Transcript of Episode 175: How to Fix Diabetes Naturally
With Dr. Daniel Pompa, Meredith Dykstra and Dr. Jason Fung
Meredith:
Welcome to Cellular Healing TV. I'm your host, Meredith Dykstra, and this is episode number 175. We have our resident cellular healing specialist, Dr. Dan Pompa, on the line. Today, we welcome back, no stranger to Cellular Healing TV, Dr. Jason Fung. Jason has joined us on Cellular Healing TV a few times. We've really delved into fasting, a subject of which he's an expert in. Today, we're going to talk about something a little bit different, obviously it connects to fasting, but we're going to delve into diabetes and some natural solutions to treating it.
If you guys missed Dr. Fung's episodes prior to this one, he was on episode 112 and 160, you can check those out. Before we dive in, let me tell you a little bit about Dr. Fung, just in case you missed the others. Dr. Fung earned his medical degree at the University of Toronto where he also completed his internal medicine residency before heading to the University of California, Los Angeles, for his fellowship in nephrology. He currently practices as a kidney specialist in Toronto.
During the course of treating thousands of patients, it became clear to Dr. Fung that the epidemic of type 2 diabetes and obesity was getting worse. The prevailing dietary recommendations to reduce dietary fat and calories were clearly ineffective. He founded The Intensive Dietary Management Program to provide a unique treatment focus for type 2 diabetes and obesity. Rather than focusing on medications, this clinic focuses on dietary changes that are simple, yet effective. You can learn more at his blog, intensivedietarymanagement.com, of which I am a subscriber. It's an amazing blog. Thank you so much for coming back, Dr. Fung, and we're excited for the topic today.
Dr. Fung:
Thanks for having me. It's very exciting to be back.
Dr. Pompa:
Doc, listen, you are a hero in our world because you've done so many of the studies, and been a part of so many studies. We have a group of doctors who believe strongly in fasting, in intermittent fasting, in really, I would say, a very unique way of addressing insulin resistance, diabetes, hormone resistance. The topic today is diabetes. I want to jump right in. You have a unique view of type 2 diabetes. I want you to explain that to our viewers.
We have lay people watching this that need to understand this. We have doctors that are watching this that need to understand this. The old of just, hey, the receptors are affected and blunting out, you really have a unique way of looking at the liver as a big part of this whole thing. Forcing in glucose to the body may make glucose levels in the blood look better, but it sure is killing us slowly. Explain it from the top. Explain the standard view of how we look at type 2 diabetes, and explain your view better, which in your book you've addressed, and even in The Complete Guide of Fasting. I've read a lot of your blogs that address it as well. Start right there, Doc.
Dr. Fung:
This is actually very interesting because I'm actually finishing the manuscript on a type 2 diabetes specific book, which is going to be coming out very soon, in 2018. This is a whole different way of looking at type 2 diabetes. First of all, just to back up a little bit, there's two types of diabetes, type 1 and type 2 diabetes. When they first started, type 1 was the focus because a lot of children, predominantly, were getting this illness, and their blood glucose would rise very high. They would lose all kinds of weight, and then they would die.
What they found was that they were severely lacking insulin. Insulin is a hormone that allows the glucose to go into the cells to be used for energy. It's really the energy storage hormone. When you eat, insulin goes up. Your body stores energy. If you have virtually zero insulin, like these children are having, your body couldn't store any of the incoming food energy. You would basically waste away. Then you'd die. In 1921, at the University of Toronto, they discovered insulin. They purified it, gave it to these kids, these kids miraculously got better. Unfortunately, the story of diabetes didn't really end there.
There was another type of diabetes, which soon became very evident. By the '50s and '60s, they started monitoring insulin levels. It was clear that there was two groups. There were those children that had severe lack of insulin. You gave them insulin, they did fine. Then you had this group of older, overweight, obese people in their 50s and 60s, and you gave them insulin, and well, nothing really happened that was all that great. You'd give them a bit of insulin, then they'd need more and more and more. It was clear that there were two groups. These older people didn't actually have too little insulin. Their insulin levels were actually very high. What they had, in fact, was something called insulin resistance. The insulin is there, but it's not moving that glucose from the blood into the cell.
The question was why. Nobody really understood what the basic problem was, what caused all this insulin resistance. There's all kinds of theories. For a long time, people thought dietary fat was a problem, dietary cholesterol, all kinds of problems. This is what we see now. In fact, today, if you fast forward today, 90 to 95% of diabetes is in fact type 2 diabetes. For the rest, or most of the rest of the rest of the talk, when I refer to diabetes, it will refer to type 2 diabetes. That's predominantly what I deal with as an adult physician. That's just to be clear. If you're type 1, you have to take this – you have to understand that.
The question is, what causes this insulin resistance? People have this lock and key paradigm. What that means is that insulin is considered a key. The cell, it is walled off. It has a wall, so that glucose can't go in. Nothing can go in without the cell letting it go in. You have a gate. Insulin's like a key. It opens the gate and allows the glucose to go from the blood into the cell. What they said was that well, something has happened that this key and this gate no longer fit together very well. Therefore, the glucose is staying outside, and not getting into the cell, and that's why the blood glucose is high, which causes all the symptoms. When your blood glucose is high, that's what we call diabetes.
What they said was that because the glucose wasn't going into the cell, your cell was facing an internal starvation because all the glucose is outside, it's not inside. Certainly, in type 1 diabetes, that's the case. In type 2 diabetes, it's much harder to make the case that these are internally starving people. When you look at them, they're obviously overweight. Their livers are huge, and filled with fat. Their pancreases are filled with fat. Their bellies, they have these huge central adiposity, which is the weight that gathers around the mid-section. It didn't look anything like these children who are dropping weight at an alarming weight.
When they tried to understand it, they said, well, we don't understand it. The insulin molecule's clearly not changed. The receptor, you can clone the receptor, you can test the receptor, the receptor is fine. Both the key and the gate were completely normal, but it wasn't working. What they said was, well, there's something gumming up the mechanism, just like if you had some gum and stuck it into the lock. Your key is fine, your gate is fine, but it's not working because there's something in there that's blocking. If you think about it that way, then the natural solution is to pump up the insulin. That was the strategy for years and years, for decades really. If you have type 2 diabetes, you'd take medication. When the medication wasn't enough, they'd give insulin.
If you think about the lock and key model, you're producing a lot of keys. Each key doesn't really work, but there's so many of them that you could get the glucose into the cell. That's what we did. Up until about 2008, that was the prevailing view of almost everybody in the world, including myself, that the high blood glucose was what causes all the damage. You simply give enough insulin to get this glucose into the cell, and you'll be fine. When they actually tested that theory, so in 2008 and 2009 several large studies came out as the Accord Study, the Advanced Study, the BADT, and there's been several since then. What they studied was, does giving all this medication and insulin to lower the blood glucose really make you healthier? Does it prevent heart attacks? Does it prevent strokes? Does it prevent death? Obviously, type 2 Diabetics were very sick. We all though the answer was an obvious yes, but it turned out that the answer was not at all. Patients were not healthier at all.
Dr. Pompa:
Just right there, from a clinical perspective, my group of doctors, we get the patients in that are on the different medications. There's many that take the glucose from the blood and put it somewhere. The blood glucose is normal, so God forbid they come off the medication because then their blood glucose rises. I love your analogy in that you're basically saying, okay, great, you're taking the garbage from the kitchen and you're stuffing it places.
This is what the medication does. You're taking it and you're putting it under the sink. Maybe you're throwing it into the bathroom. The kitchen looks great. It looks clean. However, after a period of time, the rot starts. We could call that diabetic neuropathy. We could call that deterioration of cartilage, whatever it is. Diabetics die. We know this. I've known this for years. Just because your glucose is normal, and you're on diabetic medication, it seems to do nothing for the degenerative symptoms that go along with diabetes. You've answered this. That analogy, I think, and you can expand upon it, I think it really gets our average viewer to understand what's going on here.
Dr. Fung:
Yeah, absolutely, so this lock and key paradigm wasn't really correct. The way to really understand type 2 diabetes insulin resistance is really that this is an overflow paradigm. When you think about it, you have glucose that's not getting into the cell. Why is the insulin – why is that key not working anymore? Maybe that cell is so full, already, of glucose, that you can't shove any more in. That's the idea that what's happening is not that there's something wrong with the key, and the lock, and that mechanism, but the cell is just so full that it's actually shoving it out.
Just like if you had a suitcase, for example, and you're trying to put in your t-shirt, at first when you put in your t-shirts it's fine. Once it's completely full, you just can't put in those last two t-shirts. There's nothing wrong with the t-shirt, there's nothing wrong with your luggage, there's nothing wrong. It's full. It's the same thing with our body. What we've done is we've taken this sugar, and we shoved it into our shelves. Over the decades, we shove in more, and more, and more until the cell is finally full. Now, when you try and shove it in, it doesn't go in. The answer is not to keep shoving with more and more force.
That's the real problem. If you keep shoving it in, what happens is that it fills up. Then your body says, okay, no more. The blood glucose spills out again, and then what you do is you go to your doctor, your doctor gives you insulin. Insulin doesn't get rid of that glucose, it merely takes that blood glucose and just rams it into your body. Your body goes, whoa, and then it accepts a bit more for a little while. Then it fills up again. Then the glucose starts spilling out again. You go back to your doctor, and your doctor doubles up your dose of insulin. You're really cramming it in.
That's the whole problem, you keep cramming it in, cramming, cramming it in. What you've done is you've taken the blood from the glucose where you could see it, and you just basically shoved it somewhere where you couldn't see it because where does this all go? You shoved all this glucose back in the cell, it goes back into the liver, and the liver packages it up as fat and sends it all over the body. All this glucose goes into your eyes, and your kidneys, and your nerves, and your heart, and everything. Over the decades, everything just starts to rot.
That's why diabetes affects every single part of our body. You're shoving all this stuff everywhere, where it's not supposed to go, and then pretending it's fine because you're saying, well, look at my blood glucose. It's fine. Instead of throwing the garbage out, you hide it away under the bed. You're not any better. If you hide the glucose, which you should have got rid of, into your cell, well, you're not any healthier. What's interesting is that it's a very powerful paradigm because the problem, really, to understand type 2 diabetes is really just too much sugar in the body, not in the blood. If it's the blood, then you can still hide it away. It's in your whole body. You have too much. I give the analogy of a sugar bowl. Imagine your body is just like a sugar bowl. Over the years, it fills up. Then when you eat, the sugar comes in and spills out into the blood.
What you don't want to do is take that sugar and just shove it back in. you've got to get rid of it. Up until now, all the drugs simply shoved that glucose out of the blood, into the body. Therefore, they didn't see any benefits. There's actually a new class of medication called SGLT2s, which actually cause you to excrete the sugar in your urine. You actually pee out more glucose. What's very interesting about this is that the recent studies, which just came out a year and a half ago, is that despite the fact that these drugs don't really lower your blood glucose very much. They're about as half as affective.
Dr. Pompa:
It had a significant effect on heart disease, though. I read the study.
Dr. Fung:
Absolutely. It reduced heart disease by 25%, reduced death by 30%, reduced kidney disease by so much despite the fact that it didn't lower blood glucose because they're doing the right thing. What's very interesting about this is that that is actually the body's own protective mechanism. If you think about it, the problem is too much sugar. What we've done is we've taken sugar, sugar, sugar. We've filled up our bodies. Our body sends it out everywhere. Eventually, what it does is the blood glucose goes up and you pee out the sugar. Everybody thinks that's a bad thing, but that's actually your body's protective response by trying to dump out this toxic glucose load.
That's the reason everybody has this. That's why you have the renal threshold, which is a level of blood glucose above which your body doesn't absorb anymore. Your body says, whoa, I have enough. I am just dumping the rest of it out. It's actually a protective mechanism. Now, what we do is we take insulin, we shove all that glucose out of the blood, into the cells. We actually eliminate that protective mechanism we had before, and there we are. With these medications, what you see is that there's a protective effect. I call this a new paradigm of insulin resistance. That's really one of the exciting things because what it does is it opens up the entire field to reversal. If the problem is too much sugar, if you understand type 2 diabetes is simply a problem of too much sugar, there's only two things you need to do. Don't put it in, and burn it off.
Dr. Pompa:
Therein lies the answer.
Dr. Fung:
Both are completely natural and completely free. We don't need anything but knowledge to reverse this entire disease that affects 52 -inaudible-.
Dr. Pompa:
We'll get to the answer in a minute. Something we see clinically, you're the scientist, I always draw back to clinically. We see that the skinnier diabetics have the fattiest liver. The fatter diabetics, typically, you don't see as fatty of a liver. You eat this sugar. You can only do two things with it, I guess, three. You can burn it, but there's so much that you can't burn, so you store some as stored sugar and glycogen, or you store it as fat somewhere. Explain that because our viewers have to understand this as far as where it's going, the whole fatty liver, and why that can make things even worse. Explain that a little bit.
Dr. Fung:
Yeah, so that's a good question because everybody always talks about the skinny diabetic. If you look at them, they have big, fatty livers. The problem is not actually the body fat. It's actually the so-called ectopic fat or abdominal fat, which is the fat in the liver, the fat in the pancreas, the fat around the organs that's not supposed to be there. Fat inside a fat cell is fine. That's what it's supposed to do. Fat inside the liver is not fine because the liver is not supposed to have it. What happens when you take excessive carbohydrates, but particularly fructose, and we'll get back to fructose in a second, is that your insulin goes up. Your body starts to store sugar.
Now, you can store sugar in two ways. Basically, you can store it as sugar, or you can store it as fat. you can store food energy in two ways, either sugar or fat. You can't store proteins for energy. When you eat, your body stores glycogen. That's chains of sugar. It goes into the liver. There's a limited capacity for it. The advantage of the glycogen system is that you can take that food energy in and out very, very easily. If you eat, it goes into liver, but when you don't eat, for example, when you're asleep, it comes back out of the liver. It's really, fast. It's really, easy. It's like the refrigerator. You can put food there. It's easy to put in. It's easy to take out.
Body fat is a different form of storage. It's much harder to get to. When you take excessive carbohydrates, it fills up with glycogen. If your glycogen's full, your body actually creates new fat. That's called de novo lipogenesis. You take the glucose, and you actually change it into fat. That gets sent out of the liver to the fat cells. Body fat is harder to get to. It's harder to get the stores of energy that are locked away in the body fat, but there's unlimited amount of storage. As everybody knows, you can store a lot of body fat. You have two complimentary systems. One has limited storage, but easy in and out. One has unlimited storage, but it's hard to get in and out.
Dr. Pompa:
Your freezer.
Dr. Fung:
Your freezer, yes. It's like in the basement, you put it in the freezer. It's there if you need it, but it's not so easy to get to. You can carry a lot of stuff in there. You actually have two complimentary systems. The problem is that if you store the fat, so as you eat excessive carbohydrates and insulin, insulin goes up and then it creates the fat. You're creating the fat, and you're shuttling it out to the fat cells. The problem is when you have excessive insulin, then you create fatty liver. The fat is backing up. You're putting glucose into the system. The glucose storage is full. Now we assume the glycogen is full.
As you pour in more glucose, the liver has to make fat and get it out of there. If you put in too much, if you overwhelm the export mechanism, all that fat just backs up. Then you get this big, giant, fatty liver. That's what causes insulin resistance. Now you're pouring glucose in, but you're not getting the fat out fast enough the other side, so the liver says, okay, no more. I can't take anymore, so stop it. That's when everything backs up, and the glucose goes into the blood. That's insulin resistance. Fructose, which is half of sugar.
Table sugar is sucrose, half fructose, half glucose. High fructose corn syrup is roughly the same, slightly more fructose. Fructose is actually very important. It's actually the most important input into the system. What happens is that fructose cannot be used by any cell in the body. Every cell in your body uses glucose. When you eat glucose, so starches like flour, white bread. Say you eat white bread. It's all glucose. There's some fructose in there, but that's added in. If you just eat rice, for example, it's all glucose, not fructose. That glucose can be used by your whole body.
If you're 170 pounds, for example, then all 170 pounds of your body is using that glucose. Fructose is not the same. Nobody uses fructose. The only place it can go is directly to the liver, and only the liver metabolizes fructose. What happens is that when it gets to the liver, the fructose, there's only one of three paths. You can burn it, but nobody's going to burn it because you're just changing into glucose, and you're eating at the time that you're taking in this fructose, so there's no need to burn it. The other thing is you can change it to glucose, but that's hard, or you change it into fat. Once again, fructose, essentially, goes directly into new liver fats, or de novo lipogenesis.
Dr. Pompa:
Let me say a word on that real fast. If you go to the Diabetes Association website, they still recommend fructose for diabetics. Why? Fructose, as you pointed out, doesn't raise blood glucose. It's only processed in the liver. On the surface, it looks like, hey, this is a really safe sugar for diabetics to consume. However, what you're saying is the fact that it goes right into the liver, and makes fatty liver, it is actually contributing to the larger portion of the problem.
Today, we have something very unique. No time in the history of man have we seen fatty liver in the children because of the amount of fructose they're consuming in all the energy drinks and sport drinks. They're loaded with fructose, of course, the drinks from the time they were babies. They're giving them orange juice, and this juice, and that juice. The amount of fructose we're consuming, we're seeing fatty liver, non-alcoholic fatty liver in children. I've heard fructose is being called alcohol without the buzz, meaning it's the same thing. Alcohol can only be processed in the liver, and that's why it creates fatty liver. Is there the same correlation there with alcohol?
Dr. Fung:
Absolutely the same correlation, and it's scary. If you look at diabetic clinics, and children, pediatric clinics, it used to be all type 1s. Now, it's 50/50 type 1 and type 2. It's a scary thing. The problem with the fructose is that if you think about it, so sucrose, table sugar, is 50% glucose, 50% fructose. What happens is that say you eat – a pound of sugar is half a pound of glucose. All 170 pounds of body uses that glucose. That same amount of fructose goes to five pounds of liver. It all goes directly into liver fat. In terms of causing diabetes, the fructose is something like 20 or 30 times worse than the glucose. It's much worse. That's the real problem. You see it all over the place.
In China, for example, is a very interesting case study. In 1980, about 1% of the population had type 2 diabetes. Now, it's about 11%, so ten, 11-fold increase in 30 years. A single generation, it's gone up an incredible 11 times. That's ridiculous. If you look back at the diet in 1980, 1990, the amount of white rice they're eating is off the charts. It's way higher than anybody in the United States, or the United Kingdom, and yet they had no diabetes, practically zero diabetes, 1%. Practically no diabetes, and yet they're eating 300 grams a day of carbohydrates, refined carbohydrates because it's all white rice, no brown rice, there's none of that. How do they do that?
The point is, they don't eat any sugar at all. Their intake of sucrose was virtually zero. They had no diabetes. Now, they're eating sugar. They've become westernized. Now, they eat cakes, and bread, and all this stuff. Now, they're actually the highest proportion of diabetes in the world, beating even the United States, which is super-scary. Now they have this tradition of rice, white rice, high carbohydrates. Now they take that sugar, and they're toast. They're really in a lot of trouble. That's the thing. That sugar tracks much more closely to the incidents of type 2 diabetes than carbohydrates, than body weight, than anything else.
In fact, it's scary because the average body mass index of an Asian diabetic is I think 23.7. That's normal weight. Twenty to 25 is normal weight. Twenty-five to 30 is overweight, and over 30 is obese. They're actually in the normal weight category, and yet they're all developing – that's the average. This is really scary. They're all developing because they're all getting all this directly into that liver because of the very high refined carbohydrates because of the fructose. It's basically glucose, fructose, that's the root of the problem is sugar.
Dr. Pompa:
Where does fruit fit in? Fruit's high in fructose, right? How does that fit in? Obviously, our bodies are able to take in a certain amount of fructose, but obviously it's the overconsumption. Talk about that.
Dr. Fung:
One of the first principles of toxicology is really the dose makes the poison. If you looked at whole fruit, the amount of fructose, there's fructose there for sure, but if you look at the amount that they're eating in 1915, 1920, it's very little compared to what we eat today. What happened then, of course, was that they had the sugar plantations in the deep south. In the Caribbean, they had those sugar plantations.
Back in the early 1900s there's very little sugar. They didn't have much fructose at all. Then the sugar plantations came and gradually went up. Then high fructose corn syrup was a real changer because now you could process it not out of sugar beet, but out of corn. There is a lot of corn. The prices of this high fructose corn syrup basically went to almost zero, practically. Everybody put it everywhere they could because it was cheap as anything. All these processed foods just put it wherever they could. The amount went up. If you look at the sugar-sweetened beverages in amount, percentage of calories. People are eating at its peak, I think teens were eating almost 25% of their calories as sugar. It was ridiculously high.
Things have changed, though. If you look from 2000 onwards, with this real focus on sugar, you can see that there's been a tremendous drop. Obviously, we're not out of the woods, but there has been a drop. The message has gotten through, but the fructose is really much worse than the other one. That's why if you're talking about type 2 diabetes, or pre-diabetes, the very first thing you've got to get rid of is all the added sugars. What that realistically means is getting rid of almost all processed foods because almost all processed foods have that.
Dr. Pompa:
It's the hidden sugars. Corn syrup, I mean, ketchup, corn syrup, right, I mean every – can foods, corn syrup. Corn syrup's everywhere. Like you said, it's all about the money. Corn syrup is a cheap sweetener, and it markets well. People don't even recognize it as sugar. The average person looks at it and goes, oh. They know sucrose or dextrose, perhaps, but they don't understand corn syrup. Let's get into the solution. Here in lies the problem. You tapped in a little bit on the solution. We either have to burn it down, or not put it in. Let's talk about it. That kind of piggy backs. Here, we have the person with the fatty liver, obviously, type 2 diabetes. We have a unique answer. We do something, and we've talked a lot about fasting, intermittent fasting, and things. Talk about it.
Dr. Fung:
Really, if you think about it, it's a very simple solution. Let me back up. It's not just the fatty liver. Once that liver gets all fatty, it starts sending all this fat out. The other key place it goes is the pancreas. You've got this fatty pancreas. Here's the second part of what happens. The fat clogs up your pancreas so that it can't secrete the insulin. What you see is that as the insulin levels start to drop off, again, this is actually one of your body's –
Dr. Pompa:
This explains why we thought the beta cells would burn out, what we would call pre-diabetes. This is a unique thing that I've read from you.
Dr. Fung:
What happens is that everybody thought that it's because the pancreas has been secreting so much for so long that it's just all burnt out. It can't be true for a few reasons. One is that if you look at children, there's no way that their pancreases are burnt out by age seven. That would be ridiculous and really scary. Second of all, some people said well, the high glucose is what burned out the pancreas cells. You can't because the pancreas is producing so much insulin, glucose levels stay relatively good until after the pancreas starts to fail. That is to say the pancreas fails and then the glucose goes up. It's not the glucose goes up and then the pancreas fails.
Everybody says that oh, the glucose is what kills the pancreas; not at all. The glucose is fine. When the pancreas starts to fail, then the glucose goes up. You can't say that glucose is what killed the pancreas. The third thing is that you can actually make that pancreas work better. We know that from studies of, for instance, bariatric surgery. In bariatric surgery, where you have a severe, sudden caloric drop, that diabetes – you can take a 500-pound man on 400 units of insulin, you do bariatric surgery, and two weeks later they're actually completely non-diabetic. They're still massively overweight. They haven't lost a lot of weight yet. Diabetes is completely gone in two weeks. Everybody says, how does that happen?
What happens is that the body actually pulls out your fat preferentially. When you go to a very, very low-calorie diet, first of all, remember, your body stores glycogen and body fat. You can exhaust your glycogen in about 24-hours. Then when you start to burn body fat, the first place it goes is that stuff that's in your pancreas and in your liver, which is great because that's what causes all the problems. That's how you can reverse that type 2 diabetes in three weeks in these surgical cases, which everybody knows about, because those pancreas cells weren't burnt out. You can measure them, and you can see that they're starting to secrete more insulin again. That's great news because now, all of a sudden, you have light at the end of the tunnel. It's not like your pancreas is burnt out.
This is how doctors kept telling patients, oh, it's chronic, it's progressive, your pancreas is burnt out, there's nothing you can do about it. That pancreas was merely clogged up with fat. As soon as you unclog that fat, it's going to get better. Several doctors have actually done MRI studies of this fatty pancreas. What they've found is that you only have to remove 0.6 grams of fat from that pancreas to get it going again. It's a miniscule amount. That's crazy small. That's great news because if that's the strategy, then hey, again, burning it off, intermittent fasting, is a perfect strategy.
One, you're not putting it in. You're not putting anything in. There's no anything. It's not just carbohydrates, you got nothing going in, but because your body must have energy in order to function, you're going to start burning. In the first 24 to 36 hours, for example, you're going to burn that glycogen, and maybe a little bit of protein. Then you're going to get into fat burning. From then on, your body is immediately going to go to the intra-organic fat, the fat inside the liver, the fat inside the pancreas.
That's where you see your insulin requirements. If you're on insulin, the insulin requirements go down dramatically, the medications go down dramatically. If you start having people do longer fasts, you'll see it very quickly. It's a crazy situation because I see people – and after a month, they're off of everything. It's crazy how fast they get better. I actually knew that already from the studies on bariatric surgery, but it's still incredible to watch these people who've been on insulin for 15 years, and in a month, they're off. It's like, wow, that is great.
Here, their doctors had been telling them, oh, you're always going to be on for the rest of your life. I'm like, yeah, you've been taking insulin for 10 years for no reason just because people weren't treating the proper problem. It all stems back to that misunderstanding of this lock and key, oh, internal starvation. That's type 1, that's not type 2. Type 2 is an overflow. That's the real difference there.
Dr. Pompa:
We were talking off air, and I was talking about clinically with my group of doctors, what we're doing, what we're seeing. Step one, we've moved people into a lot of carbohydrate diet, even into ketosis. Then step two, we start intermittent fasting, where we push out maybe 15 hours. They're getting more fat-adapted. In the beginning, they're hungry all the time. Eventually, they start adapting. Then our conversation was then we start throwing in days of the week where they just eat one meal, giving more time for what you're saying.
During that time, as they became more fat adapted, their body's going to start burning out that fat out of the pancreas, and out of the liver. Then we throw in even a longer fast, maybe a 42-hour fast. We're just giving more and more time to empty that fat out of those organs. I'm telling you, it is remarkable. Then, once they get even more efficient, then we can do them on longer fasts. Therein lies a very unique answer.
I want you to speak to something because in February, this past February 2017, there was a study, I believe, in Cell, that looked at a partial fast, taking people between 500 and 1100 calories. They spoke about beta cell regeneration. What they noticed was a lot of the things we're talking about. Was it beta cell regeneration? Was it that they just became activated again? I know you know the study. What are your thoughts on it?
Dr. Fung:
I think you're basically just unclogging that pancreas. It's their regeneration, potentially, although I think that they're not a huge part of why people get better. It's really too fast. If you look at Dr. Roy Taylor's work, and he's been doing this for several years now. He doesn't do a full fast. He does this 500, 800 –
Dr. Pompa:
I call it a partial fast.
Dr. Fung:
You're getting into the range where you're going to see some benefits, but to me it doesn't make any sense to do 500, 800 calories. These are sick people. You might as well do the full thing. It's a powerful dietary strategy. What he showed was recovering pancreatic function. When you measure the insulin response, it was low before, and now it's going up. That idea of regeneration came from the idea that they were burnt out. I don't think they were ever burnt out.
Dr. Pompa:
I want to go back and actually read it. I didn't, to the depth, to see were they actually seeing regenerated beta cells? How were they measuring it? Was it because the function was up? I can't answer that. I didn't read it close enough.
Dr. Fung:
I think it was the recovery of the pancreatic function. Some people have interpreted that. You do this for the first insulin response, and what you see is that over time, over eight weeks, I think they do, so 800 calories a day for eight weeks. The fat comes out of the liver much faster because the insulin resistance – you can measure the insulin resistance, and he has as well. The insulin resistance drops very quickly. That gets better very quickly, but the pancreatic problem actually takes a lot longer. It takes many, many weeks before you see it. It's even still getting better over eight weeks.
It's harder to get it out of the pancreas. The liver fat seems to come out very quickly. What you do is you measure the pancreatic response. It should produce a certain amount of insulin, but it's very low. Over those eight weeks, you can actually show that it starts to get better and better. It's a fascinating study, and again completely disproves this idea that they were completely burnt out in the first place. That's really important work, I think, that's been done.
Dr. Pompa:
Where does even part of the epigenetic component come in, maybe two, that when the cell fills up that it's sending a signal to the receptors even to shut off. It makes sense. We know that the DNA can send a signal to the receptor and blunt the receptor, so to speak. Really, it's driven by the innate intelligence to do so at different times, in terms of starvation, whatever it is. As the cell fills, then we can experience a receptor that doesn't work as well, but it's because this body was so smart to even blunt it, if you will. Does that even make sense?
Dr. Fung:
Yeah, absolutely, and it comes back to the point about the fat cell. It's interesting because some people look at obesity as actually a protective response because what you're doing is you've got all this excessive sugar. Your liver, actually, is trying to protect itself by sending it out into the fat cells. There's a ton of studies looking at the adipocyte, which is the fat cell, size. The bigger your adipocyte, the more insulin resistance you will have. Of course, that's just like the suitcase. The more clothes you put in it, the harder it's going to be to stuff it full. The fat cell is the same, the more you stuff it full. The point of the fat cell is that it holds it in a safe space, so that it's not backing up into the liver. You have these rare humans that have zero fat. It's very interesting because they have no fat at all, and they have the worst insulin resistance you've ever seen.
Dr. Pompa:
I've seen it, yep.
Dr. Fung:
It's crazy because what happens, of course, is that their fat cells cannot store fat. All the fat stores in the liver. You get immediate insulin resistance with everything. They have the worst cases you've ever seen. Fat cells, again, everybody things it's so bad. It's actually trying to protect ourselves from this excessive sugar load. Everything comes back to this toxic sugar load, sugar being glucose and fructose. That's a protective response. You're becoming obese to hold it away from the really damaging fat, which is the fat in your liver, fat in your pancreas. That takes decades.
Finally, you overcome your body's resistance to that protection. The next step is that the liver says no more, don't give me any more. Then the blood glucose goes up. When the blood glucose goes up, you start spilling it out in your urine. Everybody's oh, that's bad. No, that's good. The problem was they have too much. The pancreas is the same. The pancreas clogs up and stops producing insulin so that your blood glucose shoots up and can start spilling out. Yes, you have to pay a price. You have the symptoms. You have the high urine output, you have the thirst, and weight loss. In fact, that was all protecting you from what was the real, underlying cause of the whole thing, which was just too much sugar.
Dr. Pompa:
The body's amazing. It just wants to survive. Obesity is a survival mechanism.
Dr. Fung:
What we thought was really a path of physiology, we thought it was a disease state, is actually a natural protective factor. That's why everybody in the world has this response. Everybody in the world's getting diabetes, getting fat. Why? Is it a maladaptive response? Obviously, not. The human body is incredibly smart. We think it's always stupid. The body's stupid, you have to give it insulin. No, we were really stupid to think that we were smarter than the body.
Dr. Pompa:
I couldn't echo that more. It's amazing. As time goes on, we realize that we're always the stupid ones. Our bodies are always – therein lies God's intelligence. Meredith, you probably have a question. I'll turn it over to you as we approach the top of the hour.
Meredith:
We're finishing up. I always learn so much from both of you. Just wondering from an implementation standpoint, how these fasting and dietary strategies may differ between type 1 and type 2 diabetes clients.
Dr. Fung:
type 1 is completely different. It's the severe lack of insulin. First, you have to give it insulin. What's really interesting about type 1 diabetes is that they develop all the same diseases as type 2 diabetes. If you think about it, it's very interesting because what happens is that when you follow type 1's – so you give them – first, they have no insulin. You give them insulin, everything's fine. Thirty years later, they're gaining weight, they're getting metabolic syndrome, and you can measure that they have insulin resistance. With the insulin resistance, which is actually, I say it's not useful to call it insulin resistance. I call it hyper insulinemia because it's a much more powerful way to look at it. If you see the problem is too much insulin, then the answer's super-obvious, lower it. They all have signs of hyper insulinemia, and then they get their heart attacks and strokes.
What's interesting is that if they're getting signs of too much insulin, it can only be because we gave it to them. Their body actually doesn't make any. They, in fact, have double diabetes. They have type 1 diabetes, which is that their pancreas doesn't make it, but they actually have type 2 because they have insulin resistance and hyper insulinemia. The solution, then, becomes very obvious again. The point is that there's two toxicities in type 1. You have the glucotoxicity, that is if your blood glucose goes very high for a very high for a very long time, it's a problem. You have insulin toxicity as well. If you take too much insulin for too long a time, you have a problem. They have both.
If you have both glucotoxicity and insulin toxicity, you have to lower both your glucose and your insulin. The way to do that is eating a very low carbohydrate diet, or add some intermittent fasting. Therefore, if you don't eat 24 hours, twice a week, for example, you reduce the need for insulin because you're not eating. Therefore, you don't have to inject so much. Therefore, you're going to lower the amount of insulin that you need in the long term. It's very interesting because type 1s, if you look at who lives the longest, they had several studies on this. They followed a golden years cohort of type 1s who had lived for 50 years and done very well. They said, okay, let's look at these people and see what is it that they did very well at.
Their average blood glucose, their A1C, was 7.6%, which is not that good. In fact, not a single one of those people, who had lived 50 years with type 1, had a normal blood glucose. What they all had was a low insulin dose. There's two toxicities, glucotoxicity and insulin toxicity. Our mistake in type 2 diabetes was thinking – and type 1 as well, was thinking that you can lower the blood glucose by raising the insulin. You're only trading glucotoxicity for more insulin toxicity. You actually have to lower both in order to do well. That's the answer. You go to low carbohydrate diets, just as you said, and then intermittent fasting, which is the ultimate strategy for that -inaudible-.
Dr. Pompa:
It is the ultimate strategy. What people don't understand is every time you eat, you create a glucose and insulin spike. I don't care if it's a salad. The only way, really, to have perfect glucose and insulin is not eat. Of course, we know we need to eat. That's why my little saying has become don't eat less, eat less often. When you're not eating in spells, you have this perfect state of insulin and glucose, and you're making your body burn it. Either you're storing glucose or burning it. That's really the only state the body can be in. Am I right on that?
Dr. Fung:
Yeah, absolutely, and this is the thing I tell patients. I say, well look, think about it this way, if you don't eat, what you're doing is making your body eat that blood glucose. When that's done, it's going to eat your body fat. If you fast for three days, you're basically eating breakfast, lunch, and dinner of your own body fat. That's perfect. That's exactly what I wanted to do. Everybody always worries about nutrient density and so on. I'm like okay, but that's not the problem I'm treating here.
You can take a multivitamin, but obesity is not a nutrient-deficient disease. What am I treating, scurvy? Scurvy is a nutrient-deficient disease. Berry berry is a nutrient deficiency disease. That's not what I'm treating here. I'm treating obesity type 2 diabetes. Know what you're treating. If you're worried about certain nutrients, then you can replenish them. That's the easiest thing to do in the world.
Dr. Pompa:
You hit on one of my pet peeves. In the alternative world, everyone is so focused on the micronutrients when the diseases we're seeing are about the macronutrients, the over consumption of macronutrients, whether it be protein, carbohydrates, and the sugars. Everyone's thinking about it's this vitamin, it's that vitamin. Really, if you solve the macronutrient problem, the few micronutrient issues typically take care of themselves as well. I think the focus is in the wrong place.
Dr. Fung:
It's completely the wrong thing. Everybody's always saying, what am I not eating enough of that is making me obese and type 2 diabetic. The answer is nothing. You've got everything you need. That's not the question.
Dr. Pompa:
It's an overflow.
Dr. Fung:
It's an overflow. They've gone in the wrong direction right from the beginning. Why is that? There's a lot of money to be made in selling supplements and all these things. Really, from a scientific standpoint, it's really what do you have too much of, not too little of. When you approach it that way, you see that the answer is completely different. The solutions that present themselves are completely different. I mean, it's such an incredible idea.
We have all these diseases, heart disease, strokes, and cancer, the biggest killers of Americans, all related to metabolic syndrome, obesity, type 2 diabetes. Yet, we tell people that it's all chronic and progressive. The truth is that they can start themselves tomorrow, today, to start fixing the problem. They listen to this podcast, and you can start right now and start fixing the problem. It's that powerful.
Dr. Pompa:
Listen, when we look at all the studies on living longer, everyone things it's eating less. Really, these countries, they're not eating less. They're eating less often. I was in an African culture and they didn't eat. When you look at how many times Americans eat, whatever calories their doing, it's the kombucha, it's the nuts, whatever it is. They're constantly eating. Then they'll tell you that they only eat two meals a day, or three meals a day. Really, when you analyze it, they're eating a lot more than that. The solution is eat less often.
Dr. Fung:
Exactly, I think it's a huge part of the problem that really doesn't get talked about. If you look at the big -inaudible- surveys of Americans, 1977, the number of times people ate in a day was three, breakfast, lunch, and dinner. I grew up in the '70s. That was it. There were no snacks, there's no after school snack, nothing, no bedtime snack, no eating in front of the TV. Then you go to 2004, and the number of times people ate in the day averaged closer to six. It's like, okay, so we're eating all the time. If you're eating all the time, you're stimulating insulin all the time, which is giving your body the instruction to store food energy. If you're always storing it in, then you're not going to burn it. Not that hard to imagine how you gain weight with that.
Dr. Pompa:
Kids can't go through a day of school, today, without snack time. We're literally starting obesity and insulin resistance with snack time. I don't care if it's a healthy snack. You're either burning your glucose or your storing it. We just keep storing it and not burning. Therein lies the problem; however, at least get rid of the darn fructose and the sugars, and start eating less. Take away your kids' snacks, for goodness sakes. There's a good starting point, three meals a day. Then you can go to two, especially if you already have an issue. Then you can start fasting. We gave them the answer, Doc. I mean, come on, -inaudible-.
Dr. Fung:
The answer's right here.
Dr. Pompa:
Yeah, exactly, -inaudible-.
Dr. Fung:
You and I, we grew up in an age where everybody ate three meals a day, breakfast, lunch, dinner, and everybody was fine. Now, we imagine that every child in America and Canada must eat snacks. That's the most ridiculous. We had whole generations of kids do fine.
Dr. Pompa:
Absolutely, and we think that it has to be. Partly because they go yeah, but when they don't get their snack they can't focus. When we give them the sugar, then they focus. Yeah, because they don't even know how to use fat at the cellular level. They just eat sugar high to sugar high to sugar high. They're never burning their own fat, so they just need the next sugar hit.
Dr. Fung:
Yeah, and then we call them ADHD and start medicating them on the other side.
Dr. Pompa:
Right, I mean as insane as that sounds that you just said, that is what we're doing. We're snacking them. We're giving them sugar. Think about it. Oh, but they don't count the orange juice, the healthy juice that they drank, loaded with fructose, as even a snack. It's so much juice, it's snack, it's juice, it's snack. It's all day long, and then we'll eventually medicate them. I better stop because I'm going to come out of my skin. All right, Meredith, you better shut me down. Doc, thank you, we love you, we love your work. We appreciate you so much, my group of doctors does, and everyone who watches the show. Thank you very much.
Dr. Fung:
Thanks for having me. This is great.
Meredith:
Thank you both. Always, you both, such a wealth of knowledge. I can tell you, you're so passionate about this topic. It's going to take a culture change. All of you who are watching out there, too, I hope you spread this message, share the podcast with everyone out there. This is what we need to do to make a change.
Dr. Pompa:
People need to hear this message. Share it. You're right, Meredith, my gosh. Do you know how many lives will change if you share this? I'm telling you, people need to hear this. Anyone who has a kid, you better send them this. That's a good point, Meredith.
Meredith:
Thanks. No more snacks, all right. Thank you so much, Dr. Fung. Thank you, Dr. Pompa. Everybody have a great weekend. We'll catch you next time. Bye-bye.
Dr. Fung:
Thanks very much.
Meredith:
Bye-bye.
