Discover the science behind Type 2 Diabetes and its remarkable reversibility
Jason Fung
Unlock the Power of Reversing Type 2 Diabetes! 🩸💪 Discover the science behind Type 2 Diabetes and its remarkable reversibility. Join us in this in-depth exploration of glucose tolerance tests compared to insulin levels and learn how fasting can be a game-changer in the battle against insulin resistance. 🔍 Dive into the intricacies of glycolysis and understand the fascinating process of cholesterol transport within your body. We’ll unravel the mysteries of hyperinsulinemia and how it causes malfunction in blood sugar regulation. But it doesn’t stop there – we’ll show you how to treat the root cause of this condition and prevent pancreatic burnout. Yes, it’s true, Type 2 Diabetes is reversible! 🕒 Don’t wait! Watch this video to take control of your health and embrace a brighter, diabetes-free future. 🌟 Join us as we unveil the path to reversing Type 2 Diabetes and regaining control over your health. Hit the like button 👍, subscribe for more informative content, and ring the notification bell 🔔 to stay informed! 👉Join my membership for perks: / @drjasonfung ▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬ ▶️ Timestamps / Chapters 0:00 Intro 0:10 Type 2 Diabetes and Reversibility 1:47 Glucose tolerance test compared to the insulin 5:20 How Fasting helps people reverse type 2 Diabetes? 9:44 What is insulin resistance? 14:33 What is Gycolysis? 18:03 The process of cholesterol transport 19:03 A Process of Hyperinsulinemia 20:17 What causes Malfunction(mystery villain) 27:34 Treat the Root cause 31:20 What is pancreatic Burnout? 41:13 Key takeaways:(Type 2 Diabetis is Reversible) ============================= 📌 BOOKS: 👉 The Obesity Code – Reviewing underlying physiology of weight loss and how low carb diets and fasting can help. https://www.amazon.com/dp/1771641258?... 👉 The Diabetes Code – Reviewing how type 2 diabetes is a reversible disease and dietary strategies. https://www.amazon.com/dp/B0795BLS8D?... 👉 The Cancer Code – Scientific exploration of how cancer develops – https://www.amazon.com/dp/0062894005?... 📌 Amazon: 👉 USA – https://www.amazon.com/shop/jasonfung 👉 Canada – https://www.amazon.ca/shop/jasonfung ▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬ 📌 Please visit our :- 🔹 Website – https://www.doctorjasonfung.com 🔹 Blog- / drjasonfung 🔹 Community- https://www.thefastingmethod.com 🔹 Facebook – / jason.fung.313 🔹 Instagram – / drjasonfung 🔹 Twitter – / drjasonfung ▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬ 📌 YouTube Medical Lectures (for specialist physicians): ▶️ The Roots of the Obesity Epidemic: https: // • The Obesity Epidemic, Explained ▶️ Therapeutic Fasting – The Two Compartment Problem: https: // • Fasting and Weight Loss – Solving the… ▶️ Does Calorie Counting work?: • Why Calorie Counting rarely leads to … ▶️ Two Big Lies of Type 2 Diabetes: • Two Big Lies about Type 2 Diabetes ▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬ If you liked the video, Please Do Subscribe My Channel 😉😍 Keep Supporting me So I can Continue to provide you with free content each week!!😇 ▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬ 😍 😍 Thank you for Watching! #Type2Diabetes
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Transcript
0:00[Music]
Type 2 Diabetes and Reversibility
0:11and this is the period where they talk about insulin resistance what you get is this compensatory
0:16hyperinsulinemia which keeps the blood glucose down and that’s why you don’t see this sudden Spike and then at some
0:22certain point you get this second phase where things just shoot up and that’s
0:28that loss of compensatory hyperinsulinemia and they call it pancreatic burnout what they say is that
0:35your beta cell has basically been working so hard it’s burned out so you can’t produce the insulin even though
0:41your insulin levels are much higher than normal they’re not high enough to keep the lid on the uh the glucose and
0:47therefore the blood glucose shoots up you blow past whatever uh diagnostic criteria you have for type2 diabetes and
0:54this is what happens so what they’re postulating is that and this is the traditional thinking is that this is why
1:00it’s an irreversible disease because you have this pancreatic burnout and you can’t reverse this part and they’re two
1:06entirely different disease processes one is insulin resistance the other is a
1:12sort of scarring of the pancreatic eyelet cells so they have nothing to do with each other and yet they only occur
1:18sort of one with the other and never with any other disease which is a little bit strange but that’s why they say it’s
1:25irreversible and um of course this is what you see so you see if you look at fasting insulin levels you see this
1:31hyper insulinemia so as you go from the spectrum of normal lean to obese to you
1:37know uh obese with type 2 diabetes you see that the insulin levels are going up and up and up and that’s that insulin
1:43resistance and Slash hyperinsulinemia and this is the uh glucose tolerance test compared to the
Glucose tolerance test compared to the insulin
1:51insulin so here’s the glucose here’s the insulin and this is what we know as you go from the spectrum of normal lean to
1:58obese and type 2 diabetic what you see is that at first this is your insulin levels it’s it’s in the
2:04solid Circle so it’s going up and up and then at some certain point even though your glucose is going up the insulin
2:10actually starts to drop so your yes your insulin is higher than Baseline but it’s not as high as it was before and that’s
2:16that loss of compensation and that that’s P pancreatic burnout and the big change is that for years we said that
2:24type 2 diabetes is chronic and Progressive because of this Progressive burning out of the p pancreatic eyelids
2:31but in 2021 the big change was that this was actually a reversible disease and
2:36not Progressive so this is the American Diabetes Association and what they used to say was exactly this this was on
2:43their you know it was on by diabetes Basics that type 2 diabetes for most
2:48people is a progressive disease they got rid of that in 2018 they removed it it’s
2:53gone you can’t see that anymore and instead what they have is this in 2021
2:59they came came out with the diabetes remission criteria which of course implies that remission is possible
3:07because you don’t Define it if it’s impossible so it’s a huge change because
3:12if it this is a disease that can be put into reverse that’s what we should be doing and what I’m going to talk about
3:19is the pathophysiology be behind why we think this is so so if you think about
3:25reversal of type 2 diabetes people think that it’s impossible but we’ve actually shown it for many many years so for
3:31example you can take bariatric surgery it reverses type 2 diabetes very clearly
3:37this is data from uh 1992 so this is from 30 years ago if you do bariatric
3:43surgery on people the blood glucose Falls almost immediately and the results
3:48are for the most part very long live so going out 10 years or so so this is the
3:54data from the New England Journal of Medicine this was uh again Ruan y uh B
4:00gastric bypass versus intensive medical therapy which of course at the time was mostly insulin and suono uras you can
4:07see that over time if you just give medical treatment they stay on the same number of medications and they don’t
4:14lose weight but if you do surgery for these people to make them lose weight
4:19then the blood glucose Falls immediately so they get off of a lot of medications they come down right away so remember
4:26this is long before they’ve lost weight so you know at a month or two months
4:31they may have only lost 20 30 PBS if they weighed 500 lb that’s not a lot
4:37from a percentage standpoint but the blood glucose has gone down they’re getting off all their meds even out to a
4:42year a lot of them are still continuing to get off all their meds and yes this is a drastic situation but the point is
4:50that this is a disease that is reversible that’s very clear in these
4:56studies is that we didn’t focus on the right things we focus on giving more meds but giving more meds is never going
5:02to work if they lose weight their type 2 diabetes goes in reverse which we always
5:07knew of course and it doesn’t you don’t have to cut out pieces of the stomach you don’t uh you can do gastric banding
5:13and you’ll see exactly the same results the blood glucose Falls immediately like even within a week we see that fasting
How Fasting helps people reverse type 2 Diabetes?
5:21is also something that has helped people reverse type 2 diabetes and this is again not new so this was written by Dr
5:28Elliot Jos in 1916 so this is more than a hundred years ago and he wrote in the
5:35CJ that temporary periods of undernutrition are helpful in the treatment of type 2 diabetes will
5:41probably be acknowledged by all after these two years of experience with fasting so he thought it was so obvious
5:47that you wouldn’t even need to do a study and this is probably the most famous diabetologist in history who is
5:53writing this a hundred years ago cuz if for type 2 diabetes if you lose weight
5:59yes your diabetes will go away and he thought it’s obvious then of course what happened was that they discovered
6:04insulin everybody forgot about dietary treatments and we went ahead and gave a lot of insulin to people and if this was
6:11in the bmj is an article a case report I wrote and it was under the myth exploded that you could actually reverse type 2
6:18diabetes and they did an article in reader digest and these are some of the people who did reverse or type 2
6:24diabetes just by using intermittent fasting you see of course that a lot of them they lose a lot of weight when you
6:30lose weight your type 2 by diabetes goes in reverse and very low carbohydrate diets
6:37can also put people into remission this this is from the uh American
6:43Diabetes Association so again this was only published in in 2020 and this is a
6:48consensus report from the Ada and when they’re talking about eating patterns
6:54what they say is that reducing overall carbohydrate intake for individuals with
6:59diabetes has demonstrated the most evidence for improving glycemia that is
7:05it’s not some kind of fad diet that has no scientific bearing it is in fact the
7:10diet with the most evidence for reversal of type 2
7:15diabetes and this is a study from Dr David Unwin in the UK and he has been
7:21using type low carbohydrate diets in his practice he just gives people a handout
7:26and he tells them you know cut your carbs down so this is his experience over 6 years and what’s interesting is
7:34that over a period of 23 months he had a type 2 diabetes remission rate drug-free
7:41remission of 46% so almost half of his patients that
7:46chose to do this not only came off all their drugs but had an A1C so low that
7:54they were considered no longer diabetic half of his patients if you do
8:01the same thing with pre-diabetics their a1c’s go down to a level that they’re considered normal not pre-diabetic in
8:0993% of cases so this is all real world experience and backed up by you know the
8:16the the scientific uh data it is a disease that can be put into remission
8:21in half of our patients and that is a huge number of patients it’s going to have a huge impact on your practices and
8:29there there was no threshold uh above which it was not successful so even if you had a1c’s up in the 15% range they
8:36still came down when you restricted carbohydrates so compare that so these
8:43are strategies that reverse type two diabetes we know it we’ve seen it everybody’s done it in fact everybody
8:50knew it already so if you had a patient who said well you know hey I had you
8:55know lost 50 pounds my diabetes went away I got off metformin you’d say great job you wouldn’t say hey you’re such a liar right it’s chronic and irreversible
9:03what are you talking about no you knew it everybody knew it every patient knew it every doctor knew it that this was a disease that could go into reverse yet
9:10for years we focused on things that just led to progression that is giving more
9:16insulin giving more more suono uras giving a lowfat diet none of that actually made any difference things just
9:22continued to get worse so what was the difference and there’s two key Concepts
9:27when you understand what in insin resistance is what type two diabetes is that is the underfill versus the
9:33Overflow and looking at the blood glucose versus the whole body glucose these are Concepts that I’m you know I
9:41think about a lot as a nephologist so what is insulin resistance what is this disease uh
What is insulin resistance?
9:46process that we’re all worried about well this is how we think about it this is the classic teaching which is a
9:52locking key Paradigm right so this is normal insulin metabolism you have a cell here you have glucose you insulin
10:00insulin sort of fits like a lock in a key it brings the uh it opens up your
10:05gate and glucose goes into the cell to be used for energy so when you have
10:11insulin resistance people say something’s going on here there’s a problem now you can sequence the
10:17receptor you can look at the insulin insulin level insulin moleculees normal insulin receptor is normal so maybe it’s
10:24like a piece of gum or something that’s in the lock and it’s sort of screwing up the key so when that doesn’t happen what
10:31happens is that you you don’t get the glucose it piles up outside the cell which is what you see and inside the
10:37cell presumably you have internal starvation that is an underfilled cell you have no energy here we don’t know
10:43what causes it something causes it but it causes this internal uh sorry insulin
10:49resistance which leads to compensatory hyperinsulinemia which then drives the
10:54glucose in now the problem with that is that in this situation internal
10:59starvation this is exactly of course a situation you see in type 1 diabetes but in that case of course you don’t have
11:05insulin but you get the same low intracellular glucose and this is what untreated type 1 diabetes looks like so
11:13you see this person is super super skinny cannot gain any weight no matter how much food you give this uh poor girl
11:20she will not gain any weight because insulin is necessary for that energy to go in for the glucose to go in for you
11:27to store energy you need insulin so she cannot store energy she gets thinner and
11:32thinner until she dies and then of course you give her insulin and she goes back to normal so that’s internal
11:38starvation but this is type two diabetes phenotypically it looks nothing
11:44like that internal starvation it’s a real stretch with this person with all
11:49their abdominal obesity their big fatty liver uh to say that this is a state of
11:55internal starvation I can’t see it and it looks nothing like real internal starvation so that’s a bit of a problem
12:02so when you’re thinking about the resistance what you’re talking about is that you have all this glucose outside
12:08the cell and it cannot go in but there’s two possibilities as to why it cannot go
12:15in you could have a malfunctioning insulin receptor that gum in the in the
12:20Locking key or the other possibility is an overflow problem that is your cell
12:26just has too much glucose and that’s why can’t go in so you have the primary
12:32problem is not just the glucose in the blood it’s the glucose in the whole body so if you have a situation where you
12:39have high insulin levels for a long time you’ve been spending decades just
12:44shoving glucose into the cell it keeps going in and in and in and now there’s just too much and that’s why it’s piling
12:51outside you can’t fill it in it’s an overflow problem that’s a possibility so
12:57it has real implications because the way you treat it is going to be completely
13:02opposite in the internal starvation mode you’re going to give more insulin because that’s the right treatment same
13:08as type 1 diabetes that’s the right treatment in type two diabetes if it’s an overflow problem and you have too
13:15much insulin giving more insulin doesn’t solve the problem you’re just going to keep shoving this glucose into this overfilled cell and the minute you stop
13:23the giving the insulin it’s just going to come back out and it’s you’re not going to make the problem better you’re
13:29going to make the problem worse because you’re filling this overfilled cell so if you think about it sort of like a
13:35suitcase right we’re putting clothes in it’s going in no problem no problem no problem all of a sudden you can’t put
13:41those clothes in anymore you can’t put in those last two T-shirts could be a problem with the
13:47locking mechanism or it could be that your suitcase is full right both are
13:53possibilities think about it like this if you have a train which is like your cell and you
13:58have glucose which is like the people standing on this platform normally insulin opens the door people go in if
14:06all of a sudden you see people piled up back out here two possibilities one is
14:12the door didn’t open two is that there’s just too much people inside so giving
14:17more insulin and shoving people into that car doesn’t make it better it makes
14:22it better temporarily because there’s less people here but it makes the overall problem worse because you’re
14:28overfilling an overfill train already so how would that work from a
What is Gycolysis?
14:34biochemical standpoint well it’s very simple really and again if you think about what happens to glucose it
14:41undergos a sort of very stereotypic process so glucose under goes this process called glycolysis which turns
14:48into pyruvate amino acids come in here and fat acids come in here and essentially
14:55go from pyruvate through pyruvate oxidation to acetyl COA and acetyl COA
15:01is kind of the sort of Baseline so fats can do it amino acids can do it glucose can do it so any of those can do it and
15:08from there you go through the citric acid cycle and you generate ATP which is
15:13cellular energy now you can’t just keep on doing this forever because if you
15:18have too much ATP it’s toxic you have too much energy right it’s just like if
15:23you have too much heat you just burn down your cell doesn’t want to do that so you don’t want too much at P sitting
15:29inside your cell so if you’re shoving in all this glucose and you’re generating ATP it’s going to naturally put a stop
15:36on all of these processes the citric acid cycle the pyate oxidation and the
15:42glycolysis which is going to lead the glucose levels inside the cell to go up because you don’t want to move your
15:49glucose into ATP so when you’re backing up your glucose your internal cell glucose is
15:56going up what happens when you open up that gate so insulin attaches to its
16:02receptor opens up the glute for the gate is open but it can’t go in because this
16:08depends on facilitated diffusion you need a concentration gradient between the extracellular glucose and the
16:15intracellular glucose in order for this to go in if you’ve just backed up all your glucose that glucose just backs up
16:21out the door and that’s exactly what you’re seeing with insulin
16:26resistance so let’s follow this this through logically so what happens to
16:32that excess glucose so now you’ve got all this glucose sitting inside your liver cell your liver doesn’t want all
16:39this glucose it doesn’t want ATP it can’t generate that ATP so you activate
16:44this process called denovo lipogenesis which is here and essentially you’re taking glucose going through this
16:50process of acetylcoa citric acid cycle and then you’re eventually creating
16:56triglycerides which is fat that’s what denovo lipogenesis means it’s denovo
17:02which is from new lipo which is fat Genesis the creation it’s the creation of new fat from your glucose because you
17:09have too much glucose your body is busy turning that glucose into fat and that’s
17:15the reason almost all of the type 2 diabetics have a big fatty liver there is no internal starvation going on we
17:23know in type 2 diabetes that the noo lipogenesis is going crazy so you’re
17:28generating a lot of fat from glucose if you were to say that this is all a
17:34problem with internal starvation a malfunctioning insulin receptor if you
17:40don’t have any glucose inside your cell how are you going to make triglycerides from the glucose that does not exist
17:46right it’s like building a brick wall with no bricks you can’t do it no matter how many Carpenters you have so if you
17:52have no glucose inside the cell you cannot generate fat to give you fatty liver which we know clinically that most
18:00of these patients are going to have so again let’s follow this through
The process of cholesterol transport
18:05so you’re generating all this new fat in the liver because you had too much glucose too much insulin the liver don’t
18:12want to hold on to that fat it’s not supposed to be stored in the fat so it tries to get rid of it this is the
18:19process of cholesterol transport so you take the fatty acids package it with some cholesterol and some
18:25lipoproteins and you send it out as very low density lipoprotein goes out into the blood
18:32right so you’ve got all this excess fat your liver is trying to dump it out it’s trying to get rid of it so it goes into
18:40the blood so you see very high triglycerides the triglycerides bring those fatty acids in the blood you
18:46activate lipoprotein lipase and you goes into fat cells that’s where you get the
18:52abdominal obesity that you see in type 2 diabetes which then goes to intermediate
18:58density like protein and lowers the HDL so what you see is high triglycerides
A Process of Hyperinsulinemia
19:04low HDL which goes to LDL and and that that may go up as well but what you’re
19:10seeing now is okay here we have a process of hyperinsulinemia too much
19:16insulin too much glucose overflow situation not underfill you’re going to get abdominal obesity you’re going to
19:23get this insulin resistance you’re going to get highy triglycerides low HDL and you’re going to get high blood pressure
19:29because insulin is an anti-diuretic hormone so it causes your kidney to retain salt and water which is going to
19:35increase your blood pressure well what are those five things called This is literally the definition
19:45of metabolic syndrome it all goes together why do these cluster of things
19:51all go together is because they have the same underlying cause they’re all
19:57hyperinsulinemia your body is trying to get rid of that excess fat by throwing it into the
20:03abdomen is trying to block more glucose going in so you get glucose out the cells you got the triglycerides the HDL
20:11and the hypertension it’s all part and parcel of the same process so again if we compare the two
What causes Malfunction(mystery villain)
20:19two ways of thinking and again this is the underfill so you say that the main problem is
20:25internal starvation some kind of malfunction here what causes malfunction here well nobody knows after 50 years
20:33nobody has any clue what this is it’s some mystery villain that has been eluding scientists for decades even as
20:41it causes a worldwide epidemic we just don’t know what’s causing this this malfunction some people say it’s you
20:47know fat and some people say it’s inflammation and some people say it’s this and that well that’s not very
20:54satisfactory so this entire hypothesis which is some mystery causes insul
20:59resistance causes hyper insolia and this um intracellular starvation is going to
21:06make some predictions in terms of clinical medicine this will predict what we’re going to see in clinic it’s going
21:11to say no you’re not going to have fatty liver it’s going to say no you’re going to be skinny not fat it’s going to say
21:18Hey you lose weight it’s not going to make any difference because you have internal starvation it’s going to say insulin
21:25makes things better that’s the right treatment and the pushing the glucose from the blood inside the body will make
21:31things better and of course every single one of these predictions is completely
21:37incorrect we know this since 2008 with the Accord study that is when you give
21:44people lots of insulin and sulfon uras to make that blood glucose down you can
21:49bring it down but you can’t make them better in fact you might make things worse that’s why the A1C targets have
21:56gradually gone from 6% to like 8% and think about this for a second if
22:02your problem is that you’ve got too much blood glucose and you give them lots of insulin and shovel all that blood
22:09glucose into the liver like you never got rid of the glucose what’s going to
22:14happen well your liver is going to turn it into fat which means you’re going to get weight gain if you get weight gain
22:21your type two diabetes gets worse so you’re making the blood glucose better
22:27but you’re making the type two diabetes IES worse no wonder you didn’t have an effect and it it wasn’t shown in just
22:32this study of course every other study does the same thing this was the advanced study which showed that even
22:37after 10 years you couldn’t show any difference to lowering blood glucose by giving more medications and compare that to this
22:45other way of thinking which is this is an overflow problem right the problem is too much insulin too much glucose this
22:51resulted from dietary changes we’re eating more car refined carbohydrates we’re eating more often we’re eating
22:57more which is going to lead to hyper insulinemia because insulin is a nutrient sensor that hyperinsulinemia
23:04means you’re shoveling all this glucose into the cell that’s going to overflow your glucose going to go back you’re
23:10going to get the so-called insulin resistance which is going to cause compensatory hyperinsulinemia which is
23:15ultimately destructive because of course shoveling more glucose in is not going to do any good so this is also going to
23:22make some predictions in terms of clinical medicine which is that you will have fatty liver you will have obesity
23:29if you lose weight all of this if you get rid of that the overfilled ad deposite your
23:37type two diabetes will go away and yes it does it’s going to predict that insulin makes things worse which it does
23:44and it’s going to say that pushing glucose from the blood into the body does you overall no good which is what
23:50the insulin did and of course every single one of these predictions from a clinical standpoint which is the most
23:56important because that’s what our patient patients are seeing is correct it’s not a new uh it’s not a New
24:04Concept this was from the 2011 Banting lecture which is the sort of scientific
24:10Achievement Award for the American Diabetes Association this is the new thinking from 2011 the problem is not
24:17that you have a malfunctioning insulin receptor the problem is that you have too much insulin that is the underlying
24:23problem too much insulin which is then linked back to dietary changes which are
24:29we can track those dietary changes we know there’s been dietary changes since the 1970s so it’s not some mystery as to
24:36what’s happening we can track it back and we can see it and the treatment Paradigm of course is completely
24:42different instead of giving more insulin you want to lower the insulin because you have too much insulin
24:49already and you got to treat the whole body glucose not just the blood glucose
24:54moving the glucose from the blood into the liver does you no good because it’s still there it’s sort of like taking
25:01garbage and just throwing it under the sink it doesn’t do any good you can’t see it anymore but it still stinks and
25:08that’s the problem when you take this glucose and just put it into your body and turn it into fat you never got rid
25:14of the glucose so it’s still there causing as much damage as if you didn’t so how are you going to lower the
25:21glucose well we have drugs that will do that now and this is for example canagan
25:27so that’s an SGL 2 inhibitor it’s going to make you pee out some glucose if you pee out the glucose then your insulin is
25:34going to go down which is what this shows and that’s just sort of basic and of course then you get to studies like
25:40the emper study which is a study where they used uh sglt 2s and what they found
25:49was that the A1C luring was pretty minuscule in EMP rag the A1C reduction
25:55was only4 which is sort of me it’s like it’s not very good right if you give
26:00insulin you can get those a1c’s down 1% 2% 3% you can’t really do that with this
26:07so there’s almost no benefit compared to some of the stronger stuff on blood glucose lowering but the important thing
26:14is that you’re dumping glucose out of the body this is all caused mortality down by like
26:2232% for a barely noticeable drop in your A1C but they got the treatment Paradigm
26:29right because you’re treating the Overflow not the internal starvation and
26:36you can look at a drug like semaglutide so again it makes you not want to eat so
26:41this is semaglutide you see total energy intake about 700 calories a day less and
26:47if you’re eating less insulin is a nutrient sensor if you’re eating less insulin is going to go down so you see
26:53Pro insulin and Insulin go down with some magnetite which is not a surprise and of course you lose weight as you
27:01lose weight look at the end organ end points so this is strokes and Mi down by
27:0926% like that’s a huge benefit for semaglutide that you never saw before
27:14with insulin or suono uras or even metformin nephropathy where we’ve had no
27:20new uh drugs for renal protection since the ACE inhibitors in the 80s you know huge protection like a 36% reduction in
27:28new nephropathy like almost unimaginable benefits that you never used to see so
Treat the Root cause
27:34the point is that you got to treat root causes okay so if you have a disease like a bacteria you have it can
27:42cause an infection which causes a fever this is the symptom you can’t treat it here if you give acetaminophen for an
27:49intraabdominal abscess that’s symptomatic treatment might make it feel better but it doesn’t make the actual
27:54disease any better you actually can’t make it better until you treat the cause of the disease so the the same thing
28:03occurs in type 2 diabetes and obesity as well so your problem is hyperinsulinemia
28:09you have the Obesity which is sort of a marker for hyper insulinemia which is
28:15causing your type 2 diabetes which is causing your blood glucose to go up that’s the
28:22symptom that’s not the disease so you can’t treat the blood
28:27glucose cuz you’re not actually treating the disease you got to treat it here if they
28:34lose weight their diabetes goes away and then their blood glucose comes down what
28:41happened was we mistook the symtom for the disease so for the past 30 plus
28:49years we were treating it symptomatically we weren’t treating the
28:55root cause we’re treating what we could see we’re treating the fever and not the infection the disease was
29:03hyperinsulinemia not hypoglycemia which is why lowering the blood glucose ultimately did not do any
29:10good and that was the the lessons of the Accord the advance the vad all those
29:16very expensive studies from 15 years ago and even looking at it from a simplistic
29:22standpoint this is what happens during type 2 diabetes we know this in insulin
29:28goes way up before your blood glucose goes up then of course insulin starts to
29:33go down and glucose goes up so when you look at this entire disease process do you think it’s the insulin
29:41that’s the problem or the glucose that’s the problem and for years we said it was all
29:47about the glucose all about those a1c’s all about getting the glucose down and
29:52that’s why we said well we can’t treat it we’re treat it’s it’s chronic it’s Progressive it was never Progressive we
29:59were just treating the wrong thing we should have been treating the hyperinsulinemia instead we’re giving
30:05insulin and again it’s exactly the wrong thing it puts you into this downward
30:12spiral because we you treat this with insulin insulin leads to weight gain and
30:17it’s just a vicious cycle take more insulin gain more weight gain more weight type two diabetes gets worse so
30:24guess what you take more insulin then you gain more weight and it
30:30keeps going and this is the way we used to treat it this is the way I treated it
30:35for years and it wasn’t the right thing nobody got any better and then they got their heart attacks and then they went
30:42on dialysis and we said it was chronic and Progressive there’s nothing we can do but there is something we can do if
30:48you look at the treatments that reverse type 2 diabetes the bariatric surgery
30:53the fasting the very low carb diets compared to the treatments that lead to progression and
31:00worsening what you see is that these things all increase insulin and these things all decrease insulin so there’s a
31:07very big difference between how you’re going to treat it if you understand that the root cause is actually the
31:15hyperinsulinemia it’s a disease of too much insulin and that’s why it doesn’t work so then we get to the second
What is pancreatic Burnout?
31:22problem which is what’s happening in the pancreas because we know that the insulin levels go way up and then they
31:28start to drop so if it burns out then yes it is a chronic and Progressive disease is it really burned out so this
31:36is called the Counterpoint study it was done by Dr Taylor in the UK in 2013 and what he did was put people on a
31:43very low calorie diet 800 calories a day for uh eight weeks and the fasting blood
31:48glucose came right down so immediately came down from you know 9 or 10 to like six normal almost immediately so very
31:55very good when you measure the liver fat you can see this is the sort of normal
32:01control you see that people with type 2 diabetes have fatty livers that’s not a
32:06surprise as you sort of give them very little to eat they’re going to use up some of the fat in the liver which is
32:13good so over time the fat in the liver comes down even down below Baseline and
32:18as you get rid of that liver fat so it’s just like emptying out that suitcase right you’re taking out that excess
32:24glucose then hepatic insulin sensitivity is restored you don’t see the insulin resistance anymore it goes away because
32:31you unloaded that that cell and this is hepatic glucose production this is
32:37Baseline so again you know you’re getting too much hepatic glucose production that’s the whole problem with insulin resistance it goes away so
32:44insulin sensitivity goes right back down to normal when you get rid of the fatty liver but what’s happening to the
32:50pancreas Well turns out that when you look at the pancreas in type 2 diabetics
32:56not only do they have big fatty livers they have big fatty pancreases as well because the liver’s been exporting all
33:03this fat and you can see it on ultrasound uh in fact a lot of the Radiologists around my areas are
33:08reporting fatty pancreas all the time now this is control and this is uh the fat triglyceride content of the pancreas
33:17and over time so it’s a much slower process but you can see that the fat in the pancrea slowly goes down but it’s
33:23much takes a lot more time uh than the liver because remember the liver is right there when the body wants energy
33:29it’s just going to pull it out of the liver because it’s right there it’s a lot harder to pull it out of the pancreas because it’s got to go through
33:34this whole process of reverse cholesterol transport but what happens to the beta
33:41cell this is the beta cell function so how much insulin is this beta cell producing this is Baseline so it’s not
33:49producing as much insulin as it should be but as you get rid of that fatty
33:54pancreas it goes back up so that drop in pancreatic insulin production was not
34:03irreversible that is the pancreas cell was not burned out it is in very late stages but for most people it was just
34:11clogged up with fat which means that it’s a reversible condition the
34:16pancreatic cell has reversed its defect and so this is the Twin cycles hypothesis of type 2 diabetes which is
34:23very important uh again from Dr Taylor and from the American Diabetes Association I’m going to take it through
34:29it slowly essentially there’s two cycles there’s a liver cycle and pancreatic cycle and what you have is you have a
34:37diet which leads to very high insulin level so you’re eating all the time you’re eating a lot of refined carbohydrates this gives you the fatty
34:44liver right so you have too much insulin you’re shoveling all this glucose into your cell your cell is turning into fat
34:50you get fatty liver which leads to this hepatic insulin resistance which is that
34:55overflow which leads to higher ins levels but that’s only part of the story
35:01because there’s another cycle as your fat you know builds up in the liver it’s
35:08going to export it and you’re going to get fatty pancreas so that’s going to clog up your pancreas and it’s going to
35:15lead to this reversible beta cell dysfunction which is again going to lead
35:21to high blood glucose and insulin production again so you have a liver cycle and you have a pancreatic cycle
35:29and what’s important about it is that now type 2 diabetes with its two phases
35:36are not two distinct diseases there’s not two different pathophysiology
35:41there’s not one thing that causes insulin resistance and then some sclerotic process of burnout both of
35:47these are just diseases of ectopic fat deposition there’s a bunch of fat where
35:52it’s not supposed to be it’s the same underlying pathophysiology it’s an a a sort of uniting theory of
36:01type two diabetes so how are you going to impact this well the body figured
36:06this out a long time ago if your whole problem is that you have too much glucose leading to too much insulin well
36:13you dump it out in the in the urine just dump it out that’s why you
36:19have a renal threshold of glucose when your glucose level goes too high your
36:24body cannot absorb anymore and you get glucose Uria it wasn’t an
36:30accident the the the kidney is limited to a certain level of blood glucose above that the body is trying to protect
36:37itself from this glucose toxicity and that’s what the SGL t2s do it enhances
36:44that sort of protection and that’s why you see such incredible protection in the endorgans in the kidneys in the
36:50heart for heart failure for all of that because you’ve got the Paradigm right so
36:56these two phases are not separate and distinct entities they’re not separate
37:02and distinct diseases that’s why they’re always linked to each other because they’re actually part of the same
37:07disease it’s the same uh it’s a it’s the same underlying process that’s causing
37:13both of these problems so again if you think about the drug treatments now you can say okay well
37:20let’s think about two things first of all one is that the disease is hyperinsulinemia not
37:25hypoglycemia and we got to treat the whole body glucose not the blood glucose
37:30so there’s good drugs for that we know that s gt2s and gp1s are very good the
37:36studies are all excellent the blood glucose the effect is sort of meh for S gt2s it’s pretty
37:44good for S gp1s but it decreases the insulin which
37:49decreases your weight decreases a whole body glucose and what are the CV outcomes almost
37:57stuff we’ve never seen before in terms of renal protection cardiac protection if you look at the bad stuff
38:05like just didn’t do very much the dpp4s and the metformin they had pretty good blood glucose control it was not bad but
38:12it was sort of neutral on the whole body glucose if you take Metformin you’re not getting rid of glucose remember with the
38:20sglt sglt 2s you’re peeing out the glucose on the gp1s you’re not putting
38:26glucose into the system so the whole body is having less glucose that doesn’t
38:31happen with metformin or dpp4s so you have pretty good blood glucose control but pretty neutral on the whole glucose
38:38neutral on the insulin neutral on the weight so is there any benefit hard to
38:43tell not very many studies I mean you can go back to the UK PDS from like 40
38:48years ago but nothing really since then and then there’s the stuff that’s just ugly which is like the insulin and the
38:54Sano uras tzds too but the whole blood glucose goes up because you’re giving
39:00insulin people are gaining weight their insulin’s going up they’re gaining weight and if anything they’re making
39:05outcomes worse because again if you’re just making things worse you’re gaining
39:11weight your diabetes getting worse you’re taking more insulin well patients knew it they’re saying hey how what’s
39:18going on here all I’m doing is taking more and more and more insulin over these years and you know what they were
39:26exactly right that was never the right treatment what we should have focused on is treating
39:32the insulin because remember you can’t treat a hyperinsulinemic state with more
39:38insulin it never made sense it’s like treating an alcoholic with alcohol like
39:45yes you will have less DTS your symptoms will get better you’ll stop shaking but
39:51your disease your alcoholism is going to get worse if you have too much insulin why
39:57would you give more insulin do you treat a hyper thyroid patient with more thyroid I don’t think so so why would
40:05you treat a situation where you know you have too much insulin with more insulin
40:10andul fonal uras and then we wonder why it’s not getting better because the treatment was not correct and the whole
40:18point is that yes we have great drugs to do it but you don’t need drugs to do
40:23that because your ultimate root cause is back here in the do diet because you can
40:29use low carbohydrate diets because we know those reverse type two diabetes and
40:35you can use intermittent fasting if you don’t eat insulin levels are going to go
40:40down the whole the whole thing about insulin about fasting is that it’s very
40:45simple if you don’t eat your body still needs a source of energy the most
40:50available source of energy is your blood glucose so it’s going to use up that blood glucose that’s that’s it so now
40:58you can you can use up that blood glucose glucose is going to fall you didn’t need drugs to do it because you
41:04could do it naturally without all of those drugs is it fun no but is it
41:10effective yes it is effective that’s the point both of these treatments are free
Key takeaways:(Type 2 Diabetis is Reversible)
41:16and available we can do this we just have to change the way we think about type 2 diabetes and the key takeaways
41:25really is that this is a reverse ible disease okay that much is clear has
41:31always been clear but because we thought it was all about pancreatic burnout we called it chronic and and Progressive
41:37but it wasn’t it’s a reversible disease so that’s the Target that we should be aiming at for every single one of our
41:43patients is it going to happen no but we should be aiming for that the key treatment other than the drugs is the
41:50diet because that’s the root cause of it you got to treat the cause and not the symptoms if you treat the symptoms is
41:57not going to affect the disease process you treat the diet they lose weight that diabetes gets better nothing difficult
42:05about that the problem is hyperinsulinemia rather which causes the insulin resistance through this overflow
42:12mechanism as opposed to this sort of outdated underfill mechanism internal
42:17starvation that we all thought it was this lack of insulin relative lack of insulin is a term that that that used to
42:24be used but total insulin was way too high and you got to treat the whole body
42:29glucose so if you’re limiting the glucose that’s going into your body such as with low carbohydrate diets or you’re
42:37increasing the burning of the glucose such as with intermittent fasting you’re going to be able to reverse type 2
42:42diabetes and with that you know we’re sort of entering this whole new era of thinking because if you can
42:51get people to lose weight if you can reverse that type two diabetes you’re going to have a huge impact because if
42:58you think about it there’s so many diseases that are impacted your
43:03cardiovascular disease heart attacks Strokes cancer and then type two diabetes which causes blindness which
43:10causes amputations which causes infections which causes uh kidney disease so all of those ultimately come
43:17back to diet and lifestyle and we all you know we all grew up in an era where
43:24we have a certain way of looking at medicine that is the acute care theory of you
43:31know way of looking at medicine is that people get sick you come to the doctor I give you a drug you get better worked
43:38well with antibiotics so you know you had an infection I gave you a drug you’re all better the problem is you
43:43can’t translate that model into 21st century medicine where a lot of our
43:49diseases are chronic and dietary because look at what kills people heart disease
43:55and cancer both of them huge risk factors of diet and
44:00lifestyle all of the other diseases even covid we know that if you’re overweight
44:06that it takes a much bigger toll on you so it affects every single facet of medicine because all of medicine has
44:13moved away from sort of acute medicine like infections and you know parasites
44:18and all this stuff where we needed the right drugs to this sort of chronic
44:23diseases because that’s what affects people now and you can’t just give a drug for a chronic disease it doesn’t
44:30work like that you have to get back to the root problem which is that weight and when you can do that successfully
44:37that’s when you can make a difference for your patients and that’s how you can reverse type two diabetes
