Every meal, you end up taking on more saturated fat and more and more and more and more and more.
In a short period of time, it overwhelms your liver and muscle with too much saturated fat. Your liver and muscle end up going into a self-defense mode where they’re like, oh my God, where is this stuff coming from? I don’t even want this. I didn’t ask for this in the first place, and I can’t block it from coming in. So your liver and muscles go into self-defense mode, and self-defense mode basically says, how can I block, or how can I prevent more of this stuff from coming in? The easiest way for any tissue to block energy, fatty acids, amino acids, and glucose from coming inside is just to tell insulin to go away because insulin is the gatekeeper. It’s the master anabolic hormone in your body. Insulin’s job is literally to go knock, knock, hey muscle, hey liver. There’s some glucose inside of the blood, there are some amino acids inside the blood, and there are some fatty acids inside the blood. Do you wanna take it up? Because it’s here right now. If you wanna take it up, this is your signal. Go.
Your liver and muscle can respond by either saying, cool, sweet, thanks for telling me you’re here. I didn’t even know. And then they open their doors, and they allow that stuff to come in. Or your liver and muscles can say, uh-huh, I’m not ready. I don’t have enough space inside of me.
I don’t have enough room inside of me because, guess what? There are all these saturated fatty acid molecules that are already inside of me. I gotta go oxidize these bad boys first.
These saturated fat molecules end up occupying the space and basically creating a metabolic traffic jam such that when you eat one banana or a bowl of black beans or just a small amount of carbohydrate later, the glucose from that carbohydrate comes to the door of this liver and muscle, the insulin goes, knock, knock, there’s some glucose in the blood. Do you wanna take it up? And both of those tissues respond by saying, sorry. I’m not open for business. Go away.
So effectively, the glucose gets trapped in your blood, it ends up accumulating, you end up with a high blood glucose value, and then you end up with an insulin secretion problem too, because your pancreas goes, oh, well, these four units of insulin didn’t seem to get the job done.
Why don’t I just go make more insulin? Then it basically overpowers your liver and muscle into behaving so that it starts to take glucose into your tissues.
So what does all this mean? Low-carbohydrate diets create a metabolic traffic jam in your liver and in your muscle. As a result of that, you accumulate saturated fat in both tissues, that then causes this thing called insulin resistance, where both of those tissues are not paying attention to insulin very well anymore as a self-defense mechanism. That becomes hugely problematic because insulin resistance is the single most important condition in our health world today, in my professional opinion. The reason for that is that insulin resistance influences almost every chronic disease that you can possibly think of, whether it’s pre-diabetes and type 2 diabetes, whether it’s high cholesterol, coronary artery disease, hypertension, obesity, many forms of cancer, chronic kidney disease, erectile dysfunction, neuropathy, retinopathy, blindness, and the list goes on.
So, if you develop a lot of insulin resistance and that insulin resistance grows over the course of time, sure, you can lose weight today, but you end up increasing your risk for many chronic diseases in the future.
I don’t know about you, but I don’t want that, and I’m assuming that most people don’t want that, either. So it becomes, again, a short-term solution that turns into a long-term metabolic liability.
Instead, we recommend that people adopt a different way of eating, and that is a more plant-focused approach where they’re actually eating a low-fat diet. A low-fat diet insulin-sensitizes you and makes you hyper insulin sensitive, which is the opposite. As a result of that, you end up losing weight in the short term, which is a short-term solution, and your risk for chronic disease comes way down into the future. So it’s a short-term win, and it’s a long-term win simultaneously. Does that make sense?
Molly: It makes so much sense. I love your analogies, and you make it very clear. Thank you for that.
Cyrus: For sure.
Molly: So, I’m at the doctor, I get the news. My doctor says, “Okay, you have to eat very low carb.” I guess it depends on my numbers, but typically at that point, would I be put on medication to manage my diabetes while then focusing on a low-carbohydrate diet? Is that the typical path forward?
Cyrus: Great question. Your doctor’s responsibility is to try and figure out what’s the most effective way to prevent you from getting more diseased over the course of time. So, it all depends on what the number is that shows up on the blood test.
If you come to the doctor’s office and your fasting blood glucose is beneath 100, that means you’re non-diabetic, and they’re like, cool, sweet, high five, you did a good job. If your A1C value is less than 5.7%, they’re gonna say cool, sweet, high five. You’re technically considered non-diabetic.
If your fasting glucose is between 100 and 124, that means you’re moderately elevated. That means you’re in the pre-diabetes zone. Or, if your A1C is between 5.7 and 6.4%, then you’re in the danger zone. Again, pre-diabetes.
If your fasting glucose is 125 or greater, or your A1C is 6.5% or greater, now you’re in the type 2 diabetes zone.
Depending on where you are on this spectrum from non-diabetic to pre-diabetic to type 2 diabetes, they have to put that through their algorithm and say, okay, the standard of care tells me that at this blood glucose value, with this A1C value, with this body weight, here’s my recommendation. You should be taking metformin, I’m gonna prescribe you a thousand milligrams per day, and I’m gonna put you onto a low-carbohydrate diet, and I’m gonna tell you to go exercise. Diet and exercise. Diet and exercise. Most people who get diagnosed with some form of diabetes end up being prescribed medication. Medication does have a time and a place, but it’s not a long-term game. There can be a lot of unfortunate consequences that come along with it [and] unfortunate side effects.
What we try and recommend people do is think of your food as medicine and think of your food as being a first-line defense against a growing collection of metabolic dysfunctions.
If you can resort to food first, what you’re likely to find is what thousands of our clients have found over the course of time, which is that when you adopt a whole food plant based diet and it’s low in fat, your medication requirements plummet quickly. One of the beauties of eating a whole food plant based diet is that your need for pharmaceutical medication goes down, and your doctor can see that pretty darn quickly.
Molly: A perfect segue because my next question was what’s the alternative? And you kind of laid it out for us here. A low-fat, whole food plant based diet is an alternative to that. So, why does that work better?
Cyrus: It works better because of the insulin resistance game that we just described, where there’s an excess accumulation of saturated fat inside of your liver and muscle.
If that’s your starting point, and that’s where you exist right now because you’re eating a low-carbohydrate diet or because you’ve maybe not been paying attention to your diet, eating the Standard American Diet, there’s a way out of that.
- Significantly reduce the amount of saturated fat that goes in your mouth, because that’s the culprit. That’s the thing that’s causing the traffic jam in the first place. Number one, we have to significantly reduce the supply. Sometimes people twist my words, and they say, oh, well, I have to stop eating all fat. And the answer is no, you can’t. You can’t stop eating all the fat. There’s no such thing. What I recommend doing is to eat a whole food plant based diet that just contains small amounts of nuts and seeds and avocados and olives, and try and eliminate oil if possible from your diet, because people who are living with diabetes will benefit from reducing their oil intake or getting rid of it altogether. So number one, significantly reduce your total fat intake.
- Eat a very plant-rich, plant-heavy diet of fruits and vegetables and legumes and whole grains. When you do that, a number of things unfold in your favor. Number one, the traffic jam inside of your liver and muscle tends to get less problematic. Your liver and muscle end up taking those accumulated saturated fat molecules, and they send them to the mitochondria, and the mitochondria oxidize them for ATP. They disappear, and then you end up reducing the stress that both of those two tissues are experiencing. The way I like to think about it is that you get out of the fatty acid economy, and you enter the glucose economy. You get rid of using fatty acids for fuel and have fatty acids enter your mouth, and that is the primary currency inside of your digestive system. Instead, you transition over to the carbohydrate economy where you’re eating more of that in abundance, and you’re storing more of that, and you’re oxidizing more of that on demand. That’s number one.
But number two, we also have to talk about this fun little thing called fiber. Whole foods contain actually nine different classes of nutrients. Let me start with the top. The macronutrients: carbohydrates, fat, and protein. Those are the three energy-deriving macronutrients, carbohydrate, fat, and protein. Then, in addition to that, you have vitamins, minerals, fiber, water, antioxidants, and phytochemicals. That’s a total of nine classes. Three of them are macronutrients, six of them are micronutrients. So, every time you eat a whole food, it could be a banana, it could be a bowl of black beans, it could be some quinoa, it could be a potato, it could be a cucumber, it could be tofu.
Anytime you eat a whole food, a whole food is actually a three-dimensional matrix that contains every single one of those nine classes of micronutrients.
The distribution, what you’ll find in something like a cucumber, is just slightly different than what you’ll find in a banana in terms of how much of any one of those given things it has. But the fact of the matter is the cucumber has all nine of them. The banana has all nine of them. The tofu has all nine of them. The chickpeas have all nine of them. Now, that three-dimensional matrix basically has rebar inside of it, and the rebar is the stuff called fiber. Have you ever been driving down the highway or driving through the city and you see a highway overpass in the middle of construction or a bridge being constructed? Have you ever seen these things before?
Cyrus: Oftentimes, what they’ll do when they’re constructing these things before they pour the concrete into the support pillars for an overpass, as an example, they will frame it with a bunch of wood on the outside, and then they will put rebar, which is actually metal, on the inside.
That will give it its skeleton. As soon as that whole thing is constructed, they will then bring in the concrete trucks, and the concrete trucks will pour concrete directly into that. They will let that dry, and they’ll remove the wood, and now you have yourself a concrete pillar. The reason why we’re talking about this is that the rebar that’s inside of that concrete support is actually what’s giving it its structural stability.
Same thing. The fiber inside of whole food is what gives it its structural stability. There’s fiber inside of a banana. There’s fiber inside of a cucumber. There’s fiber inside of a chickpea. The fiber looks and feels slightly different in each one of those, and it gives it a different characteristic shape and feels and size and density, but the idea is that the fiber is there to serve as the structural rebar. Then, in addition to that, you have all the other nutrients, carbohydrates, fat, protein, water, vitamins, minerals, antioxidants, and phytochemicals that are all interspersed and distributed all throughout the three-dimensional area. When you put that in your mouth, your mouth starts to grind it up, it gets inside of your stomach, it starts to go into an acid bath and get decomposed, and then it goes into your small intestine, and you have a whole cocktail of digestive enzymes which are there to start to rip it apart.
The fiber, again, is a structural molecule, and you cannot digest the fiber. It’s actually non-digestible as far as human beings are concerned. It has to get passed into your large intestine, way further down your digestive tract, and then the bacteria inside of your microbiome are the ones that can actually break that down and use it for their own fuel.
The reason why it’s important is because fiber slows down the digestive process significantly. Fiber acts as a brake, and it slows the rate at which carbohydrates, or glucose, and fructose get inside of your blood.
It slows the rate at which fatty acids get inside of your blood. It slows the rate at which amino acids get inside of your blood. That’s a good thing because in the post-meal state, you don’t end up with these rapid blood glucose spikes and these rapid fatty acid spikes that you see people on the internet claiming to happen.
So if you’re, number one, eating a low-fat diet and you don’t have a metabolic traffic jam inside of your liver muscle, and number two, you’re eating fiber-rich foods that lead to a normal physiological response of blood glucose and fatty acids and amino acids over the course of the next few hours, then you end up with what’s called totally normal digestive physiology. That’s a good thing because it keeps your blood glucose controlled, it keeps your lipid panel controlled, and it keeps you feeling good, having a lot of energy, and being able to store those carbohydrates inside of your liver and muscle. That translates to excellent short-term health and excellent long-term health down the road.
Molly: Love it. So good. So clear. I really like how you explain things.
Cyrus: Thank you.
Molly: It makes me so happy that I eat a whole food plant based diet.
Our members have reversed diabetes while enjoying every bite
Cyrus: It’s funny because there are so many things that are happening under the surface, and what I’m explaining here is just the tip of the iceberg. There are literally thousands of things under the surface that scientists are still trying to figure out, and it’s fascinating because every time you learn something new, you’re like, I never knew that was happening. I didn’t know that was happening.
Cyrus: How long have you been eating a plant based diet for yourself?
Molly: Well, I’ve never eaten meat in my life. Never once.
Cyrus: Oh, wow.
Molly: And I’ve been eating plant based specifically since 2010.
Cyrus: 2010. So you are a 100% plant based eater?
Cyrus: What was it that got you interested in eating a plant based diet in the first place?
Molly: I was working for a plant based company. I was vegetarian my whole life, so I thought if I’m going to work for this company, I better give it a shot, at least, to drop the dairy and the eggs. I did that, and it was really easy, and I felt really good, so I didn’t think there was a reason to go back. It just stuck, and then I read more about it, and then I thought, this is amazing. It was a very easy transition for me.
The thing that amazes me, and I think amazes so many people, is that the thing that helps us the most, when we’re talking about diabetes specifically, the thing that helps us is the very thing that we are told not to do. And I think that it has people fucked up. It has people confused and thinking I can’t eat fruit. I can’t eat carbohydrates.
So if somebody is listening to this and they say, okay, I have diabetes. I’ve been told not to eat carbohydrates.
I’m hearing this, and I know that you have so many people in your community, and you’ve worked with so many people to reverse this condition. What do you tell somebody who’s confused by the conflicting information?
Cyrus: It’s very simple. Turn off the internet. I hate to be so crass when I say that, but YouTube, Instagram, TikTok, and Facebook can be very confusing places. In today’s world, it almost feels like everyone’s an expert. There are people who are qualified to talk about nutrition and fitness, and then there are people who claim to be experts in nutrition and fitness. Within a short period of time, you end up having a whole bunch of cooks in the kitchen, everybody telling you something that’s slightly different than the other person, a lot of conflicts, a lot of finger-pointing, a lot of name-calling. Before you know it, your average person who’s just trying to find a way to eat healthier gets confused, gets frustrated, and then says, you know what? Even these people can’t figure out what the heck they’re talking about. I’m going to do nothing. I’m literally going to do nothing because there doesn’t seem to be any consensus. It breeds a lot of apathy, which is unfortunate because that’s the exact opposite of what we want.
I’ve been in this game for 20 years, and when I say this game, I mean when I first was diagnosed with diabetes, it was the year 2002. I switched to eating a plant based diet in 2003, and from that moment onwards, I invested myself into really understanding the science behind it because I thought it was fascinating.
What the heck is happening inside of my body, and is what I’m also experiencing applicable to other people? If so, let’s go try and learn it so that we can help other people.
That’s not hyperbole, and I’m not trying to exaggerate something that doesn’t need to be exaggerated. Eating a plant based diet may not be the 100% solution for all humankind, but it is an unbelievably powerful medicine that can help you reduce your risk for and reverse many chronic diseases like we’ve been talking about.
If you look into the research, you’ll find that people who eat a plant based diet, or the studies that demonstrate the power of a plant based diet, show significant improvements for or can significantly reduce your risk for:
- Many forms of cardiovascular disease
- Coronary artery disease
- High cholesterol
- Type 2 diabetes
- Polycystic ovarian syndrome, the symptomology of that can be significantly improved
- Neuropathy, which is nerve tingling or nerve damage.
- There’s also a strong body of research that demonstrates the power of eating a plant based diet for reducing your risk for the development of dementia and Alzheimer’s disease 30 to 40 years in the future.
This massive collection of information that we have developed as a scientific community, from literally the 1930s all the way to now, call it 90 years worth of research, is so large that it is almost overwhelming. It is there. It is available for your average person to go read, but your average person isn’t going to go to PubMed and try to read some esoteric science because it’s too much. It’s too complicated. The research exists, and it is there, it is powerful, and it really demonstrates the incredible power of eating a plant based diet.
Yet on the internet, the exact opposite thing is happening. People want quick solutions.
People want to lose 16 pounds in the next two weeks. People want to lose 30 pounds in the next two months because they want to fit into this wedding dress or they want to look good when they go to the beach. A lot of what people do is driven by a short-term mindset and a band-aid mindset, the way that I think about it. Let me just do this thing so that I can patch this problem, and then I can solve it in the short term. I don’t care about the long term, who cares, let me just solve this quickly.
That ends up causing a lot of problems down the road. As long as there are people, there will be companies and businesses and people who prey on this short-term mindset, and then you’re going to constantly have these problems.
If you really take a step back, take a deep breath, and say, alright, I’m trying to do something for myself that works in the short term for sure, but I’m also trying to do something that works for me in the long term for sure. And I almost prioritize my long-term health more than I care about my short-term health.
If you can really, really get into that mindset and really believe it, then you are likely to migrate over to eating a plant based diet because the information and the data is so strong that it’s almost impossible to deny.
Molly: That’s a really powerful mindset shift, to say, oh, I’m doing this for the long term. Because then I think, too, we’re more likely to stick with it because we’re not looking for that instant gratification as well, not that it won’t benefit us right now, because it will, but we’re also going to stick with it because we know that this is for the long game. That was a really powerful statement, so thank you for offering that.
Cyrus: For sure. One thing that we’ve also noticed within our coaching program (we run a coaching program specifically for people with all forms of diabetes to transition their lifestyle) and in the first iteration of the coaching program, we told people “Come, join, hang out with us for as long as you want, and then you can peace out when the time is right for you,” just to make people feel like they’re not locked into some kind of contract. What ended up happening is that there were a lot of people who joined, and then they would stick around for like a month or two months or three months, and they wouldn’t get very good results because they were looking for the short-term fix. They were sort of acting impulsively, and then they would leave, and they’d be like, oh, it didn’t really work.
Then we started to switch the way that we communicated, and we started to say, “I’m not even gonna let you into this world unless you commit for a six-month period or a 12-month period. Period. End of story. If you want to solve this problem in the next month, do it by yourself. We’re not interested. You’ve got to be here for at least six to 12 months, and if you can commit to that timeframe, then we can commit to significantly improving your health.”
When we made that switch, holy crap. The number of people that got good results went through the roof, and the impact that it was having on people’s health was unbelievable. So, you’re right, you have to switch your mindset. If you’re in the short-term mindset, switch it over to a long-term mindset, and it will change everything about you as far as I’m concerned.
Molly: Beautiful. So good. I can’t believe we’ve been talking for so long. This went really, really fast.
Cyrus: No, it’s all good.
Molly: I have some questions from our community, but I first wanted to ask—we touched on if you’re doing the Standard American Diet thing or if you’re doing the low-carbohydrate thing, you know, switching to plants, okay, awesome. If people are eating a plant based diet and maybe their numbers aren’t right where they want them to be, what do you suggest? Is it just playing around with the amount of nuts and avocados and coconut milk and that kinda stuff in your diet? What advice would you give a person who’s already eating a whole food plant based diet?
Cyrus: You could take 100 whole food plant based eaters and put them into a room and ask, “What do you eat?” And you’ll come up with a hundred different solutions, a hundred different answers because everybody has slightly different preferences, different activity levels, different desires. As a result of that, there is really no template. But let’s just give an example.
Suppose somebody is eating a whole food plant based diet and they’re committed to doing that, and yet they still find that they are 20 pounds overweight and they just can’t seem to get that extra 20 pounds off of them. I would do a deep dive into their diet, and what I’m trying to figure out is things like what is your macronutrient breakdown, meaning how many grams of carbohydrate do you eat per day? How many grams of fat, how many grams of protein do you eat per day? I would want to know that. I would also want to know how much fiber are you eating per day in total. I also want to know do you include oil in your diet, because oil can be controversial in today’s world. In addition to that, are there nut butters in your diet, yes or no? And take a look at overall fat-rich foods, because we discussed that they can be problematic.
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So, let’s say we did a deep dive and we found out that this individual, as an example, who was trying to lose 20 pounds was eating 50 grams of fat per day, and eating 110 grams of protein per day, and then maybe they had 300 grams of carbohydrate per day. I would look at that and say here’s what I would try. I would do an experiment. I’m all about short-term experimentation to try and figure out what works and what doesn’t work. I would do a seven-day experiment or even maybe a 14-day experiment, and I would say you’re eating 50 grams of fat per day, here are your sources, and some of it contains oil. Number one, we’re going to take out oil for the next week. Can you take out oil 100%, and get rid of it? And people say that seems hard, but okay, I’m willing to try. So I take out oil, and then I say, your new target for fat is 30 grams of fat per day. I want to drop your fat intake by 20 grams of fat per day, and we’re going to do it by eliminating oil. I’m also going to get rid of this almond butter that you have with your breakfast, and I’m also going to get rid of this coconut milk that you usually have with your dinner.
By making those small adjustments, now we’ve dropped your fat intake from 50 down to 30, and as a result of that, maybe your protein intake might change a little bit. Then I might replace some of that energy with more fruits. I want you to eat four more servings of fruit per day.
I don’t care what it is. It could be apples, bananas, papayas, mangoes, or blueberries, I don’t care, just put four more servings of fruit into your diet. Let’s see what happens. Usually, in those scenarios, people will end up making those small tweaks, and they’ll come back a week later, and they’ll be like, oh, wow. I just lost a pound and a half. How’d that happen? That’s a good sign, right? Let’s continue it. Let’s do it again, and then we repeat it over and over and over again.
Generally speaking, people who eat a whole food plant based diet are unaware of how much fat and protein they’re consuming. They think that just because they’re eating a whole food plant based diet that everything is going to be fine, and their whole health is going to take care of itself. And the answer is, in general, sure, but eating a whole food plant based diet doesn’t necessarily mean that your macronutrient distribution is set properly.
Secondarily, a lot of people who eat a whole food plant based diet still incorporate some packaged and processed foods into their diet. There might be some pita chips. There might be an Impossible Burger here and there, and there might be a Beyond Meat burger here or there. They might have some soy crackers. So I try to look for those refined and packaged and processed manufactured foods, and one by one, just yank ’em out. Boom, we’re going to do next week with no Impossible Burgers.
We’re going to do the following week where you eat none of those pita chips. We’re going to do another week where you don’t get store-bought hummus that’s got a lot of oil in it. You’re going to make your own hummus at home.
Tiny little changes. Those things can have a significant impact because they can significantly change how much whole food you’re eating versus how much refined food you’re eating and how much fat you’re eating in particular.
Molly: I think for those people who are already eating a whole food plant based diet, those are very doable changes. It’s not drastic, dramatic things. That’s very helpful.
I’m going to just look quickly down this list of questions. Do you have time for a couple off questions, and then we can wrap up?
Cyrus: Yeah, let’s do it.
Molly: This woman has a question about her dad. Her dad finds that the glucose levels increase quite a bit after eating fruit and grains, so he decides that he should avoid those and eat more meat, chocolate, and fatty foods because they don’t raise the sugar as much immediately after a meal. What do you have to say about that?
Cyrus: The reason why his blood glucose is going up after a meal is because, I 100% guarantee, his fat intake is too high to begin with. Everything that we’ve talked about over the past hour is that the metabolic traffic jam that exists from eating too much saturated fat from meat and from animal-based foods, that is the problem. So, rather than saying when I eat fruit, my glucose goes up, I would say, no, the fruit is just the messenger. You have to pay attention to everything that you ate before the fruit. What did you eat before the fruit? And if the answer is, well, he ate meat and cheese and fish and eggs, that’s the problem. Let’s reduce your intake of that. When you reduce your intake of that, then you can significantly increase your intake of fruit, and all of a sudden your blood glucose becomes very controllable.
Molly: Beautiful. What is your thought on good quality plant based protein powder?
Cyrus: I’m for it. I’m definitely for it. For the first 14 years of eating this way, I was eating a hemp protein powder, and it helped me out significantly in putting on a little bit of weight and also helping me recover from intense exercise. So I have no problems with it.
Molly: Awesome. Most of these questions we have already answered. You have already answered. I didn’t answer any. [Laughs] You’ve done a great job. Let’s see. Nope, did that one.
The connection of fatty liver disease and diabetes.
Cyrus: Fatty liver disease is advanced insulin resistance of your liver. Insulin resistance is the precursor to prediabetes and type 2 diabetes, and insulin resistance affects your liver and your muscle tissue. So, when you develop insulin resistance in your liver, and it gets larger and larger and larger and larger and larger over the course of time, it can turn into fatty liver disease. It’s a reversible condition, but you need to, have to, must control your total fat intake and switch over to a plant based diet. We’ve had people in our community that have reversed fatty liver disease. It takes time, but it’s definitely possible.
Molly: Literally, all the other questions you have already answered. Woo! Thank you for doing this and volunteering your time to talk with me, answering all these questions, and giving such wonderful insight. It’s such important information, and more people need to know this stuff.
Cyrus: Amen to that, Molly. Thank you so much. This has been very fun, and I admire the work that you’re doing to spread the gift, the present of eating a whole food plant based diet. You’re doing a great job, and I’d love to continue to chit-chat over time and make sure that we can change people’s lives together.
Molly: For sure. Where should somebody go if they want to find your work and find out more?
Cyrus: Just go to MasteringDiabetes.org. There you can find out information about our New York Times bestselling book. We have a podcast, YouTube channel, Instagram, and Facebook presence. So you’ve got a blog and whatever you’re looking for, scientific information, you’re looking for stories, come, and we can try and help you out as much as possible.
Molly: Awesome. Thank you so much, Cyrus.
Cyrus: Thank you, Molly.
Managing and reversing diabetes isn’t only possible, it can be done, in many cases, with diet alone.
If you want to see how a whole food plant based diet can positively impact your health, sign up for a free trial of Plant Fueled Life and get started. We’ve helped countless members so far and we’d love to help you, too.
Find more from Cyrus and other resources on the Mastering Diabetes website.
Please talk to your doctor before undertaking any major changes to your diet, especially if you’re on medication to manage diabetes. Dietary changes can impact blood glucose quickly, and your meds may need to be adjusted throughout the process.
Plants for the win.
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