managing Type 1 Diabetes with Nutrition

Welcome everybody to our next show of Food, Medicine, and Lies. Before I introduce my guest Dr. Gaja here, I will want to do just the basic housekeeping. So this channel was started during COVID times, Dr. Gaja. Because I was getting a lot of questions from people on what is right and what is not right information about COVID And I thought to bust this myth, it will be an excellent thing if I could invite, you know, trained experts like you on this channel and help people find the truth behind all the information which Google and WhatsApp University offers to the people today. So I welcome you, Dr. Gaggia. So Dr. Gaggia is a board-certified functional medicine expert, is an endocrinologist and an internal medicine specialist. She also is an example of how one can manage type 1 diabetes mellitus and live a very healthy and active life and contribute to people's lives in a huge way. Dr. Gaggia, thank you very much for being here with us today, and please share something about yourself and about your journey of managing type 1 diabetes.

Yeah, thank you very much, Dr. Nanda, for having me here. I, I really appreciate this opportunity. Um, yes, I am always interested in sharing my experience with, uh, with managing, uh, type 1 diabetes. Um, interestingly, I wanted— I was interested in endocrinology, uh, even before I, I was diagnosed. Uh, so when I went to medical school, I fell in love with endocrinology. It felt logical, and I like logic. Um, so my plan was to become a pediatric endocrinologist, to work with children who have a problem with hormones. So after my medical school, I was actually rotating. One of my rotations was in a hospital, children's hospital, where we were treating type 1 diabetes. And I had the patient, 3-year-old patient, recently diagnosed, was really not happy with poking fingers, you know, doing shots, crying a lot. And I, um, we played the doctor, meaning I was poking her and she was poking me. And when she poked me, my sugar was at 500 here. So, so, and normal is, you know, about 100. So this is how I was— I learned that I have type 1 diabetes. And so I was diagnosed by the 3-year-old patient. And the funny part is I remember I was like 26 at this time or 24, um, something like this. And, um, I, I had this 3-year-old and I kept telling her everything would be fine. And so, and here I see this high number, so I had to really do everything not to freak out, um, when she noticed, uh, when she commented on my sugars being higher than hers. So So this is how I started.

So, Dr. Gaja, what this tells me is so similar to what a lot of my clients tell me. And surprisingly, see, even with such high level of sugars, if a doctor like you, especially at that age, you know, we are very sensitive from third year onwards. Every disease we read, we think we have that disease.

Yep, exactly.

Yep. And even despite that, you did not feel that, you know, you have anything like this and a 3-year-old child?

I was skinny, but I was happy I was skinny. I lost my pregnancy weight very fast. So, so that's one. I was breastfeeding at this time and I had a baby, so I didn't— I was just tired, you know, so I didn't. But I did not remember when I looked back. Yeah, sure, I peed a lot. Like I had the map, map of the public restrooms in Warsaw. So, but yeah, I didn't put this together myself at all.

No, which is like, so I used to think that, you know, only patients don't get to know. And generally in India, what we see is most of them land up in hospitals, uh, when they get diagnosed, and that's how their journey of type 1 diabetes starts. You are in a hospital with very high sugar levels, not able to manage, and then the doctor tells you things like insulin is a boon for you. Yes, I definitely agree. But doctors also tell them that, you know, nothing else you have to do. You just have to keep taking your insulin at the right time and in the right doses. So what will you say on that, Dr. Gaggia?

So when I got diagnosed, um, uh, despite the fact that I was already in a hospital with the pediatric doctors, he told me I have to go to the adult doctor hospital to get in a system. And I remember when I went, I was admitted to the hospital and the doctor who admitted me, um, they did my testing, they did my C-peptide, so measured how much insulin I produce. It was undetectable. And they told me I have type 2 diabetes. And this must be a mistake. Yeah. So, um, um, they discharged me from the hospital after 2 days on insulin. And, uh, then I went back to the pediatric doctors and they said, no, no, you are type 1. This is type 1. It's just a lot of times we think of type 1 as the children get it. And I see a lot of adults can get it. It's just autoimmune diabetes, just like to many other autoimmune conditions. So my oldest patient diagnosed, newly diagnosed with, uh, type 1 was 84 years old. So it can happen at any age. So the message I got from the adult hospital was you have to take insulin because my sugars otherwise were very high, and you have type 2 diabetes, which was completely— didn't make sense. I was skinny like a stick. Um, but then when I went to my pediatric doctors, they taught me how to learn how to use insulin according to my meaning, um, adult version was you take injection 3 times a day and you adjust your lifestyle to injections while the pediatric doctors know you cannot ask kids to adjust the lifestyle. So you have to adjust insulin. So this was the biggest first blessing of my life that those doctors opened me to like, no, no, you, you can take, you can change the insulin type to something faster acting and take it when you need it. So you don't have to eat when you don't want to, stuff like this. But then the message was, and it's still what I hear patients are telling me after diagnosis, you can eat everything, just take insulin for it. So that's what I did for 17 years of my, of my life with diabetes. Um, so, um, so very fast I realized that if I do this, I had couple problems. One problem was I kept having highs and lows. Even if I took insulin and I got really good, meaning, um, I tried different types of insulin. I even got insulin pump at one time, 10 years after diagnosis. Despite all this stuff, I would still have high and low blood sugar. So, um, so this is me following this message that I can eat everything. So, um, I thought type 1 diabetes is like this. This was the message, like, type 1 means roller coaster. There's nothing what you can do for it. I even have a support group for type 1s called Ups and Downs of Highs and Lows. I thought this is how it— this is something what I have to accept. And the last one is, um, uh, so, so, um, I was really afraid of those lows and highs and it really, um, interfered with my ability to work because I cannot see patients. I cannot, you know, save lives, like help with someone who needs, uh, urgent help if I am low, for example. So, um, I started fearing food, like I started avoiding food. Uh, what I would do is I would just not eat for most of the day, then the sugars were more stable. I would avoid like anything during work, and then after work I would eat some. And I gotta tell you, I was always eating the same because then I kind of knew I was able to predict what I can, um, What, what kind of sugars? It's still my sugar would go out always high. And then always low. So you have to understand, I was very fearful about complications of type 1. I've seen it kind of on all in my practice as the endocrinologist. So I have, for example, patients, of course, who lost limbs because of type 1 or type 2, who are blind because of type 1. I've seen it. I have a patient who got blind 4 years after diagnosis of very uncontrolled by sugars. So I lived in a fear that I will have complications. And then I started looking around and I've seen patients 50 years after diagnosis, no complications. So I started asking myself question, what's the difference? And the difference was they had better glucose control. So I started really focusing on the glucose control and I did good. My A1C was like, 6.2 to 7.2 for, you know, 17 years of my life. Uh, but I was riding the roller coaster, and this really— so I lived in fear, that's one. And I really was super regimented with food, meaning I would not eat for half of the life. So I would not eat in the morning because there was no way to, to, to control high blood sugar, and I couldn't go to work with high blood sugars. I couldn't think. And And I didn't eat that lunch because after lunch I would be like, I want to sleep, not see patients. And then I would eat after I'm done with patients. So this was my life for 17 years.

And what changed, Dr. Gaggia, for you that you started focusing on diet? And I think now you almost, you know, are on cyclic keto or ketogenic diet for a long time now. Yes. So how did it change?

So, um, honestly, everything best what's happened in my life happened because of my patients. So one day I had a patient coming to my clinic, patient I've seen him already for like 5 years by then. His name was— his name is Matt, and he is a firefighter, and I always attribute this to him. I uploaded his continuous glucose monitor. He had a sensor, and I could see his sugars And he had completely normal sugars. So this is an active firefighter with unpredictable lifestyle, with stress in life, and completely normal. So at this time, my knowledge, my only explanation I can have for this situation was he got transplant. And honestly, I felt a little bit offended, meaning like, how come you don't tell me, I'm your doctor, that you are planning on getting pancreatic transplant? Transplant. It's like, shouldn't I include it in this decision? And how? I didn't know you can get transplant if you don't need kidneys and stuff like that. Those were the questions. So I'm going to him and I'm talking and saying like, what did you do? What, what is it? And he said, I changed what I eat. And we started talking, you know. I have 20 minutes for a patient and already with the reviewing of everything, I was down to 10 minutes probably. So We had this 10-minute, uh, change and he said, this is the book, The Diabetes Solution by Dr. Bernstein. He said, I read the book and I changed, uh, what I eat. And those are the results. So interestingly, I had this book because I was diabetes expert. So I bought the book years ago. I even read the first two pages maybe. So I read the book the next couple of days and I changed my diet. I changed my diet for two weeks. And within a blink of an eye, my sugars were normal, like no more highs and lows. And I was like, wow. I was the only thinking, I was like, there must be something very wrong with this because why no one told me for 17 years? And I, I got internal medicine. I got, I got endocrinology. So I should know it all, you know, in this department. That's why I went for endo, one of the reasons. And what's happened is, so after 2 weeks, I stopped it thinking there must be something very wrong with this option. And I don't want to die with the normal sugars. I prefer to live longer and have the ups and downs if I have to. So then I, I went to work and I had again up and down and again, the fear of eating everything back. And I'm like, what the, what's happening? So I took 1 week off work. I got lots of books and I was reading and reading and online too. And, and I was like, there is nothing against it. So I got angry. This, at this point I had stages, I remember. So the first was definitely disbelief because I never, for 17 years, I never had such a good sugar so easy. So what's happened is I got angry. How come no one told me this? I wrote a letter to American Diabetes Association. Which I deeply, I was, um, uh, I was, uh, at this time like advocating for them. I was meeting with like congressmen and so, and I was, uh, I had my team writing to them for the, uh, tour the cures. I was very involved and I wrote letters saying like, how is it possible? We are not telling people that they need to change what they eat. And they said, oh, because the guidelines are, uh, are different. And so, and we don't have evidence. I, I, And I was like, are you kidding me? I just tried it for 2 weeks and I was free of my problems. So, so I, um, I kind of stopped my, uh, uh, my relation with ADA. They did change since then because more and more people advocated, but it's still up to now when someone goes to the hospital and gets, uh, gets diagnosed with type 1 diabetes, they still, and type 2 the same, um, but type 1 is definitely more, they are being told. There is nothing wrong with you, just the pancreas doesn't work. You can eat everything and cover it with insulin. And it's heartbreaking because we are losing such an opportunity. So I do want to show you something. Um, yeah, let me share my screen. I just want to show you a couple of things so it will help to understand what I'm talking about. So let me see if I can do this right. Yeah, I think you can see what I'm trying to share screen. Easy with two monitors. Share screen works. Best.

So you will see a share screen icon at the bottom.

Yeah, I do this, but then— yeah, hold on. So, so I have my, um, let me close this and let me pull this up. Yeah, I see this. So, so the only issue is it does not show me. So you tell me if you can see, um, Uh, sure, let's try. I don't think it's pulling, uh, the— see, I don't see it pulling my— oh, now it is. Or maybe it doesn't. Let's try. So I'm trying to share my, uh—

yes, I can see your screen now.

Yeah. Oh, hallelujah! Okay, so let me do the slideshow. So do you see now the, the slideshow? Okay, good. So see, so I'm calling myself a patient zero. So it was in 2017. So, uh, so the only thing what makes me upset is the fact that it took me so long to find it. I was diagnosed in 2000, and on the top you have one day of my life, uh, uh, the pink one. It's the screen of my continuous glucose monitor. One day of my life before ketogenic. And you see up and down, up and down. This is without me eating. This is like after waking up, up and then down. I always was afraid of the high, so I would push it, but then I would hit the low. And up and down and up and down. And my A1C at this time was very good, 6.2. I was good diabetic. But the truth, what we know is having this up and down is really not good for your body. And then this is, it's just a day even of eating different. You see a normal sugar and then you see no more ups and downs. And the 2 months later, this is on the bottom. You can see a screenshot of my blood work. So I couldn't believe it. I never had below, um, 6 because I had a lot of lows. If I tried to get it below 6, I remember I even heard about those patients with type 1 diabetes, which with A1C below 6, and I was Thinking they are crazy. They have to have a lot of lows. Even when patients ask me, I thought they have a lot of lows. And it's funny because the results showed me A1C 5.4, and it says consistent with the absence of diabetes. Of course, I'm taking insulin, but much less and no more ups and downs. So what I did, I just couldn't keep it to myself. So I started sharing with patients. So type 1 patients changed the life, but type 2 patients, reverse diabetes. And I know that's what you do, right? So before I knew, I had the patients coming, you know, through the windows and doors, uh, wanting to reverse diabetes. And so many people were interested. So here on the picture, you have actually a picture of our potluck. People brought food and we shared. This is all low carb. Um, and we had— so we had to meet first. I was meeting in a small, like, conference room, and then we started meeting in a waiting room in my in a group meet— a group I, I've seen patients at. So we took the whole waiting room, so other doctors were not happy.

I can understand this, Dr. Gaja, because I wrote a book, Cyclic Keto, 3 years back.

Yeah.

And since then I've helped so many type 2 diabetics reverse their diabetes, and I am myself an example of that.

Exactly.

My sugar levels are like almost balanced now.

So it's amazing because people don't know they have this option. So I am not telling everyone should do this. I'm just saying you, you should give patients an option and let patient decide. Don't make this decision for patients. So you see here on this picture on the right, the, the big guy cooking, he's a chef. He was a chef for, uh, for Disney. And he lost over 100 pounds with me and he reversed his diabetes. So it's a really nice, great guy. So I always say, uh, so what kind of keto, what is ketogenic? So we talk about the well-formulated, good protein intake ketogenic diet. So you want to get ketones low, but honestly, a lot of times it doesn't have to be ketosis to see great results with sugars. And it's so important to re— eat real food, avoid processed food. And then I always tell patients, eat when you are hungry, but then it's okay not to eat when you are not hungry. This is an example. And I always ask, is it an extreme diet? You know, and I want to show you something. So these are the pictures of different diet options, uh, different meals and so from Diet Doctor. So. Funny part is when I started ketogenic diet, I gained some weight. You have to understand, I was undernourished and I was underweight because I was afraid to eat. So within the first year, I gained like 10 pounds because I ate, I ate, I was— I enjoyed food again. So this was not just the sugar transformation, but actually my, my whole life transformation. And it can be helpful with a lot of problems. Not just diabetes. But I want to show you something. So this is a patient of mine and she let me share her information. She has Instagram, Best One Day Ever, you see here. And she— we started working together when she was like 2 or 3, almost 3-year-old. It wasn't me who encouraged her to change diet, her mom. It's always the parent. So this is a day of her food. And honestly, just tell me that this kid is You know, restricted. So this is another day and she's growing. She's doing fantastic. I have so many patients with this. So this is really not bad. Oh, I want to share this with you. Um, this is a study which was published in 2020 and I was like, oh, I have to keep talking about this because it showed like, this is type 2. I know, but it's, it's really important. Um, to hear this message when you, um, that this is pancreas, picture of pancreas. And the first one, the Rajati one, is for pancreas of patients with type 2 diabetes. And then you can see how over 2 years it improved. It went back to normal with just reversing diabetes with the, with the diet, with eating less carbohydrates, giving pancreas break. So it's amazing. It means diabetes is reversible. Can type 1 be reversed?

Okay.

I don't think so, because as long as you have antibodies, you will keep affecting it, but it can be better. I want to show you something. So I always like to show— this is Dr. Eric Westman's question, and he's like my mentor because when I learned about ketogenic, I contacted him saying like, please, I'm type 1. Is it okay for me to eat this way? I've been studying, um, ketogenic diet and doing it with patients for years. And he's the kindest man I ever— a very down-to-earth doctor, all about making it simple and meeting patients halfway. So he has this question: how much glucose is in the blood? So let's say your glucose level is 100 milligrams. So that's the, uh, state's, uh, norms. I don't know what norms you guys have. So, and we have 5 liters of blood in the body. So how much glucose total, how much sugar, how many teaspoons of sugar we have in our blood when we have a normal sugar? And the answer is 1 teaspoon. That's it. When you see something like this, it makes you like, wow, how your body is supposed to manage all this? Like, those are the simple drinks we got. Sometimes we— it just gives you one teaspoon is everything which you have when you have normal sugars. And then let's say you go to— we do Starbucks and we drink Frappuccino, 18 teaspoons of— so this is not normal. So we are not telling people, oh, this is McDonald's, so we have carbs, 192 grams of carbohydrates in the normal McDonald's. This is not normal. So see, when the doctors are telling you, you can eat everything— let me stop sharing. Okay, you can eat everything. The problem is, I think that they should be telling you, you should eat healthy. And healthy diet is not the, the doing the rice, you know, because 1 cup of rice, 45 grams of sugar, that's 9 teaspoons of sugar. So that takes a lot of pancreas work to deal with this. And I gotta tell you, if you get type 1 diabetes— see, I was 17 years in when I learned this— my pancreas function, zero, nada, nothing. When I, I tried checking No help so far. But when at this very first time when you get diagnosed, if you go low carb, I see patients being just on small amount of insulin just once a day for a couple years a lot of times. So it's so encouraging.

You are right, Dr. Gaggia. So for, for some people, what I've seen when they come early and their C-peptide is 0.6, 0.8, 1.2 That's plenty. Exactly. Huge chance for them to, you know, even be without insulin.

Yes, over a year, no insulin. Exactly. But when I check his C-peptide, it's like 0.7 now, but he is on very low carb. But then on the other hand, I have patients who do like 50, 60 grams of carbs and inject just once a day, which is so different than injecting for every meal, snack when normally you have to, right?

And what I've also seen is when we change the diet, our gut health improves.

And we all know, completely like different story, Ananda, Dr. Nanda. So the thing is, you know, uh, when you have type 1 diabetes, you have autoimmune condition. So addressing— so it's a little bit like thyroid and Hashimoto's. Addressing thyroid, giving you a pill for thyroid, is just half of the problem. The other half is addressing the autoimmune. Otherwise, before you know, you got more. So I have those patients who have type 1 diabetes, Hashimoto's disease, celiac disease, and sometimes the fourth comes like rheumatoid arthritis or multiple sclerosis. So once you get one, do something. Don't wait like a sitting duck for more to happen. So we have someone— what you are saying, yes. It's autoimmune, there is always a gut health. Always.

And even very young children, they diagnosed with type 1 this year, and 2-3 years later only they are diagnosed with Hashimoto's thyroiditis.

Exactly.

And then some of them have celiac.

Exactly. So it's heartbreaking because it's harder and harder.

Exactly.

So it's very— uh, so this is what actually you mentioned. I am, uh, I am a certified, um, functional medicine doctor, so This happened after keto. So what happened first is I learned that with ketogenic diet I can have normal sugars. I was like, oh, what's there more? You know, I started questioning if I know it all by being a doctor with conventional medicine, and I learned like, oh, I can help more, you know. So I started helping people with Hashimoto's, helping people with Addison's disease, with the fatigue, brain fog, and this took me to the How about— and this is when I started feeling best, when I cut out the gluten. But keto is always gluten-free because gluten is always high.

Exactly, gluten-free, dairy-free. Yeah, and cut out the gluten.

And I cut out, in my case, uh, milk. I don't know how is it in India, but milk in States, big problem.

In India also big problem.

Yeah, so we, we give cows hormones, we give cows antibiotics. So they are, you know, giving us more, uh, more milk. We— and unfortunately, then we drink it, and this always causes problem with the gut. So exactly, exactly. So this is like— so that's like a second stage, is like it's not just to control. So my first goal, Dr.

Gaja, what I've seen is these children are very deficient in nutrients like magnesium, like zinc. They are very dehydrated also. Body is not, you know, retaining the water the way it should because of the Wi-Fi we have around and the environmental toxins and the blue light. So a lot can be achieved in that case also if we start using sun-charged water or structured water and we start being without Wi-Fi for a few hours at least while we are sleeping, using less blue light.

I think, uh, I think the main message we need to tell people is You gotta start with food. So if you get that, it's kind of like if you have diagnosis of any chronic disease, it's like a slam dunk kind of.

You—

this is, this is a card you got, you, you were dealt with this, but it doesn't mean the game is already set. You have something to say, you can change your future. It doesn't mean you are stuck. And I gotta tell you, this is my always first message to people. This is— you can do everything. You just— we just have to figure out how to make it safe. And I see patients— I have now so many patients who are choosing. So I am like a doctor because a lot of endocrinologists don't get it. They are still telling people, no, no, your kid needs 60 grams of carbohydrates a day for brain to work. This is such a lie. And it's so—

it's Which is very sorry state. But I think, Dr. Gaja, thanks for, you know, coming here. And I really like your final message: food is medicine.

Absolutely.

I don't know why we doctors are finding it so difficult to tell it to our patients, but Hippocrates, the father of medicine, started with this: food is medicine.

And we are circling back. Exactly, exactly.

And, and we are so afraid of circling back that there are very, very few doctors like you and me who are, you know, open about it and fine telling people that you have the power to change your game, you have the power to change your health. Change the food on your plate first.

Exactly, that's perfect. I'm so happy that you are there helping people with this and making them aware of this. This is really nice, Dr. Nanda.

I am extremely happy. And Dr. Gaja, the slide which you showed, especially on the sugar Honestly, I had not seen that slide like that before, so thank you for sharing that because it was not—

slide. Yeah, yeah, he does it like the same. For me, it was like, wow.

Yeah. And I think if I can show it to, you know, people who will watch this video, once they see it, they will have to believe it. Uh, you know, anybody can keep saying anything, eat whatever you want to and take insulin, don't bother about your diet. But seeing this picture, they will know that diet is—

I always encourage people, just try it, because that's what I did, you know. Just have the taste of different kind of life. And after those years, I do not feel restricted. I just learn how to cook. This is just my whole household eat this way. We don't feel restricted anymore.

This is— there are lots and lots of options With healthy keto, if you do healthy low carb, it's not keto, but gluten-free, dairy-free, healthy low carb.

I'm just lowering carbs so it doesn't have to be. It's just healthy diet. So the whole family is this way. I don't have patients who are different than family, the whole families. And then the parents will tell me, I feel better.

I know it's like a byproduct of having a patient.

Sometimes it can be actually a blessing. You know, to get diagnosed. There was a study published a while ago and showed that actually type 1 diabetics with well-controlled diabetes, A1C less than 7, lived longer than general population.

Yeah.

The reason why is because those are the people who are choosing a healthy lifestyle. They monitor— exactly.

Yeah, yeah, I have gone through this study and I do share it with my clients. I will share it with you. I, I know of this study and I'll share with all my clients that you have two ways to look at it, and this is one beautiful way to look at that.

Exactly. Very nice. Perfect. Thank you so much, Dr.

Thank you, Dr. Gaja, and thank you viewers.

Okay, perfect.

Thank you.

Bye-bye. Take care. Bye.