Beating diabetes

In this, my second report on the 5th International Plant-Based Nutrition Healthcare Conference (PBNHC) in Anaheim, California (read the first instalment here), I’m going to summarise the two presentations that focused on diabetes.

The first was a pre-conference workshop titled ‘Treating Type 1 and 2 Diabetes with Plant-Based Nutrition’, run by the legendary Hans Diehl, creator of CHIP – the Complete Health Improvement Program – which I discussed in a previous post, and Cyrus Khambatta, whose own diagnosis with type 1 diabetes precipitated a journey of discovery which culminated in writing his doctoral dissertation on mechanisms of insulin resistance.

Hanging out with Hans Diehl 🙂


The second was titled ‘Plant-Based Pharmacy’, and was presented by Dustin Rudolph, also known as The Plant Based Pharmacist. Dustin focused his presentation on the stupendous costs and dismal results of medical treatment for diabetes, which sets such an interesting context for the information shared by Hans and Cyrus that I’m going to summarise Dustin’s talk first.

A pharmacist’s view of diabetes

In case you hadn’t noticed, there is an epidemic of type 2 diabetes mellitus (T2DM) – the type that used to be called ‘adult onset’, until teenagers and even children began developing it – that’s sweeping through both developed and developing countries.

Dustin shared this startling statistic: if the financial costs of treating the currently-diagnosed type 2 diabetics in the US were averaged out across the entire population, then every American man, woman and child would be paying out $752 per year to treat this one disease.

And that doesn’t even include treating the complications of T2DM include cellulitis, dental disease, pre-eclampsia, prematurity, birth defects and depression.

In the US, just over 80% of diagnosed type 2 diabetics are taking medications: 50% are taking oral medications alone, 18% are injecting insulin, and 13% are on both insulin and oral meds.

Metformin (Glucophage, Diabex, Diaformin) is generally first-line therapy when a person is initially diagnosed with type 2 diabetes. While it does offer some benefits – a 6-10% reduction in the risk of diabetic complications, and a 5% reduction in diabetes-related death – it causes adverse reactions such as nausea, vomiting and diarrhoea in between 2 and 12% of people taking it, and it eventually stops working for most diabetics (‘secondary failure’), which results in the prescription of more drugs.

Usually the next ‘cab off the rank’ is a sulphonylurea drug (gliclazide MR – e.g. Glyade MR, Oziclide MR, Diamicron MR; glimepiride e.g. Aylide, Diapride, Dimirel, Amaryl; glipizide e.g. Melizide, Minidiabs press). These drugs increase insulin secretion from the pancreas, and while they can be successful at normalising a diabetic’s blood glucose and HbA1c levels, and result in a rather paltry 5% decrease in microvascular complications (diabetic nephropathy, neuropathy, and retinopathy), they do so without reducing the patient’s risk of dying of diabetes.

Furthermore, they worsen diabetes by causing an average weight gain of 3-9 lb (1.4-4 kg), and between 1 and 1.4% of people taking them will suffer a major hypoglycaemic episode, which can be life-threatening.

Given the unsatisfactory performance of the sulphonylureas, a new class of diabetes drug, the GLP-1 agonists (Victoza, Byetta) was developed. These drugs slow down the emptying of food from the stomach into the small intestine, reduce glycogen release from the liver and increase insulin secretion.

While they offer a slightly better deal than the sulphonylureas – a 1.3-1.4% reduction in mortality risk – 3% of people taking them develop gallstones, and one third of those patients require surgery to remove their gall bladder, which can result in fat intolerance and distressing gastrointestinal symptoms for the rest of one’s life.

GLP-1 agonists are also known to cause pancreatitis, and in animal studies were found to increase the risk of thyroid cancer.

The next diabetes drugs to be developed were the STLT2 inhibitors (dapagliflozin e.g. Forxiga, canagliflozin e.g. Invokana, empagliflozin e.g. Jardiance), which cause increased excretion of glucose from the bloodstream via urine. While these drugs offer a small benefit to diabetics in terms of a 2.5% reduction in hospitalisation for heart attack, they also increase the risk of genitourinary infections including urinary tract and yeast infections by up to 18%, and they raise total cholesterol and LDL levels.

I wonder how many diabetics would choose to go on medications if their doctors shared accurate information about the low efficacy and shockingly high rate of side effects of these drugs, as Dustin shared with conference attendees?

Why are these drugs so ineffective at reducing diabetic complications and giving diabetics more years of healthy life? Because, with the exception of metformin, none of the diabetes drugs on the market address the 3 primary causes of T2DM:

  1. Insulin resistance;
  2. Intramyocellular lipid accumulation; and
  3. Reduction in peroxisome proliferator-activated receptor-γ coactivator 1-alpha (PGC-1α).

Insulin resistance is very closely linked with intramyocellular lipid (IMCL) accumulation – the storage of abnormal amounts of fat in muscle cells, which is a direct result of eating a high-fat diet. As Dustin explained, in animal studies, excess IMCL was found to halve the number of insulin receptors, causing insulin resistance.

PGC-1α is involved in mitochondrial biogenesis – the formation of the ‘power plants’ that produce energy inside our cells. Oxidative stress generated by eating the inflammatory Western diet, loaded with arachidonic acid from animal products and refined oils, and deficient in antioxidant components from whole plant foods, decreases PGC-1α expression in muscle cells which leads to reduced numbers of mitochondria. Without enough ‘power plants’ to burn up stored fat for fuel, excess fat accumulates in muscle cells, aggravating the insulin resistance and worsening the diabetes.

So how do diabetics get themselves out of this mess, and off medications? Address the cause – the nutrient-deficient, pro-inflammatory Western diet!

A wholefood plant-based diet with a high intake of antioxidant-rich fruits and vegetables, along with regular exercise which decreases insulin resistance by increasing skeletal muscle insulin sensitivity and stimulating mitochondrial biogenesis, can allow most type 2 diabetics to reduce and eventually withdraw from their medications – even insulin – under the careful supervision of a knowledgable doctor, of course.

A public health expert’s view of diabetes

The frustrating thing about listening to Dustin Rudolph’s lecture after attending Hans Diehl and Cyrus Kahambatta’s pre-conference workshop on diabetes, is that the dietary causes of type 2 diabetes have been understood for so long – and yet most diabetics are completely unaware of what made them diabetic in the first place, and their doctors, on the whole, are just as ignorant.

Hans Diehl presented a wonderful summary of published medical research dating back to 1927, when a Dr Sweeney conducted experiments on medical students. First, he fed them a diet that drew 65% of its energy from fat. Within just 2 weeks, 70% of these healthy young men developed diabetes, which fortunately resolved when he took them off the high fat diet. In contrast, a high carbohydrate diet which contained candy, sugar, bananas, white bread, baked potatoes, brown rice and oatmeal did not induce diabetes.

Then, in 1935, Himsworth found that the higher the percentage of fat in the diet, the lower was the insulin sensitivity, and that blood glucose level changed in direct response to the amount of fat in the diet.

In the same year, Rabinowitch published a study showing reversal of T2DM on a low fat diet, while in 1955, Singh found that 50 out of 80 insulin-dependent diabetics could be off insulin within 6 weeks by adopting a low fat diet.

Anderson published a study in 1980 showing that between 50-75% of type 2 diabetics on insulin and 80-90% on oral medications could normalise their blood glucose levels and be off all medications within just weeks if they dropped processed foods and most or all animal products from their diet and instead ate “food-as-grown”.

And in a randomised controlled trial published in 1994 Barnard showed that 71% of type 2 diabetics could stop taking oral medications in 26 weeks if they switched to a low-fat plant-based diet.

Given the number of publications on dietary treatment of diabetes, and how far back the knowledge of the true cause and effective treatment of this condition stretches, it is beyond shocking that 12% of the US adult population is now diabetic, that there has been a 300% increase in T2DM in the last 20 years, and that 1 in 3 babies born in US today will become diabetic within their lifetime. And just to drive home the point that the medical treatment of diabetes is abysmally ineffective, diabetic men lose 11.6 years off their life expectancy, and diabetic women 14.3 years, with the best of modern diabetes care.

What’s driving the diabetes epidemic? It’s in lockstep with the obesity epidemic. In 1900, the standard-sized US chair was 17 inches (43 centimetres) across. By 1970 it was 17.7 in (45 cm), but today it is 24 in (61 cm) to accommodate the rapidly-expanding American backside… and I don’t imagine the situation is any better here in Australia.

As Hans explained, the long-running Nurses Health Study found a 40% higher risk of developing T2DM in the most overweight participants compared to normal-weight women. Having a body mass index (BMI) over 40 increase diabetes risk by a whopping 7-fold.

Since it takes 200-300 years for significant genetic change to occur in a population, and the obesity crisis has occurred in the last 20-30 years, clearly the current epidemic of ‘diabesity’ is not due to our genes. It’s the food. Specifically, it’s driven by a diet high in animal products and refined plant products (including oil), with a reduced intake of unrefined starch.

Pointing out that diet composition runs parallel to GDP – as GDP increases, vegetable fats, animal fats, sugar and protein (especially animal protein) all increase, but starch declines – Hans discussed the interesting case of Japan. Before 1960, the incidence of T2DM among the Japanese was around 1%, but by 1980 it has risen to 5%, and in 2000 it reached 12%, as Western eating patterns progressively eroded the traditional rice- and vegetable-based Japanese diet.

Importantly, the diet that Hans Diehl prescribes to type 2 diabetics – based on legumes, vegetables especially greens, and whole grains, with limited or no fats and oils, sugar or salt, also offers dramatic benefits for type 1s, as Cyrus Khambatta explained.

A diabetic’s view of diabetes

After experimenting with various eating patterns, included Paleo and ketogenic, which just made him sicker, Cyrus was able to achieve a 43% decrease in his insulin dosage in just 3 weeks by dramatically increasing his intake of carbohydrates and slashing his fat intake. In fact, he discovered that his insulin requirement was directly inversely proportional to his carb intake – the more carbs he ate, the less insulin he needed – which was the complete opposite of the advice he had received from the diabetes clinic when he was first diagnosed.

Calculating his insulin sensitivity by dividing his carbohydrate intake by the number of units of insulin he used per day, Cyrus realised that he had increased his insulin sensitivity by 800%, simply by adopting a low-fat, high-carb diet.

As he began delving into the published research on diabetes in order to better understand the results of his personal experiment, Cyrus discovered the facts shared by Dustin Rudolph: insulin resistance, which is the key driver of T2DM but also afflicts type 1s, and women with gestational diabetes and polycystic ovary syndrome (PCOS), is caused by storage of fat in tissues that are not designed to store fat, principally the muscles and liver.

This increased fat storage is primarily caused by dietary fat intake. In fact, insulin resistance is the body’s self-defence mechanism to stop the entry of excess fat into these tissues, since insulin causes cells to take up glucose, fat and amino acids from the bloodstream. While excess fat of any kind can induce insulin resistance, saturated fats (from animal products and tropical oils, including coconut and palm oil) and trans fats (from processed foods and the meat and milk of ruminant animals, such as cows) are the worst culprits.

But the damage done by a high-fat diet – which is touted by innumerable popular books and websites – doesn’t end there. A low-carb, high-fat (LCHF) diet induces apoptosis, or programmed cell death, in the pancreatic beta cells which produce insulin. The very cells that are attacked by an autoimmune response in type 1 diabetics, and that ‘poop out’ due to years of excessive insulin output in type 2s, are directly damaged by the free radical formation, lipid peroxidation and protein oxidation that a LCHF diet induces.

So even though diabetics may see a temporary improvement in their blood glucose level and HbA1c when they go on a LCHF diet, simply because they have slashed their carbohydrate intake, this dietary pattern does not reverse insulin resistance and it essentially makes them more diabetic.

In contrast, a diet that is high in unrefined plant foods, and therefore

  • Naturally low in fat (Cyrus and Hans both recommended a fat intake of less than 15% of total energy intake for diabetics); and
  • High in fibre, which slows down the rate of absorption of glucose from carbohydrate-containing foods; and
  • Rich in antioxidants, which protect the pancreatic beta cells from oxidative damage; and
  • Relatively low in protein, which increases insulin resistance independently of dietary fat;

along with frequent exercise, essentially reverses the multiple pathologies that lead to T2DM, and dramatically decreases the insulin requirements and risk of complications in type 1 diabetics.

I’ve been using dietary and lifestyle measures outlined by Hans Diehl, Cyrus Khambatta and Dustin Rudolph in my practice for the last 22 years, and I feel enormously privileged to have been able to help many type 1 and 2 diabetics to reduce their medication use or cease it entirely and achieve better health than they’ve ever enjoyed in their lives! If you need help with managing your diabetes, or you’re prediabetic or have PCOS and want to save yourself from becoming diabetic, apply for a Roadmap to Optimal Health consultation today!


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