Reversing Diabetes Naturally: The Science Big Medicine Ignored

Coming up on this episode of the Dr. Hyman Show.

Patients do well if you don't feed them carbs. Isn't that how weird is that? It's a disorder of carbomydr metabolism.

Exactly.

Tell them not to eat it, they do fine. You don't take the toxin, you don't need the antinote. What if I told you there's a mineral that acts like a spark plug for your body, powering your brain, heart, muscles, and even your mood, and most of us are running on empty? That mineral is magnesium and it's involved in over 600 biochemical reactions. from regulating stress to boosting energy, sleep and digestion, but not all magnesium supplements are created equal. That's why I recommend magnesium breakthrough by bio optimizers. It's the only full spectrum magnesium supplement that includes all seven forms of magnesium your body needs to function at its best. Most magnesium supplements only give you one or two forms, but magnesium breakthrough ensures maximum absorption so you get real benefits, better sleep, improved mood, reduced stress and enhanced recovery. I take it every night to wind down and support my body, and I highly recommend it. Try magnesium breakthrough today and feel the difference. Go to bioptimizers.com/Hymen and use code Hymen10 for 10% off your order.

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For my website store for a summary of my favorite and thoroughly tested products. There are essential fatty acids. There are essential amino acids. There are no essential carbohydrates. So the body actually does not need them biologically to thrive even though it's our main fuel source. So historically we've been adapted to a whole range of diets from the Inuits and the basically a ketogenic diet to the Pima Indians who were 80% carbohydrates but it was all high fiber plant based carbohydrates that were really nutrient dense. So the body can survive and thrive on many different things and the quality of the calories matter which is really the thesis of your book, Good Calories, Bad Calories. and I think most people don't understand that they actually can regulate their biology if they figure out what their particular metabolic type is, because everybody's different. And for example, I need a little more carbohydrates because I'm kind of thin and if I don't eat them and I go keto, I'll lose too much weight. But if I take a patient who's overweight and type 2 diabetic, they're gonna do really well if I do that.

And a little bit of carbohydrates might prevent them from doing really well. Yeah, that's the, I think one of the points that I've made in my other books is we do think everybody is different and we definitely evolved to cope with the proteins and fats in our diet. The idea that the foods that we didn't, the new foods of modern life.

Ultra processed food. That's not even food.

Yeah, I'm not wild about the term ultra processed because it's sort of like the miasma. the area of all these kind of vague things that we're gonna throw in. Michael Pollan called them food-like substances. I prefer that. It gets more to the point.

But they don't meet the actual criteria of the definition of food.

We didn't have time to adopt to high levels of sugar in our diet and sugary beverages in our diet. These things didn't exist. We didn't have time. I mean, I'm agnostic about the seed oil issue. I don't find the evidence. I mean, I can easily believe that these things are toxic, but I The.

Evidence is confusing for sure.

There's a certain absence of human clinical trial evidence.

Just like sugar, when you think about sugar, we never had exposure to the amount of sugar we're eating now historically as species. We never had 10% of our diet being refined soybean oil before. That's a new phenomena for humanity.

And maybe it's okay, maybe it's not, but I think it should be questioned. Yeah, it certainly should be questioned. And that's the thing. So you can propose that those are, problems. And with the sugar and refined grains, you could see what happens when you take them out of people's lives. I mean, and we have clinical trials that show.

Can you talk about that? Like you talk about the Virta Health work and Sarah Hallberg's work and the sort of work on advanced type 2 diabetes where they actually were able to reverse it, not just slow it down or delay the complications or to manage the disease, but literally to reverse it.

Yeah, well, so this is getting back to the history a bit, we get to the 1970s, '80s, the diabetes community, their credit, did some really ambitious clinical trials. And what they find out in effect is that this disease, by their treatment, is a chronic progressive disorder. It just gets worse. A famous British trial where they show, they start people on diet only and then they add one drug and then they go and they see how many patients diagnosed with type 2 diabetes can stick with one drug monotherapy and the answer is like 10%. So as time goes on, you keep on having to add drugs to keep the blood sugar under control. They do these, we set a chord and I forget the other names of the other two trials, looking at intensive insulin therapy and they find that they does more harm than good at the very best and then they do this huge look ahead trial, $200 million to demonstrate that if you lose weight, you'll reduce diabetic complications. It's a fundamental pillar of thinking with diabetes. Just get your patients to lose weight, they'll be fine. And they get them to lose weight and it doesn't make a damn bit of difference. A trial was ended for futility, a $200 million trial. And a great quote in the New York Times from a Harvard diabetes specialist named David Nathan who says, We have to have an adult conversation about this. And they never do. But while this is true, but this.

Is an important point.

They lost weight and they got worse.

So- no, they lost weight and they didn't get better. So the idea was you lose weight, you'll have fewer complications, you'll reduce heart disease, you'll reduce strokes, you'll reduce mortality from this disease. It didn't make any- Was it because.

Of how they lost weight?

Well, it could have been because of how they lost weight. And in fact, back around 2003, when I first heard about this trial, from one of the principal investigators. I was at a conference, he invited me to talk in Houston. I remember saying to him, look, are you doing a low carb arm? Okay, just do a low carb arm. Make it not just low calorie, low fat, fruits, vegetables, whole grains, the usual. Mediterranean diet, right? Well, this was pre-Mediterranean. I mean, this was, yeah, it was just classic low fat. But in low fat, they're also saying you're eating fruits, vegetables, whole grains, you know, cut back on meat. exercise. They never crossed their mind to do a low-carb diet because that was still considered quackish. But as the diabetes community keeps learning about how ineffective their treatments are and how their belief system is falling apart on top of them and not having an adult conversation about it, which is maybe we're making some mistakes here, Other physicians coping with this increased obesity in their patients are confronted with patients who don't take their advice and instead buy Atkins Diet Revolution book and lose 40 pounds on Atkins. And a few of these doctors are open-minded enough, Eric Westman and David Ludwig, they say, I'm gonna look into this. I'm gonna actually do a clinical trial. So they start doing clinical trials. There's a big study at the Philadelphia VA, and there the woman named Linda Stern is frustrated by how much her inability to help her patients. So she literally goes to like a Brentano's bookstore and she sits down in the diet section and starts reading diets. The doctors go to the bookstore to.

Read self-help books because it's not in the textbooks.

You know, it's not, not, not, not, they definitely don't get grades, good grades for this in med school. Anyways, I think she found protein, power.

And she says, that's crazy.

She tries it on herself and this is, they're effortless to lose weight. So they put together a clinical trial and this is a Veterans Administration's hospital. So there are a lot of vets, they're not just obese, they have metabolic syndrome and type 2 diabetes. And instead of cutting them out of the trial, as you would, you know, the inclusion criteria in a pharmaceutical trial is gonna say, we're gonna not take these patients 'cause they're ill. She says, since this so associates with obesity, let's do it. And not only do these patients lose a lot of weight on the diet, but their type 2 diabetes gets better on this high fat, low carb, atkin, small protein power diet. So you start getting this groundswell, this movement of doctors who are reading these articles in the literature and saying, look, you know, Diet really seems to help. They don't know this deeper history, although Eric Westman at Duke is looking into it. It's just patients do well if you don't feed them carbs. How weird is that? It's a disorder of carbohydrate metabolism. Exactly. Tell them not to eat it, they do fine.

You don't take the toxin, you don't need the antidote.

So Steve Finney and Jeff Volek, who-- yeah. Steve is a-- PhD, nutritionist, trained at MIT and is out at UC Davis and he had studied ketogenic diets and Jeff Volek is an exercise physiology PhD then at the University of Connecticut and they start working together and publishing on this and they helped start this company, Virta Health. I remember Steve's idea, I think it was, we could just convinCe insurance companies and employers that they could save money as diabetes is an expensive disorder.

It's costing an awful lot of money.

It's the most expensive disease. $1,000 a year in medical bills. If they could save 80% of that by getting these people on a diet, wouldn't they want to do that? So they'd become the clients, not the patients. We'll go after the payers, the insurers, the Kaisers and Blue Shields of the world. And they create this company, they get this, brilliant CEO, Sami Inkinen, who was a world-class Stanford MBA, made millions creating the website. I always forget whether it was Trulia or one of the real estate websites. And it's a world-class triathlete who was diagnosed with pre-diabetes despite having come in first in his age group in the Ironman triathlon. And Sami goes to Steve and Jeff for advice on how to treat the pre-diabetes and also how he wants to this is Sam Inkin. He wants to row to Hawaii from San Francisco to Hawaii with his wife Meredith, and he thinks they could do it with- that's like a fun, crazy, crazy diet. Jeff and Steve can coach them and they start talking about this idea and they start this company, Virta Health. Meanwhile, by the way, Sami and Meredith do row to Hawaii and they break the record and they don't eat any carbohydrates on the whole trip.

I think it was 24 miles. and how he got the pre-diabetes was he was using all those goos and energy things that athletes use. to fuel their bodies.

Not only that, Sammy believed that a low-fat diet was the healthiest way to eat. He had been told that and Sammy is, I think he's Norwegian and as he put it, not that being Norwegian matters, but if he's Finnish, I apologize. He's just got the best, you know, if somebody tells him not to eat fat, he doesn't eat fat. I mean, this is an extraordinarily the man has an extraordinary strength of will, and then he's diagnosed with pre-diabetes. So there's something wrong. This is a common phenomena that happens to many people in our world, right? You're doing what's supposed to be the right thing, and it doesn't work for you. And then you do the wrong thing, which in this case is this low-carb, high-fat, ketogenic animal diet. And you get better, and you say, wait a minute, if it's wrong for me, maybe it's wrong for a lot of people, if not everybody. So they start this company, Virta Health. They realize they need a clinical trial to convince the end. They meet Sarah Hallberg, who is a physician in Indiana, an amazing woman to whom the book is dedicated, who has been asked to run an obesity clinic at Indiana Health and has to learn everything she can about obesity. And she starts reading all the literature and she goes down the rabbit hole and she experiences this, you know, based on Jello revelation. And she realizes that the only people who seem to be having effective, who seem to be effectively getting their patients to lose weight are these people like Westman who are advocating for these Atkins low carb, you know, diets. And so she goes and spends time with Westman, she goes and starts you know, advocating for this at her obesity clinic. And she meets Jeff and Steve, and they put together a clinical trial where they're going to randomize people for type 2 di people with type 2 diabetes, either this nutritional ketosis, keto with smartphones and personal coaching and nutrition, telemedicine, adjusting.

Their medications if they need to.

Yeah. Because you're going to have to adjust medication if you stop eating the toxin, you're going to have to lower the dose of the antidote. And they, it's either that or the American Diabetes Association standard of care, which is drug therapy. And they do the trial. And after a few years, they report one-year results. And after three years, they report two-year results.

Yeah.

And for patients who comply with the diet, they seem to put this Progressive chronic disease into remission. So it's not a progressive chronic disease. No. It's only a progressive chronic disease if you're eating the toxin.

Yeah.

If you're not eating the toxin, you don't manifest the symptoms. And it's not the ideal clinical trial. Yeah. There's all kinds of, there are problems with it. Wasn't randomized. Actually, I probably said randomized and I should not. It was, they let patients choose whether they wanted the diet or the, ADA standard of care. But even with those constraints, it demonstrated beyond a shadow of a doubt that a disorder which is considered chronic and progressive is not necessarily chronic and progressive and that the defining factor is the diet. Again, whether you eat the toxin.

That's true. I mean, our practice at the Ultra Wellness Center, I've seen that over and over again. People just don't on insulin, get off insulin, on meds, get off meds. Normalize their weight, normalize their metabolism, their A1C goes down. They went from 11 to 5 1/2 in a few months. I mean, it's quite remarkable.

It's quite remarkable. And so, by the end of the book, my apple eye, I mean, again, this book does not advocate. It's a dense historical.

Yeah, it's like a mystery novel.

And a mystery novel.

Who done it and who didn't do it.

I think it's a very good book. The question is, imagine a scenario where everybody, every physician, was taught not just the proper drug therapy, but how effective this dietary therapy was. Because there have always been two levers to pull to keep blood sugar under control. There's diet or drugs. Until 1921, we only had diet, and for patients with type 2 diabetes, it was effective. Don't eat these foods, you'll be fine. Once we had drugs, you had two lovers, and the idea was use the drugs, give the drugs. You know, we're gonna say that diet is integral, the cornerstone of therapy, but we don't need to pay lip service to it because we got the drugs. What if confronted with a new patient, you give them the diagnosis, you have type 2 diabetes or type 1 diabetes, and you say, look, we can do this. We can treat your symptoms with drugs. You can continue to eat exactly the way you want. Or if it's type one, you're gonna eat at specific intervals, specific amounts to allow us to maximize, craft a diet to maximize efficiency of the drug therapy. And there's all these complications we know are gonna ensue, so you're gonna have an increased risk of heart disease and stroke and dementia and blindness and retinopathies. And for some of you, no matter how well you manage your blood sugar with these drugs, those complications are gonna happen anyway. At which point, we're gonna blame you. But, the patient's fault.

Right, the patient's fault.

I don't say that. Or you can do this diet. Now what it means is no more bread, potatoes, sweets.

Yeah, which people crave.

Sugary beverages. Which people crave, it's hard, 'cause they.

Crave those foods when they have insulin resistance. Yeah, which is fascinating. If you eat this way, as far as we can tell, you'll be fine. No drugs, no complications of drugs, no needing more doses or new doses, no waiting for new drugs to come along, no dialysis. As far as we can tell, if you eat this way, you'll be fine.

Amazing.

I mean, we spend a lot of.

Time- and it probably take two or three months. It might love it immediately. It might take two or three months to get used to it, in which case, you know, like somebody who's quit smoking, you you won't miss cigarettes after a while. You will at first, you won't after a while. It's your choice. We're happy either way. Because we want you to be healthy. But this way, chronic progressive disease, diabetic complications, more and more drugs, complications of drugs, this way, as far as we can tell, and we can't, you know, There are unknown unknowns here. As far as we can tell, if you eat this way, you'll be fine. You choose. And if you do eat this way, let's make sure you do it right. And if you choose the drugs, we'll.

Make sure you do it right.

I mean, it's such a simple notion, and yet it's bucking against the establishment paradigm that we should be using drug therapy and high carbohydrate diets and diabetics. I mean, I think the ADA is starting to come along. American Diabetic Association, but it's really tough.

Well, they're starting to come along, but if you see how they do it, so they put out these standard of care documents and every year, every January, and there'll be like eight or ten of these documents. And what they do is they revise based on what research came out in that past year. So they really have no mechanism by which to say, let's just rethink this.

Everything.

And then when they're revising it, the discussion of diet is buried inside in this document where it's sort of you can do this or you can do that or you can try this diet. We have this research for this or this research for that. They don't have any mechanism to say, can we just try it? Let's try a different approach.

Yeah.

Okay. Let's divide the world up. Let's say this is what we can be achieved with diet and this is what can be achieved with drug therapy. Yeah. and this is the complications that we know of with diets, not many, and these are the complications we know of with drug therapy, chronic progressive disease. Many people might choose drugs. Yeah, maybe they're right.

I mean, I don't know.

I mean, I think, you know, when.

You look at the data, to me it's pretty clear that, that if you use drug therapy, that it is a progressive chronic disease and you can mitigate or slow the complications, but it's not going to prevent them.

Well, this is.

And if you use the dietary therapy, it goes away. And, and, you know, I think people might be listening on, well, you know, Gary, you're giving these people a ketogenic diet with 75, 80 of their diet as fat. What about their heart? And, you know, maybe save their diabetes. But actually, they looked at over 20 cardiovascular biomarkers as part of the Virta study. Part of the Virta study. And they were all improved. Actually, they got better.

Right.

You know, and I've seen this over and over. I had a patient which was really struggling with weight loss and she had pre-diabetes, she had triglycerides of three plus hundred, her HDL was very low and her total cholesterol was over 300, very high insulin levels, rising blood sugar. And I'm like, well, I don't know, try a ketogenic diet. And she did it. Not only did she lose 20 pounds, but her cholesterol dropped 100 points, her triglycerides dropped 200 points, her HDL went up 30 points, blood sugar normalized. Now, that may not work for somebody else who's a thin guy who is an athlete. And I've, I've seen people who use a sketogenic diet like that who actually don't do well. And I, I'm one of those guys. If I eat too much of the wrong fats, my cholesterol goes off, off the rails. But we don't know how harmful that is.

We don't, we don't.

Unless we look, look inside your arteries.

And then we can.

Well, you can.

Yeah.

Then.

Yeah.

So it's, it's just fascinating. I think this is really, this is really important moment in history because we have this craze of Ozempic and Wegovy, Mounjaro, it's the golden child of the moment in pharmacology. And nobody's really talking about the issue that matters, which is what we're eating and why we're eating what we're eating.

And that's because we have this mindset that, you know, the people with obesity, we're not gonna blame it on willpower. We're not gonna acknowledge that it's a disease now. This is what Oprah was saying. but we're also going to assume that they won't change their diet. Yeah. And it's really complicated. I've read a lot of the literature of mostly women, but not entirely women with obesity. They're so confused. They know it's not a willpower problem.

No, it's not a willpower problem.

And often these authors will say, I tried every diet, none of them worked, and I want to reach out to.

Them and say, well, you didn't try the right one.

Well, or did 'cause they always include Atkins in the list. They did not work for you. Or are you some, but then they'll say, you know, it's just one of these books I read recently. It's, you know, I don't want to go through my life not eating a donut.

Right.

Well, I understand.

I get that.

I get that.

I get that. But, you know, I was, I've been biased by my history as a cigarette smoker. There was a period in my life where I couldn't imagine going through my life without a cigarette.

Yeah.

And in fact, my next cigarette was what pulled me forward into the future. Maybe it's an inappropriate metaphor. I'm not sure it is or not. Well, no. And we know the, you know, there's.

Real addiction with these Foods that, particularly the, whatever you call them, food like substances or Ultra processed food or high starch and sugar foods, they activate the brain centers for pleasure, and we can map that on, on brain imaging studies. So there's no doubt that, that these have biological effects on the brain that drive our, our behavior, our Cravings, our appetite. But, but I think what what's really remarkable as a doctor treating these patients is that when you do the right thing, their brain chemistry changes, their hormones change, their metabolism changes, and they don't actually have those cravings.

It's not like they use willpower to.

Fix it, use science. If you're struggling with stress, poor sleep or low energy, you might be magnesium deficient, like 75% of people. That's why I recommend magnesium breakthrough by bio-optimizers. Unlike most magnesium supplements, magnesium breakthrough gives you all seven essential forms of magnesium for better absorption and real results. deeper sleep, less stress and more energy. I take it every night and I notice the difference. Try it for yourself at byoptimizers.com/hyman and use code HYMAN10 for 10% off your order. When you have diabetes, you become carbohydrate intolerant. It doesn't mean all of us are born that way, but we become that way because we live in a sort of a soup of sugar and starch that's washing over us for decades and that leads to the development of this metabolic dysfunction. And the solution is to kind of reverse that trend by restricting carbohydrates and increasing fats. And tell us sort of how that works and why we kind of got so far away from it, 'cause it was the treatment, you know, 100 years ago, and now we're coming back to it as the treatment. And explain the biology behind the science of ketogenic diets as a diabetes reversal treatment.

So, you know, in the trial, our patients were on a well-formulated ketogenic diet. which is very low carb, so 30 grams. But practically in our clinical workflows, we do a lot of low carb and not everybody's in well-formulated ketogenic diet. So we really try to sort of meet patients where they need to be. And there's a lot of heterogeneity in type 2 diabetes, right? We've in genome-wide association studies, we now know there's hundreds of different like types of type 2 diabetes. But sort of like the end result or the goal is to preserve beta cell functional mass, right? And the beta Beta cells are those cells that make insulin. And so anything we can do to de-stress that beta cell and keep its insulin production up is critical. And when we eat high carb diets, we add to cytokine release, inflammation, glucotoxicity, all of these things stress out the beta cell. And so that sort of accelerates the destruction of beta cell function and mass over time. And that's when you start seeing the one way trolley for type 2 diabetes. So if you can reset that and change that pathway, you can definitely improve insulin secretion and also decrease while you're losing weight, decrease the insulin resistance at other target organs like in your liver and your muscles. So you also spare the beta cell from having to produce more insulin to do the same job. So multiple layers of de-stressing the beta cell through the nutritional intervention directly, but also indirectly by affecting other parts of metabolism. I mean, energy homeostasis, is so complex. I have so much humility. You know, I started my fellowship training studying adipokines. I was in a lab where I was studying leptin and adiponectin, and like there are so many other cascades and they all interact with the gut, the microbiome, the brain, your satiety centers, your pancreas. So there's so much complexity. So really thinking about it simplistically though is really preserving and de-stressing that beta cell.

And the way you do that is by basically restricting carbohydrates and adding a lot of fat. Now, it's not the bacon and, you know, kind of cheeseburger diet, right? There's a healthy way to do this. It doesn't mean you have to be eating a lot of food that may not be great for you. And so I think people are, are often thinking, oh, fat is bad. You know, fat makes me fat. If we eat fat, you get fat. and there's this whole mythology we had about that. And in fact, that was the sort of the prevailing theory for so long. And now it's shifted. And we understand that actually for these metabolically dysfunctional people, which is most of America, that we're eating way too many refined starches and sugars. I mean, carbohydrates are also vegetables, so there's no harm in eating vegetables, but the starch and sugar and refined carbohydrates are the ones that are driving this problem. and so the solution is restricting those. And you're saying you don't always have to be fully ketogenic. You can be very low carb. And I've seen this, too. I mean, I had a patient at Cleveland Clinic who was type two diabetic on insulin for 10 years, you know, had heart failure, had kidney starting to fail, fatty liver, hypertension, had multiple stents put in for cardiac disease. It was on, you know, 20, 000 of copay medications. Her body mass index was 43, which is huge person. And her A1C blood sugar average was 11.2. And, and, and we just didn't put on a keto diet, but since she just took off grains and beans, sugar, processed food, put her on lots of good fats, olive oil, avocado, some nuts and seeds, healthy protein, lots of veggies, fiber, and it was about 50% fat, not 75 or 85% fat, which is what most keto diets are. And within three days, she was off her insulin. In three months, she was off her medications. Her A1C went from 11.2 to 5.5, which is normal. Her ejection fraction went to normal. Her kidneys got better. Fatty liver got better. Her blood pressure got better. in a year, she lost like 116 pounds. So without Ozempic, without a gastric bypass, simply by getting the group support, which we did, and, and by using kind of a very kind of low carbohydrate diet that was a very anti-inflammatory diet. So what I'm hearing you say is it doesn't have to be always ketogenic, but it has to sort of be matched to that person's state of metabolic dysfunction. And the more sick you are, the.

Probably the, the higher dose of drug you need in a sense.

Right.

I would also add that we haven't published this. Actually, we published some, but We actually have very interesting dose response data. So pharmaceutical companies usually do a, well they have to do like a dose response study. So here's the molecule, you add more of that molecule and then see what happens in terms of safety and in terms of outcomes. And you obviously you can then tease out the correlation and causation like oh more of this acetaminophen, less you have pain and whatnot. We actually have very interesting dose response data to carbohydrate restriction. and seeing what happens to weight, glycemic control and getting off the meds. And I guess the punchline is the more insulin resistant you are, the more of that dose the better is basically without sharing all of our secrets. But it's fascinating because we literally have dose response curves and it kind of tells the story. The other thing I wanted to add, Mark, when I listened to you and I was thinking, those patient outcomes and what you had seen. If I wasn't, if I did not have the 10 year history of building Virta and seeing exactly the same results now with 100,000 plus Americans, I would still be like, oh, I'm sure nutrition can work, but come on, like these are the like the grandfather who was 100 pounds overweight and then ran a marathon. Like we always hear these stories like, oh, it's a one anomaly, one out of a million. But I think really what the world needs to hear, this is individuals, business decision makers, policy decision makers, scientists, is that these results are systematically possible, absolutely systematically possible. And this idea that we have 200 million sick American adults metabolically unhealthy, and the best we can do is manage symptoms with medications is ridiculous. It is so ridiculous. And so we really have to get the message across that there is a way nutritionally, you don't have to be a superman or superwoman. Ordinary person, there's a systematic way to achieve those results. Obviously, there's a distribution. Some are hugely successful in terms of moderately successful, but that message hasn't broken through yet, and it has to. And that's why I'm grateful to be on this podcast, too, because it's ridiculous.

Yeah.

There's no other way out of this metabolic health mess. GLP-1 once in tap water is not gonna solve this mess.

No, no.

And it's interesting, when you're talking about how you, you, you're sort of able to execute on things in the sense that you learned in your research around these. hormones and molecules that regulate appetite like adiponectin and leptin and the inflammatory molecules that are produced by your fat cells. And that was sort of where your research was. And what we're learning is that the application of the right nutritional approach in metabolic dysfunction actually automatically regulates those hormones rather than having to take Ozempic, which artificially does this. Your body can naturally change the levels of the appetite and fullness hormones that are driving this overeating behavior that is driven by the carbohydrates. So, when you eat more sugar and starch, you want more sugar and starch. When you eat that, I mean, I would say nobody can eat 12 avocados, but anybody can eat a whole bag of Chips Ahoy cookies, right? So, it's just like no limit on that. And, I think the body has this natural ability when you feed it in a way that it's it's designed to work. It actually resets and it's not willpower. It's just science. So can you explain how that works?

Yeah. So when folks increase their fat intake and certainly when people achieve nutritional ketosis with higher Ketone levels, the hormones that drive appetite are naturally suppressed. And the hormones that signal satiety go up. So endogenous GLP-1, CCK go up, and then things like ghrelin go down. So again, so exactly like harnessing nutrition to appropriately do that positive feed loop that's towards improving health and decreasing hunger. It drives with just the nutritional changes.

So what's interesting is that you said something that I want to highlight and double click on, which is that when you eat in the right way, you naturally increase your GLP-1 peptides, which are regulating your appetite and that you don't have to take Ozempic. And what you also said, Sammy, earlier was that you're achieving Ozempic-like results without taking the drug, without all the side effects and without all the costs. And so can you kind of explain what?

What?

And we talked about this when we were hanging out in person in Aspen, you know, the, the data that shows that, you know, out there, the pharmaceutical companies are funding billions of dollars of research on these GLP-1 agonists and other related peptides around the whole spectrum of diseases, from depression to autoimmune disease to neurodegenerative diseases to longevity to obviously weight loss and diabetes. to cardiovascular disease, and they're trying to get all these studies done to get indications for these other applications of these drugs. But what you're saying when I heard you say was that using this nutritional approach, you can actually achieve all the same types of outcomes. And it's not the drug itself, it's actually the change in your metabolic health. Can you explain more about that, Dr. Grishman, and how that works?

Yeah, absolutely. And first up front, I want to say that this may sound like, oh, this guy is so anti-pharmaceutical. No, I'm a physicist by training. I believe in science. I believe in Western medicine. And then also these GLP-1 drugs. You know, first one was, I think, in America approved for treating type 2 diabetes 2005. And it's a tool in a toolkit. It is a tool in a toolkit for type 2 diabetes and in some cases for obesity. So I just want to be very clear and obviously, Verda, our providers practice evidence-based medicine. So anything I say next isn't gonna be like, oh, you know, drugs are bad in all cases. Not that that is the case. But to answer your question specifically, and this is all data that's published in peer review, so if anyone wants to sort of double check, you can go to vertohealth.com and slash research and find out public some period results. But indeed, so what we've been able to show is that as we run our nutrition program, Among our patients, the following things either improve or get reversed. Obviously type 2 diabetes, so that's glycemic control, so blood sugar comes down. Hypertension, so blood pressure comes down. Inflammation comes down. So this is CRP, C-reactive protein, and white blood cell count. And we also have an unpublished paper looking at 16 inflammation protein, proteins of which almost all improve, which is unheard of, better than Humira. that's unpublished, so that's a caveat. Depressive symptoms improve, sleep apnea improves, so gets reversed, knee pain goes down, cardiovascular disease risk markers and 12-year cardiovascular risk goes down, kidney and liver function improves. So we looked at EGFR and we can't really say that we can it would be a little bit overreaching to say we reverse kidney disease, but we have shown that we improve kidney function and same with liver function. So when you look at these broad spectrum metabolic health improvements, it's basically the same list that the GLP-1 manufacturers are now showing that we either improve or reverse and we've already published this data. So what can we include again, I'm not the medical doctor here, so maybe Chris can kind of COVID me up here a little bit. But basically what we, we can show is it is possible to achieve the same broad metabolic Health improvements as TLP ones may or may not nutritionally, 100 nutritionally. Therefore, it is not the exogenous molecule that is achieving these results alone, because it's possible. to achieve the same results nutritionally. Now we can still debate the mechanism. Is it all about the weight loss or are there other things in play? And our hypothesis is there are other things in play, but again, such as information, reduce information. But we can achieve the same things nutritionally, which I think again is a very important message to be heard because in the next year and two, there's gonna be headlines, oh, GLP-1 is now improved. the eighth new thing. The answer is, guess what? Nutrition improves all of those things. And then finally, I will say again, there's a place for these drugs. GLP1 is a tool in a toolkit. But I think this statement holds true, which is we don't know the short, the mid-term and a long-term side effects of exogenous drugs, but we know the side effects of healthy food.

Guess what?

There are better. longer life.

That's right.

Like healthy food. It's tough to say like, what's bad about that? Not much.

That's right. Yeah, I think you're right. I think and I'd love to hear your perspective as endocrinology of Scripps about the GLP-1s and you know, their utility but also the risks. And I sort of whether or not they're really necessary if we actually got our nutrition right and we got the delivery system right, which is this continuous care model to support people in behavior change cause that's the biggest thing. And I, you know, I sort of this sort of conversation you just mentioned, Sammy reminded me of a study I read that looked at gastric bypass and they, they did a controlled study where they took a group of obese patients. Half of them got bypass and half of them didn't. But the diet that the bypass patients got after their surgery was the same diet that the non-bypass patients got. And they both reverse their diabetes within a couple of weeks. It wasn't the diet, it wasn't the surgery, it was the food. And I hear you saying the same thing about this GLP-1. So I'd love, Gresham, you to share from an endocrinologist perspective, you know, what your thinking is about this, you know, where they play a role and actually is this approach of, you know, very aggressive nutritional intervention with the continuous care model of lifestyle support and behavioral change, you know, actually better and how do we think about that?

Yeah, no, I think that's a great question and it kind of hits on something we spoke about earlier during this call with insulin and how we sort of, I think we missed an opportunity of marrying some of the nutritional sciences to patients who were able to receive insulin. And when you think of like even type one diabetes, of course insulin was life saving, but because we didn't really invest in figuring out the right nutritional, now we have a lot of folks with type one diabetes who we say they have double diabetes, which is type one with insulin resistance. because we've just let people eat whatever they want, even if it doesn't work for their body. So I like that, like to think of that as an analogy for GLP-1. You just can't eat whatever you want just because there's a new medication. Because guess what? Again, the energy homeostasis is super complex. There's no silver bullet. Like, you actually have to eat right for your body. And there's so many, like I said, the genome-wide studies have shown that there's a lot of different types of type 2 diabetes. And if we can get to the root cause, we can help a lot of folks and not look at one target molecule that we're using today, which is the GLP-1 therapy and that. So I think really thinking more holistically about our patients that these are not magic bullets. Look, they're great medications for patients with diabetes and other non-glycemic indications like reasons outside of blood sugar control such as heart disease, heart failure, kidney disease. There's mortality and there's outcomes data to support their use. But what about like the millions of people who have not yet developed those complications who have diabetes and the folks who have pre-diabetes and obesity? And this is, you know, diabetes is the tip of the iceberg, right? We have a whole society below that where we need to drive impact because we can't just medicate everybody in the country. So really thinking about the root cause and finding the right nutrition for the individual patient. And this is, this is part of precision medicine, right? Personalizing your diet to what works for you. And it's hard work. I mean, what our coaches and clinicians do at Virta, it's a daily, again, like a white glove experience where we're getting that data, we're doing that positive feedback to make those changes, to learn and course correct when things aren't going well, to celebrate when we get those lab reviews. So really, you know, it has to be a very patient centric, holistic approach. But so I think there is a role for these medications, but I think we need a better solution for as a population.

But is your belief that if people were able to adhere to a diet that was right for them, that these drugs are redundant?

I think so. I think if you could prevent, I mean, I'm of the mindset prevention is always better. Less is more. So if you can teach people to eat well and keep them healthy, that's better for everyone. They feel better, they have all the other non, forget about just the metabolic risk. Think about neurocognitive risk, cancer risk. There's so many downstream things that just by eating right we can fix. And then I'll just really quickly say, even sort of transgenerational, when young adults who are in their prime reproductive years, when they're metabolically unhealthy, we know there's all this epigenetic changes that drives the next couple generations to have metabolic dysfunction. So there's real implications for populations when you teach them how to eat correctly. And the last thing I'll add is diabetes disproportionately affects minority populations and those with less socioeconomic means. Imagine if we could improve that without costly medications and prevent it. and close some of the complication gaps and the death gaps that we have in the United States.

Yeah, I know, absolutely. I mean, the health disparities are huge and there's a whole food inequity issue and nutrition security issue and there's all.

The ways in which-- and equity around getting medications.

Yeah.

Accessing expensive medications and accessing expensive technology like CGM. There's all kinds of equity issues. So what if we went to the root cause and just helped people be healthier from day one?

So how do we think about type 2 diabetes from a functional medicine perspective? What's the root cause? Functional medicine is all about root cause. The root cause is something called insulin resistance. And this comes from eating a diet that's high in sugar, refined flour, grains, ultra processed food. There's no doubt about this. Also from lack of exercise and being sedentary, not moving enough, or being under muscle, right? Muscle. is your metabolic spanx according to my friend JJ Virgin. And how do you address that? Will you eliminate ultra-processed food, processed grains, refined grains, starches, sweets, sugar-sweetened beverages especially, and that improves your blood sugar balance and your insulin sensitivity? And what should you be eating then? Good quality protein and it can be meat. Okay, that's my view of the literature. not my opinion, but it's pretty much evidenced by the randomized control trials. Fiber, right? Fruits, vegetables, nuts, seeds, sometimes whole grains if you're not fully blown diabetic. Healthy fats, olive oil, avocado oil, macadamia oil, none of these will affect your blood sugar. And then you want to use testing to test your fasting glucose, your fasting insulin, your A1C, triglycerides, and other markers to understand of your insulin resistance. Now, I co-founded a company all function health. You can go to functionhealth.com. we've created an initial test of over 110 biomarkers. It's 499 a year membership and includes testing twice a year. And you get all the metabolic markers you need. You get insulin, which your doctor almost never tests, A1C or blood sugar. But you also look at lipid particle size, we call lipoprotein fractionation. That's just your regular cholesterol profile, but whether or not you have small particles, dense particles, large or small triglycerides or HDL, all these will tell you about your cardiometabolic health. We also measure inflammatory markers like C-reactive protein and others so you get a really good understanding of where you're at. So go on and check it out. Go to functionhealth.com, you can use the code YOUNGFOREVER if you want to jump the wait list, but it's really a way to get testing to see what's going on with you and what's going on with your diet. So again, test, don't guess. Now it's no secret that navigating the realm of nutrition has become a challenge for the general public and even for people like me in health professionals who've been studying this for 30 years. One week, eggs are good for us, only to be vilified for allegedly raising cholesterol levels the next week. The narrative on dietary fats is no less tumultuous. I wrote a whole book on this called Eat Fat, Get Thin. Some experts say that it's a chief culprit behind heart disease, others say it's critical for overall health and well-being. Well, more recently, a study made headlines linking red meat consumption to an increased risk for type 2 diabetes, leaving the public once again confused and understandably so. And that's why in today's Health Bites episode, we're diving deep into the findings from this paper and unpacking the study's design flaws, its inaccuracies, and where the researchers got it straight up wrong. The study was entitled Red Meat Intake and the Risk of Type 2 Diabetes in a Prospective Cohort Study of United States Females and Males Published in October of 2023. Now, this was a type of study design. It's important to understand study design because you have to understand science before you can interpret science, and you have to understand the type of studies that are done and which can show cause and effect and which can show correlation, not causation. For example, every day I wake up and the sun comes up. It's 100% correlated, but it's 0% causal. You know, if I die tomorrow, the sun's going to keep coming up if I slept through till the middle of the day, the sun's going to keep coming up. So it has nothing to do with each other. And essentially that's what these observational studies like this particular study did. They looked at correlation, not causation. And that means that we can't prove cause and effect. So when you hear the headline, red meat is linked to causing type 2 diabetes, it's BS. Okay, we have to look at what the data show and what it doesn't. And these studies are not wrong, they're not bad to do. They're done in order to help us understand what might be a useful avenue for further research, right? They're not the end of the research. They're useful for generating hypothesis. For example, in the study of smoking and lung cancer, they did observational studies, right? They weren't going to do a randomized controlled trial because they're not going to have people on cigarettes and have people on not on cigarettes. So basically they found that there was a 20-fold increase, maybe 10 to 20-fold increase in the risk of lung cancer in smokers. Now, to put that in perspective, that's a 1,000 to 2,000% increase in your risk of having a particular disease. And that ended up being correct because it was such a strong correlation. Whereas in this Red Meat Diabetes Study to cut to the punch, it was about a 20% increase, right? Which essentially is relatively meaningless. And let's just say 200% increase in a correlation study, you pretty much want to ignore the data. And Dr. Ioannidis from Stanford has written a lot about this. This is an incredible scientist who's, I dissected the value of different types of studies and what we can learn from them and what we can't. So we have to start out really understanding that the study was not designed by his very nature, which all scientists would agree to prove cause and effect. It's just the nature of science. Okay, so let's get into the study. This is what we call a prospective cohort study. And it's an observational study, a population study, an epidemiological study all means the same thing. Essentially, it studies a group of individuals over time to look at the association between certain exposures, behaviors, diets, and risk factors on specific outcomes. So basically they tracked thousands of people over many, many years, looked at what they ate, and saw if there was a correlation with diabetes, and lo and behold, they found one. But let's talk about the problems with why this may not actually be as clear as the study seems to generate. Now, in this type of study, mainly people are identified based on their exposure status, and then they're followed over time to observe and record outcomes. In other words, what did people eat over many decades and what was that diet and was it correlated with any bad outcomes later in life? So you follow people for 30 years, you have them track their diet records, which we'll talk about in a minute, and then you see whether or not a particular food or types of food seems to correlate, not cause, correlate with some bad outcome like diabetes. And that's what they did. And basically the goal is just to assess relationships between various insults, exposures, toxins, smoking, diet, whatever, and outcomes. So it essentially looks for things that may be worth further studying with a randomized control double-blind trial. Okay, this was not done here. Now, it can be helpful, but they say, well, we're going to control for variables, we call confounding variables, which means things that kind of can throw the study off. In other words, we'll talk about this, but for example, there was a study done many years ago by the NIH and the AARP, the American Association of Retired Persons, that looked at meat eating and chronic disease and death and cancer and so forth. They found a big correlation, but that study showed also that the people who ate meat didn't care about their health and smoked drank more, ate more calories, about 800 more calories, about 800 more a day, were more overweight, didn't eat fruits and vegetables, didn't exercise, just drank more alcohol, didn't take their vitamins. Of course they had more disease. It wasn't because of the meat. It was just a problem that was shown because of these confounding variables. And we'll talk about more about that. Now this study was published in the American Journal of Clinical Nutrition and it was published by folks at Harvard who are great scientists but they're focused on epidemiology, particularly at the School of Public Health, which is where the study was published out of. and, and unfortunately, you know, people have bias, and the study authors are very biased toward a plant-based diet. And so right off the bat, you kind of look at, all right, well, they already have a bias, and that affects the study, the outcome study. So basically, the objective of the study was to assess the link between total processed and unprocessed red meat intake and type 2 diabetes, and then to estimate the effect of substituting different protein sources like vegetable nutrients, not seeds, beans, grains, for red meat and type 2 diabetes risk. So we're doing, but again, just a hypothesis generating study. Now, again, this was a population study. It was based on the Nurses Health Study, which was about 216,000 participants, the first and the second one, and the health professionals follow study, which was including men. Now, the first study started in 1976, female nurses, and then another one in '89, female nurses in Professional Study was started in '86. And they followed people for a long period of time. They calculate the amount of years and people and they come up with a number called the 5.4 million person year. So that's pretty good. And what they did was really interesting. They looked at something called a food frequency questionnaire. And this is it, assesses that people's diet every two to four years from the baseline. Now, can you remember what you had last Thursday for lunch? Okay. Can you remember the amount of this or that you had over the last week? probably not, right? And so these are flawed tools and there's a lot of research and science about how flawed these tools are and how imperfect they are and how often they are very misleading. We see that in this study. So the study findings, right, just to be clear, and this is association, correlation, not causation, they found between the lowest and the highest red meat intake, there was a risk of diabetes that went up by 62%, right? Not 200%, 62%. Processed meat associated with 51% and unprocessed red meat was about 40% risk. If you substituted one serving of nuts or beans, then your risk was 30% lower. If you substituted for processed red meat, the risk was 41% lower and unprocessed meat, was about 29% lower. So they're basically saying if you had one serving of dairy for total processed or unprocessed red meat, you had a lower risk of type 2 diabetes. Now, this study is really important because it kind of misses a lot of the point. What is the mechanism here? Now, they try to explain some of the mechanisms, but it's pretty weak. We know that the sugar that you eat, sugar and refined carbohydrates, is the primary cause of type two diabetes, not red meat. And ancestrally, we've been eating meat for as long as we've been human. I just came back from the Masai population in Africa, as I mentioned on different podcasts. And, and these people ate the blood, the milk, and the meat of their cows. That was their main diet. They were healthy, they were super thin, they were very fit, and they had no diabetes. I recently visited their community and the Coca-Cola truck drives up every day. They get processed cookies from the local town. that are made by the industrial food system. And now they're gaining weight and type 2 diabetes is rampant in this Maasai community in Africa. And it's just heartbreaking to see that within minutes, this entire Coca-Cola truck, a big truck, just was emptied out by the local population not knowing what they were doing themselves. And they didn't even know that it was connected. So, you know, this basically, this study fueled a lot of clickbait headlines. For example, a web MD said, just two servings of red meat per week raises diabetes risk. Well, that doesn't. It shows that it's correlated but not causing eating red meat. Sir, more than once a week is linked to type 2 diabetes risk. That's CBS. This is just bad reporting and bad journalism. And the social media was just all over the place, right? Some people were pro-red meat, some people anti-red meat. People are super confused and then nobody knows who to believe and everybody's distrusting public health and dietary guidelines and it's just a mess. So I'm gonna try to unpack it for you so you really understand how to think about this and also how to actually know what to believe around this whole issue of red meat and diabetes and what we know. So basically the problem with this study, as we mentioned, is an observational study and we just cannot draw conclusions from an observational study. It doesn't prove causality. And we have to look at also the limitations of the study. There are a lot of limitations. The study authors, for example, as I mentioned, are very biased toward a plant-based diet and veganism. how they pick the participants of the study, which may not be an issue. Industry funding we want to look at, that probably was an issue here. But there's this thing called recall bias, which is common with food frequency questionnaires. People are more likely to report healthy food than unhealthy food and desserts, sugar, sweetened beverages, alcohol are underreported. This is published. We're going to put all the references for everything I'm saying in the show notes. So have a look at those. Everything I'm saying is documented. is well researched and you can kind of dive in, but would take me about 10 hours to cover every study in detail. So basically, you know, I've got to find this my practice. People overestimate how much extra they exercise and they underestimate how much they eat. It's pretty difficult. My humans are pretty flawed. Now, the 2012 study from red meat consumption and mortality and looked at prospective cohort studies. from the people who ate a lot of red meat, about the highest 20%, had a 45% high risk of dying from heart disease compared to those who ate the least red meat, the lowest 20%. However, when they looked more closely at the people in these extreme groups, they noticed that besides eating red meat, they had other habits that made them more likely to have heart disease, like don't exercise, they ate too much, they smoked, their cholesterol was worse. or they maybe had fish consumption which affected their health and risks. For example, maybe the people in their lowest risk group exercised and didn't eat meat, but they also didn't smoke and they also ate healthier food. So you can't quite tell what's going on. So the study supports the idea that eating a lot of red meat is linked to high risk of heart disease. People who choose to eat more or less red meat have other lifestyle issues that influence their health. Now there are other factors, these confounding variables I mentioned. You know, when you look at confounding variables, they try to control for these, but it's really tough. And they only control what researchers think to control for, and it basically makes it really hard to determine true cause and effect. Like I mentioned with the AARP study, they smoked more, they drank more, they ate less fruits and vegetables, they didn't exercise, they had all these other issues. That's why they had more disease, not because of the meat. so that it's basically, you know, other issues with the study could be design flaws and maybe the study population is different from the regular population, so it may not be widely generalizable. And, and also they do all these weird statistical calibrations to normalize the data. And we're going to talk about what that means. And they did this in that study. There was, I think, a scientist named Roger Williams who said there's Liars, damn Liars and statisticians, or maybe, maybe that was Mark Twain. I don't know, but I think it's true. You can kind of manipulate the data to make it show what you want, and that's clearly been done here. And the other thing this study does is it actually supports dietary guidelines to limit red meat consumption. And why does it say that? Well, I mean, the study basically said our study supports this current dietary recommendations for limiting the consumption of red meat intake and emphasizes the importance of different alternative sources of protein for type 2 diabetes prevention. dietary guidelines, just like this study, are heavily based on observational data, the data that can't prove cause and effect. And the systematic reviews and meta-analysis of observational data are the weakest types of studies, right? There's confounders, there's bias, there's a lot of problems with the studies. And often the researchers have ties to industry, the expert panels are not independent, it's kind of a mess. So how do we know what to do in science? Well, randomized controlled trials are the gold standard for drawing causal inferences between exposures and the outcomes. For example, you know, you give people placebo or blood pressure drug who have high blood pressure and you follow them for three months and you can see, okay, well, did the people taking the placebo lower their blood pressure or the people on the pill? That's a randomized controlled trial and you randomize people so they're not stacking the deck in favor of healthier, sicker population. Now they're hard to do in nutrition because you need to control everything and it's really hard to do. It's great in a lab rat, but it's not really easy in humans because they're what we call free living and they do whatever they want. So you say, well, I want you to eat a low fat diet or I want you to eat a low carb diet or I want you to exercise 150 minutes a week or I want you to not smoke or I want you to sleep eight hours a night or whatever you want, you tell them. they're not going to probably do it. And it's hard to do. You have to basically put people in a locked metabolic Ward and put them there for years and give them the food that they eat and track everything they do in order to actually know what's going on, like a lab rat. But we really can't do that. We can't take, you know, 10, 000 people and feed them a vegan diet and 10, 000 people and feed them a omnivore diet, including red meat and healthy foods, follow them for 30 years and give them all the food and track that. It would be billions and billions of dollars and impossible to do. so it's not practical, it's not ethical, it's expensive, it's hard to recruit volunteers for this, and people just, it's hard to do these nutrition studies. So we have to do the best with the data we have, which are systematic reviews and meta-analysis of randomized controlled trials, mechanistic studies, lab studies, there's many different levels of evidence. So you have to look at the total community benefit of all the evidence. So now let's dive into this problem of study design. and what was wrong with this paper and why it does not prove that red meat causes type 2 diabetes. So what they did, as I mentioned before, they gave them a food frequency questionnaire. They're highly inaccurate, right? Every two to three years, people get asked, what do they eat? And they got a questionnaire. What's their average intake of food and beverage over the last 12 months? Do you know what you ate over the last 12 months? I couldn't have a clue. I mean, how often do you remember eating X and Y food, right? Do you eat chicken with the skin on or without the skin? Do you eat hamburgers, hot dogs, processed meats? They give all these questions. They also, you know, kind of weirdly track things like beef, pork and lamb as a sandwich or mixed dish, but no serving sizes were noted. You know, sandwiches and lasagna have also bread and pasta and processed carbs. So, is that part of it? We don't know. So, they basically kind of looked at, you know, what they were eating. The second issue is, and by the way, I can go way more into these food frequency questionnaires, but, Just trust me based on the data. We'll put the links in the show notes. They're really highly inaccurate. They've really been proven to not be a good tool for looking at nutritional intakes over time and don't really correlate with a valid metric for tracking outcomes. So right off the bat, it's a tough study to do. The second issue, and I kind of mentioned it, is that the Red Meat definition included sandwiches and lasagna. which basically were counted twice and as processed and unprocessed red meat. Now processed red meat is hot dogs, bacon, meat sandwiches, sausage, unprocessed red meat is like hamburgers, beef, pork, lamb, a sandwich. So it's kind of weird. They kind of included other foods in the meat. So you have to be clear. The third issue is the serving sizes changed over time. And why? Because the food frequency questionnaires were different. in the different parts of the study. So one was in 1980, one was in 84, one had 61 items, one had 120 items, and they basically changed the definitions of what a serving is, even in these food frequency questionnaires. So it's super confusing. So the nurses in the study asked how often they consume two slice of bacon. Now the serving size of bacon is one slice, but before it was two slices, right? How are they adjusting for One serving of processed red meat is considered 45 grams. How do they measure it? Did they weigh their lunch meat? Did they take their bologna or salami and put it on a scale? I doubt it. What about chicken, beef, or lamb? They say six to eight ounces was a serving. Today, one serving is three ounces. Did they know this? Did they translate a three ounce serving to a six to eight ounce equivalent? Probably not, and it creates more error in the studies. Issue four in the study was that this is really crazy. They use statistics to massage the data to have the outcome they want. It calls this process calibration. We're calibrating the results using a seven-day weighted diet record and food frequency questionnaires from two other population studies. In other words, they kind of acknowledge that food frequency questionnaires are not that accurate, so they're going to use other ones to correlate and see if they can kind of create this mishmash of data to show what they want. So what they found was that, this is kind of crazy, the calibration doubled the effect for total red meat, processed meat, and unprocessed red meat. So before the calibration, for example, one serving an increment of total red meat was associated with a 28% high risk of diabetes. After the calibration, it was 47% before the calibration, one serving increment of processed red meat was associated with a 50% high risk of diabetes after it was 101%. So it's like, what are you doing here?

Right?

So guess what number was repeat reported in the headlines? Not the uncalibrated, but the calibrated number.

Right.

Too much red meat is linked to a 50 increase in type two diabetes. Well, in, in NPR, they didn't really do a good job of doing a review of the study. They didn't do investigative journalism, which I think is sorely and basically they found that there's 50% increase in red meat. So like I said, before the calibration it was 28% after it was 47%. The next issue was the authors compared the lowest intake of red meat to the highest intake, but have historically reported the risk using servings and for example, which is a more quantitative metric. So to explain what that means, In the 2011 paper, another one called Red Meat Consumption and the Risk of Type 2 Diabetes: Three Cohorts of US Adults and an Updated Meta-Analysis, they reported 12% risk of diabetes for one serving and 32% for processed meat and 14% for total red meat. But this paper compared the highest and lowest intakes, claiming a 51% increased risk for eating unprocessed and 101% increased risk for processed and 40% for total. But basically this method using qualitative versus quantitative generated a lot more headline worthy statistics. So in other words, the way they reported this, it just makes it more sensational and look better for the agenda of having a study show that red meat causes diabetes. Another thing with this study is the women in this study, right, the nurse's health study compared to the men in this study show that the women ate more red meat than the men. Now, this is the first study ever to claim this. now typically every other study has shown the opposite. So what does that mean? Well, I don't know, but it just seems to kind of be a clue that maybe the study is a little wacky and doesn't comport with all the other data we have around meat consumption and being female on male. The next issue was the total red meat intake had a higher risk of diabetes than both processed and unprocessed red meat. So that doesn't make sense, right? If you, if you, how could this, the total red meat be worse than the individual types of red meat when the total is the sum of both of them, right? So you don't get like 1 plus 1 equals 3, right? It doesn't make sense. So most studies are looking at the risk associated with red meat show that processed meat is riskier than unprocessed red meat. In total red meat, the sum falls in between, right? So if you have processed red meat being a higher risk and unprocessed lower risk, the average risk is going to be lower, right? Kind of a combination. But in this study, they found the opposite, which doesn't make any sense. If red meat, it's processed, makes you have a higher risk of diabetes and unprocessed red meat is lower, then if you add them together, you shouldn't have a higher risk when you combine them. So it doesn't make sense. The next issue of the study was what we call healthy user bias. And I think this is really, really important. Essentially, it's talking about what I mentioned earlier, which is the idea of confounders. This idea of why were the people in the study having more diabetes or not? Was it because of the meat they were eating or a bunch of other habits? The people in this study, when you look at their characteristics, they had much higher body mass index. In other words, they were heavier, they were less physically active, they were more likely to be smokers, and they were less likely to take vitamins. Right? So, of course they're going to have more risk, right? So the healthier people didn't eat red meat. Why? Because they thought that red meat is bad. That's the propaganda that we have in our society, which is red meat causes heart disease, red meat causes cancer. So we should be eating less meat. In fact, we are, which is really another really important point. When you look at the amount of meat we're eating, it's dramatically decreased over the last 30, 40 years, dramatically, because the message in the public health health domain has been to eat less meat. But at the same time, what's happened? The risk of diabetes has skyrocketed, right? Just double, tripled in different populations. So how could that make sense? Red meat's going down, diabetes going up. Okay, well that's a problem. How do we explain that with this study? What was so interesting to me in this study was that they didn't adjust for body weight or what we call BMI. That's nuts because the group that actually had more diabetes was more overweight. Now, was that attributed to the red meat intake? That's what they say that red meat causes you to gain weight, but there's just no data to support that. I mean, they basically said because the likelihood that weight gain mediates at least part of the association between red meat intake and type 2 diabetes, we did not adjust for adiposity in the primary analysis. In other words, they did not actually account for the fact that the people who ate more red meat were more overweight. Now, a lot of other things can cause that, and particularly they do, particularly ultra-processed foods, sugar, and refined carbohydrates. That's clear from the data, not meat. The next issue was grains and sugar were excluded from the characteristics table. That's crazy. How do you actually evaluate the effective diet if you exclude the very thing that's causing diabetes, namely sugar and refined carbohydrates? They just said, oh, we're not going to include that. okay, we're not going to look at that. Why? Well, I don't know, but it doesn't make any sense to me. The next problem with the study is that calorie intake was reported extremely low. Now, this doesn't make sense because people we know eat a certain amount of food. They're not starving themselves. And in the study, they basically excluded people who ate less than 500 calories a day for women or more than 3500 calories. They just got rid of them from the analysis. It's the same thing for men, men who consume less than 800 calories a day or more than 4200 calories a day were excluded. And you can see how do you get these numbers? Well, because food frequency questionnaires are so problematic, people will do all kinds of things that show that they're not actually truly reporting on how much or what they ate because they're getting all these extremes. Oh, men are eating 800 calories a day or 4,200 calories. It doesn't make any sense. But what was really interesting is the average calorie intake for women was 1,200 calories and for men it was 1,600 calories. That's not a sustainable diet for people. They're not going to eat that much. They're going to be starving all the time. So it just shows you the flaw in these food frequency questionnaires. They don't show you what people are actually eating. You have very low averages for healthcare practitioners. People, especially nurses, are on their feet all day. So that just kind of makes me want to throw out the study altogether. Because again, how do you rely on data that's so imperfect where your calorie.

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