Plant Based Diet for Diabetes with Dr. Cyrus Khambatta: Rational Wellness Podcast 144

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Dr. Cyrus Khambatta discusses how A Plant Based Diet Benefits Patients with Diabetes with Dr. Ben Weitz.

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Podcast Highlights

3:12:  Dr. Khambatta was diagnosed with Type I Diabetes when he was 22 years old and he developed 3 separate autoimmune conditions within a 6 month period of time.  Dr. Khambatta developed Hashimoto’s hypthyroidism, Type I Diabetes, and Alopecia universalis, which is why he has no hair.  He followed his doctors’ recommendations to follow a lower carbohydrate diet with 100-125 grams of carbs per day.  He started eating more peanut butter, eggs, chicken, fish, olive oil, and reduced his intake of carbohydrates, including fruits, starchy vegetables, and whole grains.  Not only was he having trouble controlling his blood glucose, but his insulin use was gradually going up as well, from the mid 20s, to the mid 30s, to 40-45 units per day.  He decided to try a plant based, high carb, whole food, low fat diet, with the help of Dr. Douglas Graham.  He started eating 5 to 6 times the number of grams of carbohydrates per day and his blood glucose fell within the first 24 hours and he cut his insulin use by 40%!  This led Dr. Khambatta to get a PhD in Nutritional biochemistry from UC Berkley in order to understand what was going on in his own body.  He claims to have dug up over 100 years of information from scientific researchers that document how a low fat, plant based, whole food diet can help maximize insulin sensitivity and enable people with both Type I and Type II diabetes and prediabetes to get the same results. This led him and Robby Barbaro to see up the Mastering Diabetes coaching program to educate people about the benefits of the plant based diet for diabetes.

11:55  The recommended diet for those with both Type I and Type II diabetes can be quite similar, according to Dr. Khambatta. There are three components to a plant-based diet that are beneficial for those living with diabetes: 1. Low fat, 2. Plant based, and 3. Whole food.  Dr. Khambatta recommends that no more than 10-15% of calories should be consumed as fat because low fat will improve insulin sensitivity.  You should eat as much plant material as you can, but you should avoid processed and packaged food products, even if they are plant based. You should stick with whole fruits, vegetables, whole grains and legumes and avoid plant based burgers and soy ice cream and crackers and chips, etc.

14:26  Insulin. If you consume too many calories, insulin will signal your liver and muscle to store the excess energy as glycogen and then as bodyfat.  Insulin is a very powerful anabolic hormone that has many other effects, including to signal amino acid uptake from protein and fatty acid uptake from fatty acids. Insulin can signal cholesterol uptake.  Insulin can also promote DNA synthesis, DNA repair, RNA synthesis, and glycogen synthesis. 

16:39  It is important to avoid consuming too many calories if you have diabetes, since excess calories will tend to be stored as fat.  But if you avoid refined carbohydrates and you eat a whole food plant based diet, it is very rich in fiber and water and this creates bulk, which fills you up and makes it hard to eat excess calories. Fiber is very important for slowing the breakdown of the food into sugar, for creating bulk in our stool, and helps feed our microbiome and promotes the production of butyrate by our microbiota.

18:21  People who are overweight usually tend to overeat carbohydrates, but these are usually refined carbohydrate foods, like chips and cookies and crackers and pastas and cereals. Such foods are made hyperpalatable that tend to encourage overeating, whereas whole food plant-based carbohydrate foods, like potatoes are filled with fiber and water and tend to fill you up.

20:58  Eating carbohydrates with proteins or fats does slow the absorption of the carbohydrate into sugar in the bloodstream.  But if you eat in a way that promotes insulin sensitivity with a high carb, low fat, whole foods, plant-based diet, then the glucose molecules from the potato you eat will get inside of your muscles, which will keep your blood glucose from going high.

25:10  If you eat too many carbohydrate calories, more than your caloric needs, then you can have your blood glucose spike and start storing some of those carbohydrate calories as fat in the liver and in adipose stores. But if you eat a low fat, whole food, plant-based diet without refined carbohydrates, then you are less likely to eat excess calories and you are likely to be sensitive to insulin, so the glucose will continue to be shuttled into the muscles and liver and your blood glucose will not be high.

30:37  The Glycemic Index, which rates carbohydrate foods based on the rate that they are turned into sugar, matters, but not so much if you are insulin sensitive due to eating a low fat, whole food, plant-based diet.

36:04  Insulin resistance is a complex topic, but Dr. Khambatta feels that the research shows that eating both fat, esp. saturated fat, and/or protein increase insulin resistance, as compared to eating carbohydrates. Saturated fat appears to be the most significant contributor to insulin resistance, according to Dr. Khambatta.

39:57  Dr. Khambatta recommends eating a fruit-centric meal in the morning and if you exercise in the morning, which he recommends, this can give you a lot of energy for your exercise. Such a meal could consist of a bowl with two bananas and a mango with a tablespoon of flax seed oil dripped on it or you can have oatmeal with fruit. If you are a Type I diabetic, it is best to eat and then exercise and under-dose your insulin a little bit so you don’t get hypoglycemic with exercise.  If you have Type II diabetes, then it’s fine to exercise first in a fasted state and eat your fruit after you exercise.  Lunch could include some starchy carbohydrates like potatoes, squash, corn, or some whole grains.  In the evening would be a good time to have some green leafy and non-starchy vegetables with some legumes.

44:50  Nutritional Supplements.  Dr. Khambatta recommends a supplement containing Indian gooseberries, Amla Green, which contains Amla berries with green tea.  He also noted that there are some effective anti-diabetic medicinal herbs, including cinnamon, berberine, fenugreek, gymnema sylvestre, and bitter melon, but he does not see them as a core component of the natural managing diabetes approach.

46:08  Exercise.  It is recommended to do at least 30 minutes of exercise six days per week with 50% being cardiovascular exercise and 50% resistance training.  Exercise should be intense enough that you cannot talk or answer a phone call or sing your favorite song while exercising.  Exercise is a powerful insulin sensitizer and has many benefits for your glucose management, your brain, your bones, your muscles, your thyroid, and your mental health.

 

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Dr. Cyrus Khambatta has a PhD in Nutritional Biochemistry and he has coauthored a number of peer-reviewed scientific papers and he is the co-host of the annual Mastering Diabetes online summit.  He is also the co-author of a new book along with Robby Barbaro, Mastering Diabetes, which was just released on 2/18/2020.

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.

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Podcast Transcript

Dr. Weitz:                            Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest and cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates. And to learn more, check out my website, drweitz.com. Thanks for joining me, and let’s jump into the podcast.  Hello Rational Wellness Podcasters, thank you so much for joining me again today. For those of you who enjoy listening to our Rational Wellness Podcast, please go to Apple Podcasts or wherever you get your podcasts and give us a ratings and review. Also, if you’d like to see a video version, go to my YouTube page, and if you go to my website, you can find detailed show notes and a complete transcript.

Today our topic is, The Prevention And Treatment Of Diabetes With A Diet And Lifestyle Approach.  Type 1 diabetes is an autoimmune condition that usually starts in childhood or in the teenage years and is marked by damage to the ability to produce insulin, and requires taking insulin injections for the rest of their lives.  But 90 to 95% of those with diabetes have Type 2, and this is a condition that results from diet and lifestyle and is entirely preventable. One of the biggest questions is, which diet and lifestyle factors are the most effective for this task? For example, is it more effective to follow a lower carb diet, which as Dr. Brian Mowll recommends, who we spoke to in episode 139?  Or is it more effective to follow a higher carb, lower fat program such as Dr. Cyrus Khambatta, our guest today advocates? This is a very important topic because diabetes and prediabetes are epidemic and the prevalence continues to increase in the United States and around the world.  9.4% of adults in the US are diabetic and at least 87 million people in the US have prediabetes and rates are climbing, especially among children and teens. Dr. Cyrus Khambatta has a bachelor of science in mechanical engineering from Stanford university in 2003 and a PhD in nutritional biochemistry from UC Berkeley in 2012. He’s coauthored a number of peer-reviewed scientific papers. He appeared on the Forks Over Knives’ documentary and he’s the co-host of the Annual Mastering Diabetes Online Summit, and he’s coauthored the soon to be released book, Mastering Diabetes With Robby Barbara. There you go. Is it available right now?

Dr. Khambatta:                 It’s available for pre-sale right now and it’ll be available on February 18th for everyone.

Dr. Weitz:                         Okay. And he’s also a nutrition and fitness coach and he’s been living with Type 1 diabetes since 2002. Dr. Khambatta, thank you for joining me today.

Dr. Khambatta:                 Thank you so much Dr. Weitz. I really appreciate the opportunity to be here today.

Dr. Weitz:                          Excellent. So maybe you can start by telling us about your personal experiences living with Type 1 diabetes and eating a plant-based diet.

Dr. Khambatta:                 For sure. I was diagnosed with Type 1 diabetes when I was 22 years old, I was a senior at Stanford university at the time and I was just trying to graduate and move on with my life, and I started to feel really thirsty, like incredibly thirsty where I was drinking about one to two gallons of water per day, and my energy levels were just terrible, very little energy. So I picked up the phone and I called my sister and she’s a doctor of osteopathy and I said, “Hey Shanaz, here are my symptoms, what am I experiencing?” And she said, “Cyrus, you are explaining Type 1 diabetes to the T, go to the health center right away.”  And I was like, “Shanaz, I don’t have Type 1 diabetes. What are you talking about?” And she said, “I don’t have time to explain, just go.” So I didn’t know anything about biology, I didn’t know anything about medicine at that point. I just thought that diabetes literally had something to do with old people and cake. That was it. So here I am, I’m like 22 year old guy, I’m athletic and I’m like, “I’m not overweight. I don’t understand what’s happening.” So I checked myself into the health center and while I’m there, they checked my blood glucose and it’s over 600. My brother goes, “Anybody’s blood glucose is supposed to be between 80 and 130 on a given day.” And mine was basically six times higher than it needed to be. And I didn’t know what that meant, but they basically looked at me and they said, “We’re taking you to the ER right now.”

So we go to the ER together. When I checked myself in there, they basically put me into a room. They gave me an IV of saline in one arm to hydrate me, and then they also gave me an IV of insulin into the other arm and they started to control my blood glucose and bring it down using insulin. While I was in the hospital for 24 hours, they pieced together my health history, and they helped me understand that I now had developed, not one, not two, but three autoimmune conditions within a six month period. So the first autoimmune condition was Hashimoto’s hypothyroidism. So I developed Hashimoto’s about six months prior and I was taking a synthetic thyroid supplements, was taking Synthroid and that was supposed to solve that problem.  Then a couple of months later, I developed alopecia universalis, which is why I have no hair, I have no eyebrows, I had no eyelashes, I had no ear hair, no hair, nothing, I’m gone. And then in addition to that, I developed Type 1 diabetes. So all of those setting within a six month period and all three of them were autoimmune. So the doctors looked at me and they were like, “We’ve never ever seen somebody that has these three conditions before.”

Dr. Weitz:                          But actually autoimmune conditions do tend to group together. Having one autoimmune condition increases your risk of another.

Dr. Khambatta:                 No questions asked, you’re absolutely correct. And I’ve gone on to learn over the course of time that there’s actually different types of autoimmune conditions that cluster together. So Hashimoto’s, hypothyroidism, Type 1 diabetes, celiac disease, they all cluster, but I didn’t know that at the time, all I knew was that I’d felt thirsty and I needed some help. And the doctors were basically telling me, they were like, “Well we kind of know what to do and we kind of don’t know what to do.” So I got discharged from the hospital 24 hours later with a blood glucose meter, test strips, two different types of insulin, syringes, carbohydrate counting guide and a life alert bracelet that basically said, “If something happens to me and you find me passed out on a field, call 991.” So I got really nervous really quickly because-

Dr. Weitz:                          Yeah, that’s pretty scary.

Dr. Khambatta:                 Yeah, exactly. So I followed the advice of my doctors at the time and they basically said, “Listen, we know how to treat Type 1 diabetes because it’s pretty classic and there’s a safe way to treat it and that is, to eat a low carbohydrate diet.” So I said, “Great. Let’s do this.” So I started eating more peanut butter, more eggs, more chicken, more fish, more olive oil, and I was trying to reduce my intake of carbohydrate rich, anything, whether that was fruits or starchy vegetables or whole grains. And by doing so it was supposed to make my blood glucose more controllable and it didn’t. It definitely did not.

So maybe I did a low carbohydrate diet terribly incorrectly, but I was trying to control my carbohydrate intake to be about 100 to 125 grams per day, which falls within the low carbohydrate classification. And not only was my blood glucose hard to control, my insulin use was going up over time, started out in the mid-20s, and then it creeped up to the mid-30s, and before I knew it, it was 40 to 45 units per day. And then in addition to that, I also just started to feel very tired and my joints and my muscles were starting to hurt and I couldn’t be as athletic as I wanted to be. And having grown up as an athlete, a soccer player, weightlifter, and just like generally, very active, as soon as my mobility got compromised, I got really frustrated.

So I started looking for more information, I got introduced to this idea of eating a plant-based diet and I said, “Heck, I’ll try it out. Let me do it.” So under the guidance of a nutrition professional named, Dr. Douglas Graham, he helped me transition to a plant-based diet, literally overnight, cold turkey. Now, I don’t really recommend transitioning cold turkey overnight, but I happened to do it just because that’s the situation I was presented with. So I switched over to a plant-based diet and Dr. Weitz, I can’t even tell you how incredible it felt for the first week. Within 24 hours, my blood glucose went from being relatively high and difficult to control, I hit six hypoglycemias within 24 hours. So my blood glucose began to fall and it began to fall rapidly.  And as a result of that, I had to back off on the amount of insulin I was giving myself so that I wouldn’t drive myself more hypoglycemia. Over the course of one week, I’d cut my insulin use by 40%, which is mind boggling, but the beauty was that I was doing it by eating five to six times the number of grams of carbohydrate per day. So that was really where this light bulb went off in my head when I was like, “Wait a minute, I had been told up to this point that carbohydrates equals more insulin, but now I’m eating way more carbohydrate energy and my insulin use is going down, so there’s like they’re moving in opposite directions. How is that possible?” So that’s when I got really interested in studying it at the PhD level, so I went to UC Berkeley. I enrolled in a PhD program there and I got to try and understand what was happening inside of my own body because it was a fascinating experiment.

Dr. Weitz:                          Well, it certainly is counter intuitive.

Dr. Khambatta:                 Oh, it’s fascinating. Yes, absolutely perfect..

Dr. Weitz:                          We basically, carbohydrates, pick a carbohydrate, rice is essentially a long chain of glucose molecules together. And when you eat a carbohydrate like rice, it gets broken down over a period of time, faster or slower depending upon the carbohydrate, into glucose, and if the issue is glucose, it certainly makes sense that eating more carbohydrates is going to raise your blood glucose.

Dr. Khambatta:                 That’s exactly So the overall philosophy of eating more carbohydrates equaling more glucose, equaling more insulin, it makes perfect sense. From like if you step backwards and draw it out on a piece of paper, it makes perfect sense, but my personal experience went exactly opposite to that. And so that’s where I either thought to myself, I was like, “Either I’m a fascinating “N” of one experiment, and what’s happening inside of my body is I’m a genetic anomaly or what’s happening inside of my body is actually applicable to other people living with Type 1 or maybe even other people living with any other form of diabetes.”

So that’s why I went to school and that’s why I tried to educate myself about it so that I could answer that question. Then while I was there, I was able to dig up almost 100 years’ worth of information, from the 1920s and beyond of experiments that scientific researchers have run that mimic exactly what I had gone through myself. And there’s a whole collection of information that really highlights the power of a plant-based diet, especially a low fat, plant-based whole food diet in helping to maximize insulin sensitivity and really enable people living with Type 1 and Type 2 diabetes and prediabetes to see the exact same results, which is higher carbohydrate and take less insulin demands, less insulin biological requirements.  And that’s when I started to say, “Oh, wait a minute, I’m not special. I’m really not special. I just happened to be one person that experienced something that has already been documented for over 100 years.” And so we set up the Mastering Diabetes coaching program to teach people living with all forms of diabetes, how they can also transition to a plant-based diet so that they can achieve incredible similar results.

Dr. Weitz:                          So how should a diet for somebody with Type 1 be different than somebody with Type 2 diabetes?

Dr. Khambatta:                 It doesn’t necessarily have to be that different. At the basis of what we teach, and the basis of all of the scientific investigations that I’ve been involved in in the past 15 years, is that there’s three components to a plant-based diet that are really going to be beneficial for people living with diabetes. Number one, low fat. And when I say low fat, I basically mean approximately 15% of total calories as fat or maybe even a little bit less, somewhere between 10 to 15%. Number two, plant-based, meaning eat as much plant material as you possibly can. You don’t have to go 100%, but it does the further you can increase your plant intake, the better.  And then number three, whole food. And I want to put a focus on whole food too, is very important because as you know yourself, there’s a lot of plant-based packaged products that are now available on the market. There’s plant-based burgers, there’s soy ice cream, there’s crackers, there’s chips, there’s cookies, there’s enchiladas, there’s burritos, you name it.  And we don’t actually recommend eating more of those products even though they’re technically plant-based.  We’re talking about literally eating more fruits, more vegetables, more whole grains and more legumes.  So when you eat a low fat plant-based whole food diet, what ends up happening is that in a low fat environment, when the total quantity of that is quite low in your diet, that enables glucose metabolism to function very efficiently and then enables insulin to become very effective at signaling glucose to enter tissues.

And so to answer your question, you say, “Well, how would a diet for somebody with Type 1 be different than a diet for somebody with Type 2?” The answer is, it doesn’t necessarily have to be. As long as you’re eating a low fat, 10 to 15% of your total intake as fat, plant-based, whole food diet, then what we find is that people with Type 1 diabetes, Type 2 diabetes, people with prediabetes, we’re all doing the same thing under the surface.  And that same thing is we are maximizing insulin sensitivity.  And when you maximize insulin sensitivity, then effectively you allow insulin to do its job very effectively.  So small amounts of insulin can then usher or signal large amounts of glucose to get inside of tissues and that helps keep your blood glucose controlled very well.

Dr. Weitz:                         Isn’t the amount of calories really significant? Isn’t insulin essentially the hormone that allows us to store extra energy?

Dr. Khambatta:                 Yes.

Dr. Weitz:                         In other words, if we consume more calories, calories being a measure of energy, than we need, then we can store some of that energy as glycogen or as fat, and that insulin helps to stimulate that, right?

Dr. Khambatta:                 Yes. So insulin is actually a pretty misunderstood molecule, and what you’re saying is actually very true. So think of insulin as being basically the single most powerful anabolic hormone in your body. And when I say anabolic hormone, I mean, anabolic is a term given to like growth. It stimulates synthetic processes. So insulin is more powerful at stimulating synthetic processes than is testosterone, than is estrogen, than is growth hormone, than is IGF-1, you name it. So insulin’s role in your body, its primary function in your body, is to signal to tissues that glucose is available in your blood.

So when insulin is present, it’s a high energy signal that basically says, “Hey, liver, Hey muscle, would you like to take this glucose up? There’s glucose in the blood, go get it.” And then glucose, if the tissue say, “Yes, okay, no problem,” then glucose can get inside of those tissues. But insulin also has a number of other effects. Insulin can signal amino acid uptake from protein and insulin can signal fatty acid uptake from fatty acids. Insulin can signal cholesterol uptake.  Insulin can also promote DNA synthesis, RNA synthesis, glycogen synthesis. It can stimulate DNA repair. I mean, it’s literally endless what insulin is capable of doing.

But everything that insulin does is synthetic by nature or building by nature. And it also shuts down catabolic processes, meaning it shuts down the oxidation of fatty acids, it shuts down the oxidation of glucose. So it’s basically simultaneously turning up synthetic processes and minimizing or impairing catabolic processes, etc. So to answer your question, if you eat excess calories, does that stimulate an excess insulin production and then increased fatty acid synthesis or increased glycogen synthesis? The answer is absolutely, no questions asked.  So it’s very important for somebody living with any form of diabetes to be very cognizant of the amount of calories they’re consuming and to not over-consume calories.

And one of the things that’s actually very beneficial about a plant-based diet in particular that I’ve learned over the course of many years is that, when you eat a plant-based diet, it’s actually relatively challenging to overeat on calories, just naturally. And the reason for that is because when you’re eating a whole food plant-based diet, the whole food plant-based diet is incredibly fiber rich and is incredibly water rich. And if you add fiber and water together, you end up creating this thing called bulk, this substance called bulk. And there have been many experiments that have been performed over the course of time. And there’s a woman named, Barbara Rolls, who’s the pioneer of this branch of biology.  And what she has shown is that the single most satiating aspect of food, of all food is bulk. So when you consume foods that are fiber rich, that also are pre-packaged with a ton of water, then it’s actually, it fills you up quickly, and as a result of that, you don’t take very many bites before your digestive system signals up a neurological signal to your brain that says, “Hey, I’m getting full, slow down.” And as a result of doing that, you end up not actually taking on too many calories, it’s a natural break to prevent you from taking on excess calories.

Dr. Weitz:                         It doesn’t seem to match with my experience.  From what I’ve seen, people who tend to be overweight, tend to overeat carbohydrate foods. Rarely do people gorge on chicken or eggs–they’re eating bowls of pasta and chips and bagels and those are the typically the foods that lead people to be overweight.

Dr. Khambatta:                 The types of carbohydrate that you’re talking about are actually refined carbohydrate foods. You’re talking about chips and cookies and crackers and pastas and cereals and carbohydrates, sorry, carbohydrate-rich food that has gone through a manufacturing process in order to become a thing that you buy at the grocery store. And you are absolutely correct.  Refined carbohydrate foods can be very addictive because food manufacturers play games with those foods and when they put them into a package, they add natural flavorings to them such that they make them hyper palatable and it makes it much more likely that as soon as it hits your tongue, it sends a dopamine signal into your brain, sorry, your brain generates dopamine, which then gives you a happiness signal, which then makes you want to eat more.  So the nice thing about eating a whole food plant-based diet is that when you’re eating potatoes, potatoes don’t have that same hyper palatability, they’re tasty, and they’re filling and they’re filled with fiber and water. And as a result of that, they fill you up without making you feel like you’re addicted to wanting to eat more and more and more.

 

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Dr. Weitz:                            We’ve been having a great discussion, but I’d like to take a minute to tell you about the sponsor for this episode. I’m thrilled that we are being sponsored for this episode of the Rational Wellness Podcast by Integrative Therapeutics, which is one of the few lines of professional products that I use in my office. Integrative Therapeutics is a top tier manufacturer of clinician designed, cutting edge nutritional products, with therapeutic dosages of scientifically proven ingredients, to help patients prevent chronic diseases and feel better naturally.

                                                Integrative Therapeutics is also the founding sponsor of Tap Integrated, a dynamic resource of practitioners to learn with and from leading experts and fellow clinicians. I am a subscriber and if you include the discount code Weitz, W-E-I-T-Z, you’ll be able to subscribe for only $99, instead of $149 for the year. And now, back to our discussion.

 

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Dr. Weitz:                          Now, don’t carbohydrates break down into sugar more quickly if they’re consumed alone versus if they’re consumed with protein and/or fats because the proteins and fats take longer to digest, you’ll get less of a blood sugar response from eating that meal, isn’t that the case?

Dr. Khambatta:                 I’m very glad you asked me this question because this is a highly misunderstood topic and the answer is true but also true but. If you eat a carbohydrate-rich food, like let’s take for example, sweet potatoes. You eat sweet potatoes and you also eat the sweet potatoes with a protein-rich food. Give me an example of a protein or fat-rich food.

Dr. Weitz:                          Salmon.

Dr. Khambatta:                 Perfect. You eat it with salmon. So you eat the two of those foods together, they basically go in your mouth, they travel down your esophagus, they get into your stomach and then they get into your small intestine. Now, once they get into your small intestine, the lipid soluble components are actually absorbed into your lymph system quickly. So effectively, what that means is through the walls of your small intestine, the lipid soluble components being fatty acids plus cholesterol, they get absorbed through the walls of your small intestines, they get put into your lymph and then they get put into your blood and they circulate as chylomicrons.  These chylomicrons basically are just delivering fatty acids, “Here, you want this fatty acid, go for it. Take it, take it, take it.” Once that lipid absorption starts, that lipid absorption process has a whole bunch of complex signaling mechanisms back up to your brain that then signal back down to your digestive system. So there’s a two way neurological pathway that happens as soon as lipid-rich food gets into your mouth.  So one of the things that happens is that your brain gets a signal from your digestive system that there’s lipid present in the food, and your brain then sends the same signal back to your stomach and it slows your gastric emptying rate.  So it actually slows down the rate at which your stomach passes food into your small intestine. So there’s a pyloric sphincter at the base of your stomach and that pyloric sphincter basically just like closes and its harder to open.  So as a result of that, you actually have like a small, a minor traffic jam of chyme or undigested food material inside of your stomach.  And that’s actually a good thing because what it does is like you said, it slows down the absorption.  So carbohydrates is slowed down as a result of that, and it basically evens down blood glucose response. That is a true statement.

Well, let’s do the opposite now, suppose you just ate the sweet potato by itself and there wasn’t any salmon to come along with it. Does that mean that the glucose from the sweet potato would be present in your blood and it would cause a blood glucose spike?  And the answer is, yes and no, depending on the situation.  So I’ll give you two different scenarios.  If you were to eat a sweet potato and you ate that sweet potato and it went into your small intestine and it got absorbed through the walls of your small intestine and the glucose is put into your blood.  If the glucose cannot get outside of your blood and into tissues, then it’s going to get trapped inside of your blood and you’re going to see a high blood glucose value and you’re going to see that quickly.   The reason that that would happen is if you already are living with insulin resistance, if you’ve eaten the diet that has made you insulin resistant such that your liver and muscles are not accepting of glucose. So if you’re already insulin resistant to begin with, you eat that sweet potato, if you check your blood glucose and it’s going to be high.  If you had eaten yourself into insulin sensitivity and you’ve reversed insulin resistance using your diet, then as soon as the glucose molecules from that sweet potato get inside of your blood, they have an exit route and they can get inside of your liver and they can get inside of your muscle, and that’s going to prevent your blood glucose from going high. The glucose will get inside of your blood and it’ll get out of your blood very quickly and that will keep your blood glucose from going too high.

Dr. Weitz:                          But let’s say I don’t have insulin resistance, but because I’ve been eating a lot of carbohydrates, I have plenty of carbohydrates, my muscle glycogen, my liver glycogen is filled with as much glucose stored as glycogen as it can handle, so I have plenty of glucose and now this is an excess glucose that can’t go anywhere.

Dr. Khambatta:                 There’s a couple of things to think about.

Dr. Weitz:                          In other words, can’t it be the case that it’s not just that we’re not sensitive enough to insulin to utilize it, but that there’s just an excess of glucose.

Dr. Khambatta:                 I mean, sure. You can always eat a diet that has an excess amount of carbohydrate and/or glucose energy, that is absolutely possible. And that is most likely going to happen when you’re overeating calories, period, end of story.  But if you’re not overeating calories and you just happen to be, let’s just say your calorie requirement for a daily basis is 2,500 calories, just for the sake of argument.  Let’s say you’re eating a diet that contains 2,500 calories, so you’re not overeating.  If the majority of your energy was coming from carbohydrate. And when I say the majority, I mean, like 70% or sometimes even more, does that mean that you run the risk of glucose overload, of carbohydrate overload and that’s going to cause your blood glucose to go up?  And the answer is, it depends.  If you are insulin sensitive, if you truly are insulin sensitive, then you can eat a dramatically high carbohydrate intake, 70 to 80% or even higher, and you will not get glucose overload.  Glucose will not get trapped inside of your blood, it’ll easily get imported into glucose, sorry, into your liver and muscle, and that will prevent against high blood glucose values.

Dr. Weitz:                          But can’t my liver and muscles have all the glucose they can use? Can’t they be filled up?

Dr. Khambatta:                 The answer is yes. Yes and no. Glucose is present in your blood at all times, and glucose gets inside of your liver and gets inside of your muscle.

Dr. Weitz:                          But there’s a limit to how much glucose you can store, right?

Dr. Khambatta:                 There’s a limit to how much glucose you can store, absolutely. There’s no question about that.

Dr. Weitz:                          And after that, it turns into fat, right?

Dr. Khambatta:                 Well, let’s think about it this way. Glucose can get inside of your liver and it gets inside of your muscle and it can get stored as glycogen. And on average, you have approximately about 1800 to 2000 calories of glycogen at any given time. So let’s say for now, you ate a dinner that was carbohydrate rich and you topped off your glycogen stores inside of your liver and muscle, and you’re full of glycogen and that’s it. Then you go to sleep, you wake up in the morning, your glycogen stores are now less than they were when you went to sleep. So you’re actually burning glycogen in the middle of the night while you’re sleeping.

Dr. Weitz:                          Okay. But let’s say I wake up and my glycogen stores are still full.

Dr. Khambatta:                 Okay. My point is that that doesn’t happen.

Dr. Weitz:                          It doesn’t happen?

Dr. Khambatta:                 No. So glycogen is a temporary storage tank that you can always fill. You can put more glucose into the glycogen repository, but it’s not like glycogen is a stagnant structure and that as soon as you put stuff in, it’s full and then it stays full for 24 hours. Glycogen is constantly being depleted at all times, 24 hours a day. Right now, you are going through your glycogen stores and so am I. We’re sitting in a chair, we’re not doing anything because glycogen is a fuel tank. It’s just that like if you were to go exercise, you would burn through your glycogen stores much quicker.  Right now your glycogen stores are decreasing, so that means the next time you go eat a glucose-rich meal or a carbohydrate-rich meal, you now have some space to put more glucose back into that glycogen storage tank. So I think what you’re trying to get at is-

Dr. Weitz:                          Let’s say I have this much space but I take this much glucose.

Dr. Khambatta:                 For sure. So you can have a small amount of space and you can take on an extra amount of glucose and yes, that can be a problem. But the question really becomes, is that clinically relevant? And the answer is, if you’re eating a refined carbohydrate diet, you will find two things that are happening. Number one, glucose gets into your blood much quicker than it would if you’re eating whole foods, no question. Number two, it can actually create insulin resistance inside of your liver in particular. So you’ve got hepatic insulin resistance, and as a result of developing hepatic insulin resistance, now you have a traffic jam of glucose that’s present in your blood so your glucose can go higher.  And then like you said, also some of those glucose when it gets inside of your liver, if it’s insulin resistant, boom, now, all of a sudden your liver says, “You know what, let me convert this into fatty acids.” And then it does this conversion of glucose into fatty acids, DNL. However, DNL is actually, it’s a last resort mechanism and it doesn’t really happen as efficiently as most people believe. So we can go into that in detail in a little bit.

Dr. Weitz:                          This is also why you often see people who overeat refined carbohydrates have fatty liver.

Dr. Khambatta:                 No questions asked. Absolutely, 100%. So you’re on the ball about the fact that refined carbohydrates are not healthful foods by any stretch of imagination. So you don’t recommend eating them, I don’t recommend eating them, nobody from the functional world, the plant-based world, we all agree, everyone’s like, “You know what, refined carbohydrates is not an ideal option.”

Dr. Weitz:                         How much does glycemic index matter?

Dr. Khambatta:                Ooh, good question. The glycemic index is important-

Dr. Weitz:                         By the way, for the listeners who are not aware, the glycemic index is a measure of the rate at which a carbohydrate food gets converted into sugar in your system.

Dr. Khambatta:                Exactly right. It’s the speed at which a carbohydrate-rich food gets converted into glucose.

Dr. Weitz:                         You get a big spike or is it a slow gradual release.

Dr. Khambatta:                So the glycemic index is important for people, let’s say you’re eating a plant-based diet and you tend to be eating high, you’re on the glycemic index.  Does that mean that that’s bad for you?  Does that mean that it’s going to-

Dr. Weitz:                         You’re having a lot of white potatoes?

Dr. Khambatta:                 The answer is if you are living with insulin resistance to begin with, if your liver has accumulated a sufficient amount of insulin resistance over the course of time, if your muscles have accumulated a significant amount of insulin resistance over time, then when you eat high glycemic index foods, those high glycemic index foods will get absorbed into your blood, the glucose is going to get into your blood quickly. And it’ll get trapped inside of your blood and it will absolutely cause the glucose spike. If, again, the name of the game is reversing insulin resistance. If you have or have become insulin sensitive through many lifestyle factors, including a low fat plant-based food diet, including frequent movement, including maybe some intermittent fasting.

If you do all those and you do those on a daily basis and you have become tremendously insulin sensitive, then when you eat a high glycemic index food, your blood glucose does not spike, absolutely does not spike. One other thing that I also want to say about the glycemic index and I think is slightly deceiving is that, the glycemic index is basically a measurement of how quickly an individual food metabolizes to glucose inside of your blood. So white potatoes as an example have a higher glycemic index and then does beet-

Dr. Weitz:                          Sweet potato.

Dr. Khambatta:                 Or a sweet potato. Now, when you put a meal together, generally speaking, you’re probably not eating just one food in isolation. Some people might do that, but if you’re putting together a meal, you might have a little bit of salmon, you might have some white potatoes, you might have some broccoli, you might have some wild rice in there. So the glycemic index of each one of these foods matters.  And then when you actually eat the meal together, you’re getting a combination of glycemic indexes, which is going to slow down the rate of absorption of all material that comes from that food.  So the glycemic index is important in isolated situations when you’re living with insulin resistance or when you’re only eating one food at a time.  And the glycemic index is also something that you can change literally, by changing the way you cook a food or by changing the temperature at which it’s served.  So it’s a helpful indicator, but it’s also slightly not that helpful.

Dr. Weitz:                          Right. For example, if you were to cook those white potatoes and then you were to eat them cold, you get an increase in the resistant starch.

Dr. Khambatta:                 That’s exactly right. So the glycemic index then gets lowered as a result of that, even though it’s still the same white potato.

Dr. Weitz:                          Is that something that you employ in some of your strategies?

Dr. Khambatta:                 What? To lower the glycemic index in particular of a certain foods?

Dr. Weitz:                          Yeah. Using say, resistant starches or, you know.

Dr. Khambatta:                 We don’t directly employ that because we don’t necessarily find that it’s necessary. So we are a huge fan of resistant starch because resistant starches, very helpful at blunting of glycemic response, no questions asked. But people can get resistant starch also from eating slightly unripe bananas, they can get it from. Tell me, what other foods are high in resistant starch that you know of?

Dr. Weitz:                          Jerusalem artichoke.

Dr. Khambatta:                 Yup. I think certain types of beans are also high in resistant starch if I’m not mistaken.

Dr. Weitz:                          I think so.

Dr. Khambatta:                 Yeah. So they’re helpful for sure.

Dr. Weitz:                          And then we got the fiber. That’s another big factor in this whole release of carbohydrates, right?

Dr. Khambatta:                 Exactly right.

Dr. Weitz:                          If you talk about whole food, whole grains, you’re talking about foods that are higher in fiber.

Dr. Khambatta:                 Absolutely. Fiber is such an important molecule for a bazillion reasons, but at the upper end of your digestive system, the presence of fiber slows down the rate at which glucose enters your blood. So it blunts your glycemic curve after you eat a meal. By the time fiber gets into your large intestine and then becomes a food for your microbiome, your microbiome can secrete cellulase, break it down into cellulose, and as a result of that… Sorry, break down the cellulose into glucose, and as a result of that, they can metabolize those glucose units and use them to create short chain fatty acids like butyrate, which is going to help not only your small intestine, but other tissues as well.  And then also fiber tends to block your stool, which is a good thing. So yes, fiber is a magical molecule in 1,000 different ways. And again, when you’re eating a plant-based diet, especially if it’s coming from whole foods, then you can dramatically increase your fiber intake without even trying.

Dr. Weitz:                            So insulin resistance seems to be a very complicated and confusing concept when you really get into it. I read several recent papers and it seems like even the top researchers are a little confused about exactly what results or how it results in changes in insulin resistance.

Dr. Khambatta:                 Yes. So over the course of time, insulin resistance has become a more complex topic than I think, even researchers had once believed it to be. And so as a collection of medical professionals, I think the answer is, we don’t know everything that contributes to insulin resistance, but we absolutely do know certain components of food and certain nutrients that are more influential in creating insulin resistance. And we know certain types of nutrients can also reverse insulin resistance at the same time. So if you really look at the types of… What we’re trying to understand here is very simple. Are there specific components of your food that block the action of insulin? That’s what it boils down to.

So are there certain nutrients that you can find in either animal-based foods or plant-based foods or both that when you eat them, the action of insulin is decreased? And if the answer is yes, then those foods are going to contribute to the development of insulin resistance because insulin resistance is at its core, a reduction in insulin signaling and an inability or reduced ability of insulin to do its job. So the question really becomes, well, what nutrients in food are impairing the insulin signaling pathway inside of your muscle and out of your liver. Now, there’s been investigations as far back as 1920s to try and answer this question, and they’re still ongoing today.

And what many of these investigations have found is that, lipids as a general class of molecules are definitely, they can impair insulin signal. So lipids refer to like fat rich molecules, but not necessarily all fat rich molecules are going to impair insulin signal. The most problematic are saturated fatty acids. Now, what ends up happening is that when you eat a food that’s rich in saturated fatty acids, the saturated fatty acids, they can get inside of your liver and they can get inside of your muscle and they can directly slow down the action of insulin inside of those exact cells. So there’s a whole collection of intracellular mechanisms that are initiated when cells uptake saturated fatty acids, and that leads to insulin receptors that are less functional than they were before the saturated fatty acids came in.

So if you have a meal, there’s just some, actually some phenomenal research here that’s been done in Type 1 diabetes in the last couple of years, that takes individuals and they feed them either a meal that’s high in saturated fatty acids or a meal that’s high in protein or a meal that’s high both. And what they find is that over the course of the next three to five hours, insulin signaling is impaired dramatically. And as a result of that, people with Type 1 diabetes who eat either a fat-rich meal or a protein-rich meal or both end up with an increasing need for insulin as much as 65% increased need for insulin over the course of the next five hours.  And that is an indicator again, that saturated fat as one type of molecule can impair the insulin signaling pathway and can alter the biology of your liver and muscle to make it such that those tissues have a difficult time responding to insulin.

Dr. Weitz:                            Do you recommend eating the same types of foods throughout the day or do you recommend for example, eating say, less starchy carbohydrates at night, or maybe more fats, having nuts or things like that?

Dr. Khambatta:                 We have found that over the course of time, that eating certain types of foods at certain times of the day can be very helpful at controlling your blood glucose. So I’ll start out with the morning. In the morning hours, we recommend eating a fruit-centric meal, for a number of reasons. Number one, fruit-centric meals at the beginning of the day, can actually… It’s easy to prepare for breakfast, they don’t require much preparation from like a logistical stand-

Dr. Weitz:                         What would a fruit-centric meal look like?

Dr. Khambatta:                 Suppose I were to put together a fruit bowl that contains two bananas and one mango. That’s it. Two bananas and one mango, or it could be two bananas, one mango with a tablespoon of flax seed drip on top of it. Very simple. If you were to eat that in the morning hours, what we find is that number one, it keeps your blood glucose nice and controlled. Again, assuming that your overall diet has made you insulin sensitive to begin with, and if you are insulin sensitive, then metabolizing that fruit rich meal is very simple. Number two, it keeps you full for two to three hour period until lunch rolls around.

And number three, we also recommend people to exercise in the morning hours, if they can make that happen because it’s a simple way to get your day started and it makes sure that you do it. And so having fruit bracketed with your exercise either before, during or after, is something that’s very helpful at giving you a ton of energy so that you can actually go perform exercise.

Dr. Weitz:                          Do you recommend eating the fruit and then exercise or vice versa?

Dr. Khambatta:                 It’s a personal choice at that point. It depends on the type of diabetes you’re living with, to be quite honest. For people living with Type 1 diabetes, we absolutely recommend eating something before you exercise, and then giving yourself like under-dosing on insulin just a little bit, to have a little-

Dr. Weitz:                          Yeah. You don’t want to take a chance of hypoglycemia.

Dr. Khambatta:                 Exactly, right. For people living with Type 2 diabetes, they have a choice. If they want to eat breakfast before they exercise, go for it, if they don’t want to eat before exercise, they can exercise in the fastest state, it’s no problem. Now, some people choose not to have a fruit-centric breakfast and they instead want to eat something that’s a little more savory. So in that situation we recommend having something that’s containing either beans or quinoa or some rice and some vegetables. So if they want to go for a more savory dish, totally fine as well, both of them are going to give you a good glycemic response.  Then when it comes to lunchtime, lunchtime is our favorite meal for increasing the intake of starchy carbohydrates.

Dr. Weitz:                          It’s interesting. I would say, the most calming carbohydrate-centric meal, you hear people eat is oatmeal with fruit.

Dr. Khambatta:                 Yeah. Oatmeal with fruit, that’s a great example. You can absolutely eat oatmeal with fruit. We’ve got no problems with that.

Dr. Weitz:                          Okay.

Dr. Khambatta:                 How was that? So when lunch rolls around, that’s your opportunity to eat slightly more starchy carbohydrates. So we recommend eating, you can either eat potatoes or squash, you can have some corn at that meal, you can have some more fruits at that meal if you want. You can even eat some whole grains at that meal as well. And we find that people who do that in the middle of the afternoon or for lunchtime are able to keep themselves full for a three to four to five hour period until dinner rolls around, which prevents them from overeating and trying to eat more refined carbohydrates. And their blood glucose response is actually because starchy carbohydrates slow down the glucose response and not necessarily get you a high blood glucose size, it takes time for that to unfold.

So if you put the starchy meal in the middle of the day, then over the course of three to four or five hours or so, you get a nice distribution of glucose coming into your blood, feeding your brain properly and keeping you energized. Then by the time dinner rolls around, we actually recommend eating things that are more what I would consider to be fluffy. When I say fluffy, I mean, more green leafy vegetables, more mushrooms, more non-starchy vegetables. And then having some legumes as well. At that time of the day, we don’t necessarily recommend starchy vegetables, because we find the people who’d start your vegetables in the evening hours sometimes can find their blood glucose to go high and/or stay high in the middle of the night, and then that can be problematic and it can drive your A1c value higher.  So it’s like fruit and/or whole grains in the morning, starch and whole grains in the middle of the day, and then more vegetables and fluffy material towards the end of the day. It’s a simple way to think about it.

Dr. Weitz:                          Are there nutritional supplements that can help patients with diabetes?

Dr. Khambatta:                 Nutritional supplements that can help patients with diabetes?

Dr. Weitz:                          Are you not a supplement guy?

Dr. Khambatta:                 No, not a huge supplement guy. Truth be told, we sell a tea, it’s considered a supplement, I guess you’d call it, and it’s made of this stuff called amla, which is Indian gooseberries, and Indian gooseberries have tremendous anti-diabetic properties. And so that’s something that we encourage people to incorporate into their diet as well. So ours is called Amla Green because it’s basically amla berries mixed with green tea. But it’s not required by any stretch of imagination, so something that’s very helpful.

Dr. Weitz:                          What about herbs like cinnamon or berberine?

Dr. Khambatta:                 Yeah, for sure. There’s plenty of anti-diabetic medicinal herbs. So there’s cinnamon, which is like controversial as to whether it actually helps blood glucose management, then there’s berberine, then there’s fenugreek, then there’s gymnema sylvestre, then there’s bitter melon. And we love all of these things. Sometimes they can be hard to find. And so again, if people want to incorporate them into their diet, green light, absolutely love them, but they’re not necessarily required, it’s not necessarily a core component of the natural managing diabetes approach.

Dr. Weitz:                          What is the best type, amount and frequency of exercise for patients with diabetes?

Dr. Khambatta:                 Okay. 30 minutes per day, six days a week. And when I, when I want you to exercise, I’m asking you to do a couple of things. Number one, I want you to get a good distribution of cardiovascular movement versus resistance movement. So when I say that, it’s hard to put specific numbers on it, but if I were to tell you to distribute your activity between approximately 50% cardiovascular movements and 50% resistance movements, that makes sure that your cardiovascular system is in check and that makes sure that you’re also putting a significant stress on your muscles to keep your bones strong over the course of time.

Dr. Weitz:                          Is it okay to do an hour of exercise a day?

Dr. Khambatta:                 For sure. 30 minutes minimum. Absolutely. Sorry, didn’t mean to confuse. 30 minutes minimum, no question. And then I also want to make sure when you’re exercising, that you’re exercising significantly hard enough and fast enough that you cannot talk to someone else, that you cannot answer a phone call and that you cannot sing your favorite song.

Dr. Weitz:                            Some level of intensity.

Dr. Khambatta:                 Exactly right. What types of recommendations do you have in general for exercise?

Dr. Weitz:                            I like to seem amount and frequency. I think it’s best for diabetics to exercise every day as you just mentioned. I think seven days a week if possible to help regulate your sugar and your insulin in accordance with your exercise. I think resistance training and cardiovascular exercise are equally important as well as incorporating some stretching and balance training even though those are not necessarily for blood sugar control, they’re still beneficial for health.

Dr. Khambatta:                 No doubt. 100%. And exercises is… I think in this world of nutrition, we’d like to talk about food a lot of the time. And I’m actually glad you brought up the exercise topic because exercises is something that is, it’s such a powerful insulin sensitizer. It’s hard to put into words, exercise has so many tremendous benefits, not only for your glucose metabolism but also for your brain, for your bones, for your connective tissue, for your muscles. It can improve the health of your thyroid gland, it can improve your mental health. It’s endless what exercise can do. And teaching people how to move their body on a daily basis is something that I think can become very addicting and something that we are huge proponents of.

Dr. Weitz:                         What about the effects of stress on blood glucose?

Dr. Khambatta:                 Yeah. Stress can be a doozy on your blood glucose. When you get stressed either like in a traumatic situation or whether there’s some baseline chronic stress, that can increase your cortisol levels as one type of hormone. And that cortisol can go signal to your liver and it can basically, it can significantly impaired glucose metabolism. And as a result of that, if you’re living in a high stress environment and that’s chronic, blood glucose can absolutely go up and it can make it such that your medication requirements can increase. And simply by, just like you’re saying, literally stretching your body, taking a mindful practice, relaxing, going outside and going for a walk, these are all simple things you can do that have a physiological effect on your blood glucose level.

Dr. Weitz:                         Yeah. If you’re having trouble with that morning fasting glucose number and it’s higher than it seems like it should be based on their diet and everything else, definitely look at stress

Dr. Khambatta:                 For sure. No questions asked.

Dr. Weitz:                          Do you ever address adrenal function or measure adrenal function as a way to look at salivary cortisol levels?

Dr. Khambatta:                 No, actually we don’t. Feel free to educate me on that. I’d love to learn a little bit more.

Dr. Weitz:                          You can measure your cortisol levels through the saliva and you can just spit into little tubes and you can measure them multiple times a day. What’s common is a four-part cortisol test. And now we have the cortisol awakening response where you’re actually measuring your cortisol as soon as you wake up and then 30 minutes later after you get out of bed, and then three other times during the day. And then you plot it out, you get a plot as to what happens with your cortisol curve.

Dr. Khambatta:                 That’s phenomenal. And where can you get these cortisol kits from?

Dr. Weitz:                          Oh, there’s a number of companies. Genova is a common popular company that people use. Great Plain labs, Dutch Lab testing, but-

Dr. Khambatta:                 Very cool. Yeah, I think that’s actually a very important component of monitoring your diabetes health because, even if you don’t have diabetes we live in the modern environment, which we live in, it’s stressful.

Dr. Weitz:                          Yeah, absolutely.

Dr. Khambatta:                 Whether you’re sitting in traffic, whether your internet connection went down, whether your phone is working, whether your boss is breathing down your neck, these are all mildly stressful enough. And when they count down one on top of the other, before you know it, you now are living in a state where you’re like, “I’m exercising, but how come my chronic disease went up? How come my hypertension is gone high? How come my cholesterol’s gone high?” And sometimes the answer is stress.

Dr. Weitz:                          Chronically high cortisol levels, or you can reach a point of burnout and then you have chronically low cortisol levels. A cortisol flat line is correlated with the worst prognosis for cancer and other chronic diseases. So, those are important. Yeah. And then of course we have sleep.

Dr. Khambatta:                 Sleep, sleep, sleep, sleep, sleep, sleep. Yes. There’s this interesting statistic that losing one night of sleep… I’m sure you’ve heard this. It says something like losing one night of sleep puts you at the functional equivalence of somebody who’s had, I think it’s like four beers. So if you don’t get sleep one day and then you go try to drive a car in the next morning to go to work, you’re effectively driving with the same level of mental capacity as if you had four beers. As far as diabetes is concerned, losing even one night of sleep, it has a dramatic effect on insulin resistance in the next morning. You can measure it.

You can actually see how your blood glucose levels are rising and how insulin has become less effective. So imagine if you’re in a position where you’ve become an insomniac or maybe you’re not sleeping enough or maybe the quality of your sleep has gone down. You’re doing everything else, you’re getting a plant-based diet, you’re exercising frequently, you’re doing a mindful practice, but yet you’re not sleeping properly. That unto itself can cause blood glucose to go up and it can frustrate you.

So addressing sleep is something that’s absolutely important and there’s many specific techniques that you can utilize to try and get yourself to go to sleep and stay asleep. And that’s something that’s there’s this research actually that’s actually linking sleep deprivation over the course of many years to cognitive decline, so increased risk for Alzheimer’s and dementia.

Dr. Weitz:                          Absolutely.

Dr. Khambatta:                 Right. And so sleep has profound effects not only for diabetes but also just for your brain health, for your heart health, for kidney health, you name it. All of these tissues require sleep in order to fully function at their optimal.

Dr. Weitz:                          Absolutely. Just as important as unregulated blood sugar is for brain health and Alzheimer’s risk.

Dr. Khambatta:                 Absolutely. And type three diabetes, no question.

Dr. Weitz:                          Right. Good. Okay. Any final thoughts for our viewers, listeners?

Dr. Khambatta:                 Yeah, I would say in this world of nutrition, it’s easy to get caught in between different ideologies. One nutrition expert can say go eat a ketogenic diet, the other nutrition, “Oh, I listened to that guy, he told me a plant-based diet. Oh, I listened to that guy who told me to eat a paleo diet.”

Dr. Weitz:                          No, I mean, we are so polarized in the nutrition world, it’s kind of like our politics. You’ve got carnivore diet and then you’ve got the complete opposite.

Dr. Khambatta:                 Exactly right.

Dr. Weitz:                          Yes. More information and people are more confused than ever.

Dr. Khambatta:                 Than ever before. Exactly right. So the thing that I like to focus on is, rather than like spending your time getting frustrated by the differences, try and find the commonalities because there are some serious commonalities that I think unite every single health professional or most health professionals, and those are the commonalities that are really important. So just like you said, number one, sleep. Please go to sleep, stay asleep and improve the quality of your sleep. Number two, move your body. Please move your body on a daily basis.  Number three, do whatever you can to minimize your stress levels because chronic stress is a real doozy and it can increase your level of chronic disease. Everybody’s going to agree on this. Number four, vegetables are good for you. Everybody would agree that eating vegetables is good for you. Eating vegetables isn’t sexy. People aren’t like, “Oh, I can’t wait to go home and eat lettuce and broccoli.” Right?

Dr. Weitz:                          Yeah. Not everybody’s going to agree quite as much on unlimited fruit, but definitely vegetables.

Dr. Khambatta:                 That’s exactly right. People will not agree on unlimited fruit, that’s what we have seen and the research that we’re privy to. And our results show that it’s not about unlimited fruit, but about fruit is not your enemy. Right? And so increasing the quantity of fruit in your diet is something that can be tremendously beneficial for many tissues in your body, and it can help you control and reverse insulin resistance. And then another thing that we would all agree upon-

Dr. Weitz:                          And you also don’t think it matters if you… because you mentioned having bananas, it doesn’t matter if you have berries versus bananas versus grapefruit.

Dr. Khambatta:                 Yeah, it does not matter what type of fruit you eat. And there’s this common misconception that like bananas as an example are a high-glycemic fruit. Bananas are actually not a high-glycemic fruit. Just as one example, bananas are actually medium glycemic. There’s only really one fruit that’s high glycemic, and that’s a watermelon. All the other fruits, pawpaw, mangoes, strawberries, peaches, pears, plums, nectarines, you name it, those are all medium to low-glycemic even though-

Dr. Weitz:                          Part of it depends on how ripe they are.

Dr. Khambatta:                 Even in the ripest state, a banana as an example, a ripe banana is not technically considered a high-glycemic food, which is crazy because if you look at its placement on the glycemic index, you’ll actually find that it’s in the medium category. But point being is that no, we don’t differentiate between the types of fruits because again, your ability to eat fruit is dependent on if you are eating an insulin sensitive diet, an insulin sensitizing diet. But to get back to what I was saying, one thing that we all agree upon as well is that packaged and processed refined foods, there’s not a single health professional that I know that’s saying go eat more refined foods.  You would agree, I would agree, every single health professional says, “Okay, fine, let’s eat more natural foods because that’s actually going to improve your overall health.” And then another thing that we would agree upon, this could be the final one is that there are many ways to eat to reduce your dependence on pharmaceutical medications. And the goal is not to eat a diet that enables you to take a pill to live, instead, we as a community of healthcare professionals, regardless of our ideology, are trying to help you use food as a substitute for pharmaceutical medication.

And if you approach food from that perspective, then I think you’re going to be pleasantly surprised by what you find and that whether you’re going high fat, low fat, high carb, low carb, high fiber, low fiber, like you can experiment around to find something that feels good for you and it gets you good results. But the goal is to try and minimize your dependence on pharmaceutical medications and live as free of pharmaceutical medications as possible, and do it in a way where you’re eating real food as much as possible, and that’s going to have lasting, lasting benefits for every single tissue in your body.

Dr. Weitz:                          Awesome. How can our viewers find out about you and your programs and your book?

Dr. Khambatta:                 Cool. Thank you for asking that question. We wrote this book, Mastering Diabetes, hopefully you can see it on the screen here. And so this book basically is 400 pages long with 800 scientific references inside of it. And we’ve scoured the literature to really understand what is insulin resistance, and how can you wrap your head around it. And it also has a go-to manual for exactly what you can do today to start improving your health and become the most insulin sensitive that you’ve ever been.  You can get it on Amazon, you can get it on Barnes and Noble, you can preorder it right now. It’s going to go live on February 18th.

Dr. Weitz:                          I’ll make sure to put a link in the show notes.

Dr. Khambatta:                 Thank you. Thank you for doing that. And then if you’re also looking for more information, we have a coaching program for people with all forms of diabetes, go to masteringdiabetes.org. You can learn about it there and you can see if this approach is something that resonates with you. And we have tremendous success with our clients and we’d love to be able to help you out if diabetes is something that you’re dealing with.

Dr. Weitz:                          Awesome. Thank you.

Dr. Khambatta:                 Thank you.