Doctor's Note

What does “gum up the insulin receptor pathway” mean? See the prequel video: What Causes Insulin Resistance? And the sequel, Lipotoxicity: How Saturated Fat Raises Blood Sugar, goes into the types of fat and their effects.

The fat leaking into our bloodstream may also contain fat-soluble pollutants that accumulated from our diet: Pollutants in Salmon and Our Own Fat        

The spillover effect may also help explain the increased heart disease risk associated with obesity: Low Carb Diets and Coronary Blood Flow.       

If you haven't yet, you can subscribe to my videos for free by clicking here.

To post comments or questions into our discussion board, first log into Disqus with your account or with one of the accepted social media logins. Click on Login to choose a login method. Click here for help.

  • Arjan den Hollander.

    Never heard of the spillover effect. Sounds like a detoxing mechanism if you combine it with the bile cycle.

    • largelytrue

      Let us know when/if you’ve watched the video or read the transcript.

      • Arjan den Hollander.

        Bucket 1 is still spilling isn’t it?

        • largelytrue

          “Energy balance” by definition means that some fat will come out of the fat cells over the course of time: exactly as much as goes in, in fact. This isn’t necessarily the poorly-regulated ‘spilling’ that you see in Bucket 2.

          • Arjan den Hollander.

            So tell us the story of fat soluble pollutants and their fate please.

          • largelytrue

            You first. What’s the problem that you are identifying with the accumulation of pollutants in fat tissue? Do the fat cells suddenly get sick and burst when the levels of pollutants are too high, or what?

          • Arjan den Hollander.

            I’m going to watch a movie or something, have a pleasant evening.

          • largelytrue

            Heh. I’m just looking for a good way to say that I’m not offended; that I understand about the difficulty of managing trains; and that taking a break and coming to a different conclusion is the sort of courage that the world needs, especially in people who take the time to advocate for what they believe to be right.

          • Arjan den Hollander.

            Why thank dear Sir, for this most generous of compliments!
            Please allow me to return in kind, I am much obliged for your magnanimity.
            I bid you a good night, it was a pleasure!
            (male curtsey ;)

          • HereHere

            I think your question is regarding fat-soluble pollutants, like PCBs. Would the spillout effect help the body rid itself of any fat-soluble pollutants we have acquired over our lifetimes? My thought is, the fat cells would need some sort of transport mechanism to get the pollutant out of its cells. Vitamin D is also fat-soluble, and can get depleted, but can other toxins get transported out of the fat cell? I think it may depend on many factors, including the shape of the pollutant. Looking at whales, their blubber has high levels of PCBs, sometimes at such high levels that their bodies are considered hazardous waste when they die. They are bio-accumulating these toxins by eating fish, which also bio-accumulate. I am not an expert in this area of toxin accumulation in fat cells, so I can only speculate whether a detoxifying process exists in humans. In the absence of this knowledge, prevention would seem a logical place to start. I would also wonder if the free fatty acids might be containing toxins, and if so, whether these are absorbed into the muscle cells.

          • Dane Rogers

            Hello, let me jump in here with some personal data. Several years ago,
            at age 51 and overweight at 235 lbs, I learned a method of juice fasting
            – about 400 calories per day of fruit and vegetable juice along with a
            home made vegetable broth. My first fast I went for 68 days!
            Seriously, it wasn’t that hard just very boring. Essentially it was a
            high fat diet (living on appetite suppressing keytones) consuming my own
            stored fat – and what ever accumulated fat soluble chemicals they
            held. About two weeks into the fast I developed a rash across my back
            and shoulders that eventually became painful like a bad sunburn. This
            rash gradually subsided and by the end of the fast it had mostly cleared
            up. I didn’t think a great deal about it until I repeated the fast a
            year later (yes, I’m a slow learner and regained most of the weight I
            had lost by returning to using dairy and oils.) But during the second
            fast, again dropping around 50 pounds of body fat, but that time, there
            was NO rash – none at all as my skin stayed perfectly normal. In
            hindsight, I decided that the rash during the first fast was caused by
            the life time accumulation of fat soluble chemicals being released to my
            bloodstream and being expelled via my skin. Even though I regained the
            weight, it was over a shorter period and accumulated less fat soluble
            chemicals, so the second fast my skin stayed clear. Actually, I
            repeated that cycle several times (very slow learner) and my skin always
            stayed clear on subsequent fasts. Only the first one resulted in the
            bad rash. I noticed no other side effects of shedding those chemicals –
            at least none I was aware of. Yes, it was a “toxic load” but not
            nearly as serious a fear as people describe. I don’t know what harm
            those “toxins” might have done had the remained, if any, but I’m glad
            they are gone. I will note that I’ve consumed a pretty clean and
            sometimes organic diet for the latter half of my adult life prior to the
            fast. A different diet with more fat laden foods might be considerably
            worse. I’m convinced that the only valid way to remove these chemicals
            is to consume and metabolize all ones body fat. Without causing the
            fat cells to release ALL their stored fat, I doubt the chemicals would
            ever come out – regardless of how much one spends for “detoxing”
            products or procedures. Simple message – if you want to lose fat
            soluble chemicals, lose the fat.

          • James Kantor

            So what are you doing now now to regain the weight? Have you ever thought using a smart phone app like Lose it, or my fitness pal?

          • Dane Rogers

            James, Luckily I learned to give up dairy and oil several years ago and no longer regain the weight. 100% whole food starch centered diet as described by Dr. John McDougall – did the trick for me.

          • James Kantor

            So no flax seed oil or olive oil either? So what would a typical lunch or dinner look like for you. Thanks

          • Dane Rogers

            I started today with a large (170g dry weight) bowl of oatmeal with maybe 15 to 20g of lightly ground flax seeds, and soymilk. Lunch was a large plate of shredded red and green cabbage with a homemade dressing, a couple of carrots, followed by an apple then a few raisins. Yesterday, I made a large batch of an FOK recipe – Spinach-Potato Tacos ( We will have that filling again tonight with home made corn tortillas. I’ll probably have frozen blueberries with soymilk for desert. I tend to eat very starch centered meals for breakfast and dinner, and concentrate on vegetables for lunch. I never use any extracted oils. All the essential fats I need are right there in the food.

  • Sheamarsh

    Can eating sugary foods result in these sugars being turned into fat in the bloodstream, even in the absence of eating fatty foods? I think i’ve read that some junk food carbs that are void of fat actually create a fatty profile in the blood. True?

    • Darryl

      Yes. De novo lipogenesis occurs in the liver and fat tissue, producing some of the more hazardous fatty acids (for insulin resistance) like palmitate and stearate. However, avoiding both dietary saturated fats and obesity may offer results like this.

      • Sheamarsh

        Can improper or faulty digestion of FODMAP fruits and other carbs, if in eaten in too large quantity, create lipogenesis?

        • Darryl

          On the contrary, some FODMAPS like inulin have been investigated for potential benefits in preventing high-fat diet induced diabetes and associated inflammation (1, 2, 3, 4, 5, 6), primarily through their role as prebiotics. FODMAP content may account for some benefits of whole grains and some vegetables in reducing diabetes risk.

      • G-man

        While you absolutely correct about Vegetarians having lower risk of Diabetes compared to Nonvegans but there risk is still higher than Vegans.In India where majority of population is Vegetarian the incidence of diabetes is still rising rapidly because of high intake dairy products especially butter and ghee

      • BruK

        What about the high-fructose-corn-syrup many of us have been eating for years … is there a different more dangerous type of fat involved in the digestion of HFCS? Or the different types of fat, i.e. hydrogenated or trans-fats? I seem to recall Dr. Lustig talking about the different routes different sugars take in the body to be digested?

        • Sean

          re: HFCS; Thats only a problem in America, most of the rest of the world consume only a fraction of the amount Americans consume.

          • BruK

            Thanks for writing all Americans off. That is a typical Internet thoughtless comment.

          • Wolfenstein

            No one writes anyone off. Simply, food companies in USA tend to use high fructose corn syrup. For example here in Europe many companies use fructose glucose syrup instead and even classic sugar (from beets)

        • Micheline

          In some recent studies, it was shown that it’s not high fructose corn syrup that causes obesity but just the excess amount of sugar we consume throughout the day. Unfortunately, any type of sugar is digested the same way and absorbed the same way in the liver. This causes the storage of fat in our bodies. We can’t particularly blame HFCS even though it is so prevalent in food products.

    • Micheline

      Yes. Your body converts any excess sugar to fat in the liver. This is also why non-alcoholic fatty liver disease is on the rise. Many people eat so much sugar, the liver doesn’t know what to do with it and causes excess storage of the fat in the tissues and organs of our body.

  • Ignatius Turchi

    there was no mention of the types of fat. So should I stop taking fish oil? Should I stop eating coconut oil? Dr. Atkins is turning over in his grave.

    • Mark G

      There are a number off videos here that reference the high saturated fat content of coconut butter and that it should not be eaten. You can search it within this site and you’ll get a good selection of info. But the short answer is, put it in the garbage, not in your mouth.

      • Daniel Wagle

        I have heard that coconut oil and cocoa butter, even though they are both high in saturated fat, could be good on one’s skin or face. So maybe instead of eating these, just put them on our skin. I have used cocoa butter as a hand moisturizer for years.

        • Mark G

          I’ve thought of using it for that but read that any natural oils on the skin creates an environment for bad bacteria to grow. What’s been your experience?

          • Pete

            I’ve had very positive effects with coconut oil and matcha green tea power. Google green tea coconut oil. I used matcha tea since it was the highest antioxidant until Greger posted the video on Hibiscus. I microwave the coconut oil until it starts to melt. Then I stir in matcha green tea powder. When it cools, it’s like a bar of soap. I use it on my face and hand when I get out of the shower.

          • Daniel Wagle

            I looked at that site you link and it did seem a bit paleolithic, as it denies the lipid hypothesis. Actually, I got the idea of using coconut oil on skin or hair because of what a coworker of Neal Barnard stated in a comment on Huffington Post. And she actually got the idea from Caldwell Esselstyn!!! I have hardly ever used coconut oil in any way, but cocoa butter as a hand moisturizer for years.

          • Thea

            Mark G: I can’t speak to the concept of oils on skin creating an environment for bad bacteria to grow from scientific perspective. But I can share that lots of people use a combination of coconut oil and baking soda as a natural deodorant. I can say from personal experience that it works pretty good. In other words, it seems to do a pretty good job of preventing stinky bacteria from growing. I’m thinking that “stinky bacteria” is not what you were referring to when you said “bad”. However, I would think that if the oil allowed “bad” bacteria to grow that people would be reporting problems with using this natural deodorant, and I haven’t heard anything like that. Again, it’s not scientific, but it gives you something to think about.

          • Brigitte

            Hi Thea!Maybe it’s due to the stong effect of baking soda against “smelling bacteria”.
            Personnally, I use baking soda alone. A pinch under the moist armpit after the shower, ( both sides!) and that’s it- no need of oil!

          • Thea

            Brigitte: I think you are right in terms of the main active ingredient. On the other hand, I have heard that coconut oil has some anti-bacterial properties. If true, then the coconut oil might play a small part in addition to the baking soda. Just a thought.

            That’s very interesting how you go straight for the baking soda. Thanks for sharing.

          • Just like Charzie said I also find the use of coconut oil as a skin moisturiser (body, face and hair) excellent. I’ve been using it for years now and love it.

            I’ve also used it as a nappy/diaper cream instead of the standard mineral based ones for my three children and it’s worked brilliantly. Only when they are teething have we had to resort to a “stronger” non-mineral based one that has zinc in it and some natural herbal extracts to aid healing and enhance the barrier protection.

            My wife doesn’t use the coconut oil herself though as she’s not overly keen on the smell (personally I love it) and also I think ladies would need to use it more sparingly on the face as it can give an oily/shiny appearance which is an undesirable look to have so I am informed.

            I also use it as a sunscreen and it works well. Only if I am out for a long time in the summer and at peak sun strength would I use specific sunscreen. But then I do live in Northern Ireland, UK, so hot sunny days are sadly quite rare lol.

          • jj

            I am extremely sensitive to odors (migraines) but need to use coconut oil on my cats skin issues and mine. Found a brand “refined from the meat of mature coconuts so there is no coconut flavor or aroma”. It works for me.

        • Charzie

          I have had lots of issues in the past with commercial moisturizers that cause me to have breakouts on my face. Even as I need some moisturizing of my (unwelcome geriatric 62 y o) complexion, the tradeoff wasn’t worth it. I heard about some positive results with coconut oil from a few sources and gave it a try, and was very pleased! No breakouts either! What people seem to forget is the moisture for your skin does NOT come from the oil, it comes from plain old WATER! You have to hydrate your skin well first, (both internally and externally!) and then apply the oil to form a barrier to prevent that water from evaporating. Best to apply the oil straight out of a hot shower, but some people either splash water on their face and wait a few for it to hydrate, lean over a light steam source, or just incorporate the water into the oil like most commercial products do. Living in FL as I do, coconut oil will often become semi-liquid at room temps, so I never try to mix it with water or it will just separate, but maybe it’s the binders in commercial products that cause me issues, who knows? Who cares, simple is better, I have a great solution that works for me!

        • Antinutrient

          You can mix coconut oil with olive oil to get a texture wich is more “lotion like” at room temperature (~20° C) makeing it easier to apply it on the skin – especially in winter time or in places where indoor temperaturs seldom reaches more than ~20° C (like in my native Scandinavia).

          However, I have been wondering about if there might be potential side effects from using coconut oil on your skin since some preliminary studies suggest that fatty acids can be absorbed through the skin:

          (skin absorbtion or skin metabolism might be a cool subject for a video.)

        • Biff

          Thing is Daniel, those oils also cause us to have more skin … even in unsightly places. Daniel very good … oils very bad. Daniel deserves health diet without any refined oils !! ;)

      • VegCoach

        Hey, according to Neal Barnard Coconut oil is good for waxing your car! :)

        • Bruce Cropley

          I have found personally that it helps me to heal mouth ulcers by swishing it around and spitting it out. :)

    • Darryl

      There hasn’t been a human trial, but high coconut oil diets appear to impair insulin sensitivity in rats, (more rats), hamsters, and rabbits.

      • BruK

        >> high coconut oil diets appear to impair insulin sensitivity

        What does that mean?

        • I think he was saying that diets that include a large amount of coconut oil seem to increase insulin resistance. It seems like everyone in my neck of the woods is going all out for cocoanut oil but I’ve never seen any good science on it. Where did this idea come from I wonder?

          • VegCoach

            The coconut oil industry? ;)

          • BruK

            Yeah, coconut oil just magically appears on supermarket shelves, there is not anyone who grows it, processes it, markets it and sells it and tries to think of reasons to tell other people to buy more of it. … none of that.

      • Charzie

        Maybe I should just wait for the next video, but it sounds like the focus will be coconut OIL when my question is about WHOLE coconut, the food. I don’t use free oils as a rule, except for the occasional drops of flavoring oils, so I get any fats from the whole food that they are native to. I have mostly avoided whole coconut because of the associated negative press regarding it’s saturated fat content, (a concept I am still struggling to comprehend satisfactorily), specifically of it’s oil or “milk”, but I can’t find any info here about the WHOLE FOOD. I can’t help thinking that island and/or tropical people would have vanished long ago if eating coconuts as a staple was so unhealthy, (though I get that reproduction, good health, and longevity are related, yet separate, issues). Not that I would ever make it a staple, but I would at least like to be able to use some freshly grated coconut in my nonfat papaya muffins without feeling like I’m nullifying all the health benefits I am working to attain! I would really appreciate any feedback on this because I have so much respect for the knowledge and opinions of this group! TIA!

        • Darryl

          The national dish of Malaysia, and popular in neighboring countries, is nasi lemak, rice cooked in coconut milk. Unfortunately, it impairs endothelial funtion as much as a McDonald’s meal.

          Many oceanic cultures consumed coconut in good cardiovascular health. However, this was usually as part of relatively low fat diets where taro and yams were staples and the lifestyle was strenuous. It seems that substituting coconut fats for other fats within a Western high-fat diet and sedentary lifestyle isn’t a step forward.

          • Charzie

            So I guess if I wanted to grate some coconut into my muffins they should be taro or yam muffins, but I’d need to shimmy up the tall palm tree and snag a coconut and then run to the farm and harvest the taro or yams from the field, run back home with the ingredients … LOL!

        • guest

          I’m an immigrant from southeast Asia. Where I come from coconut is not just a staple; it’s a way of life, a big part of culture. People use every part of the coconut tree for something necessary in life. People consider rice and coconut a gift from God. I’m sure my first meal of solid food contained coconut milk. I’m 56 now and have been consuming coconut products all my life. My coconut consumption has gone down since I moved to the US due to the unavailability of fresh coconut, but I still use coconut milk and oil in cooking regularly. I don’t have heart disease. Coconut hasn’t made me fat either (I could gain 20 lbs and would still be underweight) . By the way, rice cooked in coconut milk Darryl mentioned was my first solid-food meal – it is every baby’s. It’s the center of every celebration.

          • Charzie

            You know, you made me think of a friend I had in high school who came here from Thailand if I’m remembering correctly, it was a long time ago! I loved to go to her family home because there always seemed to be a large bowl of coconut rice available, and it was delicious! They didn’t speak much English but would laugh and giggle at my obvious enjoyment of what they seemed to consider a staple. Her extended family including her great-great grandmother all lived together, and also enjoyed coconut regularly, so it does make me think. Thank you.

          • jj

            I apply whole foods plant based to my choices of foods to ingest. So unsweetened shredded coconut meat is a whole food so where is the problem. Probably in dosage.

          • Charzie

            jj, for better or worse, that is exactly the approach I have come to adopt. I am totally vegan and very basic in using food as it comes from nature, or with minimal processing, as in cooking or fermentation, and vary my selections as much as possible. I am trying not to stress too much over limited and occasional use of “questionable” foods like coconut, especially in context of what is passing as “food” on the plates of most people I know these days. The dramatic improvements in my health and weight speak volumes about why I need to just embrace the big picture and quit worrying about the fine print. (5 years ago I was a 300+ lb diabetic so I’m a bit jumpy sometimes.) And you are certainly on target with the dosage issue, a few tablespoons is certainly a whole different “animal” than a pound!

      • Brigitte

        Thanks Darryl.
        So, let’s apply the precautionary principle!

    • That’s my next video–stay tuned!

    • CRT

      Dr. Atkins went to his grave very over weight and very ill. His diet certainly didn’t work for him. Look at vegan Docs who tell us about heart disease. Fit and thin and well!

    • There is no nutritional need to consume oils of any types for the majority of the population (exceptions including athletes or those who are unable to consume adequate calories for medical or other reasons). In fact, the easiest way to decrease total fat intake is by minimizing or avoiding oils in the diet, since oils are processed, composed of 100 percent pure fat, and contain 120 calories and 14 grams of fat per tablespoon and nearly 2000 calories and 216 grams of fat per cup. Healthy fats include the essential omega-3 and omega-6 fats from sources such as nuts, seeds, and soybeans as well as from monounsaturated fats found in olives and avocados. For more information on types of fats, see Good, Great, Bad, and Killer Fats and these other videos on specific types of fats.

    • Justin Edwards

      Much of the research that the high protein movement leans on is truly misleading. The videos posted below does an incredible job breaking down the information step by step!

    • Sasa

      And again, there is no explanation on types of fat which should not be used. Discussion went to the coconut oil. What about Polyunsaturated/Monounsaturated fats? Should we avoid Nuts, almond… etc? Or “no” is only for Trans and Saturated?

      P.S. I am aware that this discussion happened two years ago, by I will give it a try. Thanks for answers in advance!

    • Sasa

      I asked about types of fat that are safe to be consumed… actually, there is explanation in video named: “Lipotoxicity: How Saturated Fat Raises Blood Sugar” .

      Best regards!

  • Enthusiast

    Am I the only one that spent time trying to figure out what “belly-butter thighs” were?

    • BruK

      Well, what is it?

    • We laughed at the way bellybutterfat rolled of Dr. Greger’s tongue!

  • BruK

    So, does that imply that even a vegan that ate lots of sweet things like fruit, along with say many carbs, and just too much in general could get to be overweight, be spilling fat and then get type-2 diabetes?

    Doesn’t diabetes means sugar in the urine? So, having lots of fat in your blood or whatever other process that happens in your body to keep one from processing sugar would keep that sugar in your system to be excreted in the urine, no?

    Any ideas as to the root cause of high blood pressure?

    • jj

      Primary high blood pressure has no identifiable cause tends to develop gradually over many years. .

      Secondary hypertension, tends to appear suddenly and cause higher blood pressure than does primary hypertension. Various conditions and medications can lead to secondary hypertension, including: Kidney problems; Adrenal gland tumors; Thyroid problems; Certain defects in blood vessels you’re born with (congenital); Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs; Illegal drugs, such as cocaine and amphetamines; Alcohol abuse or chronic alcohol use; Obstructive sleep apnea.

      • BruK

        >> Primary high blood pressure has no identifiable cause tends to develop gradually over many years. .
        I’ve heard that … how can that be .. there must be something out of spec. when these people are studied, or something that changes over time to result in high blood pressure. This really bugs me (not your comment) that I have heard they say there is no reason for HPB.

        One interesting PBS Series I watched called “Unnatural Causes” (which everyone should watch by the way) talked about how the very social positions of people in society can effects on their health, even if they eat the same and live the same. I think they did statistical tests on British Civil Servants to determine this.

        I speculate that really our medical industry does no want people to understand how the social and economic system affects peoples bahavior, lives and health, as well as the amount the government has to spend on them because the people who runs things resist any kind of democratiation process.

        I figure someone knows or has good numbers and a good ideas as to what causes high blood pressure, and it is probably certain kinds of stress, and human beings are very susceptible to stress because our minds can induce stress that other animals might not every consider or be able to think about.

        Dr. Robert Sapolsky’s baboon studies really show this as he followed a baboon troop and took stress hormone samples from them at different times in their lives depending on what was going on.

        • jj

          I think “no identifiable cause” really means it is something they just don’t understand yet.

  • tom

    I understand this column is largely about food and nutrition, but now we’re discussing diabetes could you touch on regular “long exercise” and its effect on insulin resistance?

  • Being fat = bad!
    Got it…

    • tkramer

      I think a diet that encourages around 10% body fat is ideal. Dr. Esselstyn comments that his diet produces body fat of between 9-11% in his patients.

      • I roll around about 15% and feel weak when I get lower.
        When I bloated over 20%, I felt fat and experienced slight health issues. I am thinking about just getting down and holding at around 12% to see what happens over the course of a year.
        Maybe the body adjusts over time.

  • Charzie

    So when I was diabetic and weighed 300 lbs, that is certainly obese! How is it then, that in a matter of weeks on a WFPB diet, my blood sugars were virtually normal, when I had only lost maybe 15 lbs? I would image there would be “tons” of free fat circulating, so how do I conceptualize what was going on there? Anyone?

    • Good basic diet choice. I applaud your efforts. My guess is that your dietary fat and overall macronutrient calories decreased significantly. This likely decreased your bodies need for higher levels of insulin. At the same time your body started to receive the micro-nutrients that it needed to better function. Also, this improvement in blood glucose does not mean that your insulin levels have returned to a normal (healthy) level. They could still be high. Only now your pancreas is able to keep up with the demand.

      For example, a newly diagnosed Type 2 may have 4 times the amount of insulin as a non-diabetic. He had “normal” blood sugars when his body only need 3 times the amount. Now that it needs 4 times it is unable to keep up with the demand.

      Positive changes in diet can quickly decrease the the demand. Our pancreas may still be called upon to produce extra, but now it is enough to keep our sugars closer to a “normal” reading.

      • Charzie

        Thanks for the explanation! Since then (about 5 years ago) I have lost about 150 lbs total and would still like to lose more, but that is another chapter. I know it sounds ridiculous, but I, like many others, “dieted” my way up to that weight by following the standard dietary plan they used to hand out to every “chubby” in the Dr.’s office that told you to eat this not that and count and weigh and measure. Wrong, wrong and wrong. Lose 25, get tired of the unnatural and restrictive patterns and gain back 40, etc etc etc. Add into the mix all the non-food “diet” food that was pushed and you have a bunch of fat, undernourished, guilt-ridden, sick people, wondering what the hell happened! Of course there are also those who just don’t care too, but I think you’d be surprised at how many really do, and just don’t have a clue! I wish I learned how simple and effective WFPB eating was in my twenties instead of my sixties! “Forks over Knives” and the like should be mandatory viewing in every classroom, even just to plant the seed…pun intended. Dr Greger and his colleagues are truly the unsung heroes of the era! Thanks so much for all you do!!!

  • Kristian

    Hey Doc,
    What about Systemic Candida. Whats the best cure.
    I hope you can help.
    Best regards

  • Louis

    One thing I hope someone can shed light on for me: so high fat in the diet causes insulin sensitivity to go down and blood sugar to go up.

    Yet, the diet that is taking South Africa by storm (largely because Dr Tim Noakes of University of Cape Town, Sports Nutrition) — the Banting Diet — which is basically a high fat medium protein low carb plan, causes people with Diabetes Type 2 to have their blood sugar IMPROVE. My sister is one of these and I don’t have much to counter her on because she is living it. She claims to have more energy, her diabetes is getting ‘better’ and she is losing weight.

    Now I am a firm believer in plant based eating instead – and I ALSO have a lot of weight to lose (although I am one of the ‘lucky’ overweight people not to have diabetes) – but I don’t know how to change her mind.

    Anyway, the question is, why DOES high fat ALSO seem to improve blood sugar?

    • Ignatius Turchi

      I have not seen any discussion of the omega-6/omega-3 ratio.

    • (00)

      You already had the answer. “She claims to have more energy, her diabetes is getting ‘better’ and she is losing weight.” Any diet that causes you to lose weight will improve diabetes to some degree. The problem is people can’t lose weight forever, and a diet that avoids carbohydrate (which is an unhealthy diet to begin with) doesn’t really fix the underlying problem of insulin sensitivity/resistance, it just avoids the issue. It’s like if you had a broken toilet and you hired a plumber to fix it, and the plumber claimed to have fixed the toilet but that you also can’t use the toilet anymore because his “fix” is that you just have to poop somewhere else instead. “The toilet won’t bother you anymore as long as you don’t use it. Problem solved.” Likewise, a diet that tries to fix a broken glucose metabolism by having you not eat glucose anymore isn’t a cure, just an unsustainable workaround.

    • Konstantin Efremov

      There is great article on this topic on Dr. McDougall’s site:
      The Banting Diet suppress appetite -> she is eating less calories -> she is losing weight -> her blood sugar improves, cholesterol drops, insulin sensitivity drops too. But these improvements are temporary.

      BTW, Dr. Tim Noakes has Type 2 diabetes and is taking metformin daily to control his blood sugar. He said that he has diabetes because of high carb diet which he followed earlier in life. Not because of his high fat diet for last 10, may be 20 years. :) Probably he should read Dr. Barnards works.

    • Mike

      When you first eat a high fat diet it clogs up up your cells ability to deal with blood sugar using insulin pathway, as described by Dr Greger. However, if you keep on with a high fat low carb diet your body learns to convert fatty acids into ketones, over a few weeks, and use this as fuel instead of glucose. Just like Tim Noakes’ Banting diet. The body can always manufacture all the carbohydrates it requires without having to eat it and your insulin stays low as a result. This means you can “cure” Type 2 Diabetes either way, just choose which you prefer. As to which is best for long term health I think the jury is still out!!

  • cyndishisara

    This has a lot to do with how well our muscle Mitochondria is working to convert fatty acids into energy. Mitchondrial failure to drive the muscle must be looked at as a reality here.

  • alvarowier

    why haven’t the videos been posted to youtube lately?:) thanks for all the great content!

  • DaMali

    When watching this and similar videos, its sounds like diabetes is reversible. I hear different people stating this, but is this marketing for their products/books or is there real evidence. I know of Dr. Bernard’s works, Dr. Fuhrman, and Dr. McDougal, but these people sell their books/products. I think many people would really appreciate clarification on that.

    • 2tsaybow

      I am not a physician and there are volunteers on this site who are probably more qualified to speak to this issue, but my experience says yes you can reverse type 2 diabetes by changing your diet. I switched to a whole food plant based diet in September of last year and my body has been able to process insulin much better since that change. I still take a teaspoon of amla in the morning to keep my blood sugar low, and to gain the other health benefits of the plant, but this way of eating will reverse your type 2 diabetes.
      By the way, I’m still fat. I need to lose 50 pounds and I am losing weight, but very slowly. You don’t have to get thin before you see the benefits of this diet. It took only three days for me to start feeling the difference.

    • Thea

      DaMali: I think it depends on how you define “reversible”. If you define “reversible” as being able to get off type 2 medications and stopping the progression of the disease and where possible, reversing symptoms (it’s not always possible. For example, if you have a foot amputated, a good diet is not going to grow back the foot…) and likely restoring a portion of insulin sensitivity, then it appears that Type 2 is indeed reversible. I can’t speak to Dr. Fuhrman or Dr. McDougall, but Dr. Barnard has done clinical experiments that got published in peer reviewed journals. It doesn’t matter if Dr. Barnard has a book or not. He’s got some pretty good science to back him up. In Dr. Barnard’s case at least, it’s not a matter of just anecdotes.

  • Arjan den Hollander.

    Unrelated but WOW, sometimes watching a TV show does prove useful, I was watching The Blacklist s02e10 0:11:45 in
    and they talk about tet1 gene and its role in erasing trauma/memories.
    Matthew Lattai, associate professor of behavioral neuroscience at Oregon Health and Science University, who was not a part of the study, says the findings could pave the way for treatments for PTSD.

    OMG moment, could there still be hope for a few decades of normal life? On the other hand the U.S. Army will be on top of it and abuse the shit out of it. Mmmmm crap, that’s a Faustian bargain if ever there was one.

  • vegank

    Thank you Dr Greger for also explaining why thin people may end up with the spill over effect or Type 2 diabetes. I’ve been wondering about this for years.
    It made me wonder if this is also why when indigenous people or people who move to western countries and adopt the standard diet often develop type 2 diabetes and or other problems (because their system isn’t used to it or simply can’t deal with it).

  • suepy

    The Counterpoint study gives a demonstration and good analysis of how Type 2 diabetes can be reversed. It is well known that many diabetics undergoing gastric bypass surgery see their Type 2 diabetes reversed within weeks of surgery. This study replicated that effect by restricting their Type 2 diabetics to a very low, 600 calorie diet for 8 weeks with no exercise. Fasting plasma glucose normalized within day 7 of the diet, and within 8 weeks insulin response and secretion were normalized. The study authors hypothesized: “Too much fat within liver and pancreas prevents normal insulin action and prevents normal insulin secretion. Both defects are reversible by substantial weight loss. A crucial point is that individuals have different levels of tolerance of fat within liver and pancreas. Only when a person has more fat than they can cope with does type 2 diabetes develop. In other words, once a person crosses their personal fat threshold, type 2 diabetes develops. Once they successfully lose weight and go below their personal fat threshold, diabetes will disappear. Some people can tolerate a BMI of 40 or more without getting diabetes. Others cannot tolerate a BMI of 22 without diabetes appearing, as their bodies are set to function normally at a BMI of, say 19. This is especially so in people of South Asian ethnicity.”

    • Very interesting and helpful reading, thanks. People with type 2 would benefit from these and possibly the “notes for your Doctor” although I really doubt mine could have been bothered. My GP and Cardiologist both think the wonderful drugs made me healthy enough to become more active and drop the lard. She (my Cardiologist) takes credit but admires me for being a “star patient”. Nice enough people I guess but I don’t miss them much.

      Dr.: “Is that Doctor [Esselstyn] trying to take you off your medication?”
      San Dera Nation: “Well, yeah. I’m hoping that’s the goal!”

      …we still have a ways to go

  • S Ham

    You know the image of the fat belly “spilling over” at the beginning of the video is really offensive and disgusting. Its not productive to use fat shaming and objectification to get a point across about nutrition and healthy eating. The person who’s body is being shown has a face and is in fact a person. They are more than their body. This man may in fact be the father of a happy, loving family and/or maybe a renowned world expert or leader. Of course the message of the video is productive and important, but this image is not. If you are an overweight person coming to this site, is feeling shame about your body the first step to getting healthy? I don’t think so. This image is also damaging to the rest of society. It encourages people to be disgusted by fat. And by showing just part of a body, it encourages us to see overweight people as fat first and people second.

    • jj

      The picture in full screen is very unappealing and not something to have to look at. But there it is everytime one comes to this video.

    • b00mer

      I already upvoted your comment, but feel the need to comment again in agreement. I came here to share the url for this video with someone, and not knowing if the person I’m going to refer to it themselves struggle with body weight, I do wish it had a different screenshot. There is plenty of shame already for an overweight or obese person in this world. They don’t need more shame or objectification, but hope and encouragement. Which this site certainly provides in spades, but in this situation, I feel has missed the mark. It would be great if the image could be changed. How about the buckets figure? I thought that was a nice eye-catching schematic.

      • Joseph Gonzales R.D.

        Forgive me for not seeing this earlier! Let me ask Dr. Greger about changing the picture. I would hate to offend folks who come here for support, as you kindly stated. Thanks, b00mer.

  • Katja Meier

    How does that fit with the finding that patients with bariatric surgery are (nearly immediately) cured from diabetes? They are still morbidly obese and the spillover effect still should cause insuline resistance.

    • largelytrue

      Let me start by pointing you to suepy’s comment, in case you haven’t seen it:

    • suepy

      I can give you my layperson’s understanding of the Counterpoint study and hypothesis, and please, anyone correct me if I misunderstand it. In the fasting state, you’re not consuming any food to be converted to glucose, but your liver is constantly producing glucose in order to keep your body functioning, unless that production is suppressed by insulin, which your pancreas releases in either a small steady amount or a large amount in response to food. When the liver is stuffed with fat (nonalcoholic fatty liver), it becomes insulin resistant and keeps producing glucose and is unresponsive to insulin. Eventually the excess fat spills over to the pancreas, leading to beta cell dysfunction, reaching a trigger level, and causing clinical Type 2 diabetes.

      After a sudden drop in calorie intake, by either gastric bypass surgery or dieting, the body must suddenly draw upon it’s reserves. The liver fat is burned first, before visceral or subcutaneous fat, as shown in the study where liver fat dropped 30% after one week on the hypocaloric diet. After 8 weeks, the liver fat had dropped 80% and pancreatic fat gradually decreased. Since fasting plasma glucose concentration depends entirely on the fasting rate of liver glucose production, that dropped also after one week because the liver was now becoming responsive to insulin. The study authors suggested that the road to Type 2 diabetes starts with muscle insulin resistance, which is the first detectable signal of risk for Type 2 diabetes. In people who are relatively insulin resistant in muscle, and therefore have higher insulin levels, chronic excess calories are more likely to be turned into fat and stored in the liver. This seems to be the mode of operation for the majority of Type 2 diabetics who are consuming more calories or fat than their bodies can handle. For those of us who are lean vegans with impaired glucose metabolism or prediabetes, I wonder if other factors are responsible. We generally don’t have insulin resistance, and losing weight is unfortunately not an option!

      • Arjan den Hollander.

        For those of us who are lean vegans with impaired glucose metabolism or prediabetes, I wonder if other factors are responsible.

        Look into choline, done some reading on that recently and that might be the culprit.

  • Bruce Cropley

    (off topic) I’m curious about quercetin and berberine as treatments for brain cancer, and how to get enough for therapeutic treatment. I’ve read that Goldenseal contains berberine, and many plant based sources (inc. capers) contain Quercetin, but I’m not sure whether I could get enough to be significant through natural sources. TIA :)

    • highest food sources of quercetin (according to US govt database): wild arugula, capers, yellow chili/ancho peppers/ coriander/ dill/ fennel leaves/ kale/juniper/ lovage leaves, dried oregano/ radish leaves/ outer layers onions. Top berry sources: elderberry (you could buy the drops or maybe a dried powder), also some in cranberry, blueberry, goji. Also Black Diamond plums. Or you could purchase a supplement.

  • Guest

    I want to know what percentage of calories from fat was used in the studies mentioned. I can’t find the information in the sources cited. Anyone have any suggestions?

  • DStack

    I want to know what percentage of calories from fat was used as “high-fat” and “low fat” in the studies. I can’t find the info in the sources cited. Any suggestions?

  • justme

    Did I hear that correctly? .. Low carb diet increased fat in the muscles ? at 1:59

    • Lauren Bateman

      Well, Dr. Greger is presenting here that a high saturated fat consumption with low carbohydrates — promotes a spillover effect for inducing diabetes. A whole plant consumption prevents and reverses diabetes, weight falls off, and carbohydrates and fat don’t have to be counted or focused on at all :)

  • Heather Johnstone

    If you have not seen the previous video in this series, ,do take some time to view it, as it will help clarify some of the concepts presented in this video.

  • Martin351

    Spillover in a nut shell:

    – your liver holds about 70 grams of glycogen (carbs)
    – your muscles hold about 1-2% of their volume in glycogen (about 150-220 grams for average male).

    The more muscle you have, the more glycogen they can hold. Either way, it isn’t a lot. If your not burning the glycogen out of your system and continue to eat carbs, you’ll spill over and they’ll be stored as fat. Even if you exercised your butt off and burned out all that glycogen and were about as insulin sensitive as you can get, a simple plate of pasta, potatoe, and some fruit juice will top you up and spill over.

    The problem with the studies the doctor is describing here is the diets of those patients mentioned actually were consuming about 200 grams of whole grains during the study. I know the study he is talking about and it was a vital part left out, the whole grains caused the spill over.

    Put it this way, if researchers were trying to prove that say meat caused brain damage and they followed 100 people, 50 people ate meat and 50 didn’t, then the 50 who ate meat turned out to have brain damage, so the researchers automatically chalked it up to meat. What they failed to mention is that the 50 people who ate meat were also boxers who obviously had been clocked in the head one too many times.

    You see, it’s things like this that need to be mentioned, the actual causing factors.

  • I am very happy eating Vegan and am so thankful for all the information this site provides. However I have one reservation and that is high triglycerides on a Vegan diet. I have never found an answer on this sight.

  • Billy Dee

    So if you are obese and ffa are flooding your bloodstream, how are you suppose to procede? High fat low carb – no , high carb low fat no, Starve yes?

  • chris white

    Curious. I see that in NutritionFacts the promotion of anti animal fat or saturated fat content. When I’ve found sources that counter accusations against saturated fat. Is it more detailed then what I’m seeing or is it really that black and white?
    Wheat Belly by William David M.D.
    Eat The Yolks by Liz Wolfe, NTP

    • Thea

      That Wheat Belly book is a sham and a shame. While the author sites studies, the studies do not often support his claims. Here is one site showing how the science does not back up the claims in Wheat Belly. (And this is from an anti-gluten site!)

      Bottom line is that Wheat Belly is just another form of the Atkins/Paleo/low-carb/Eat For Your Blood Type diet fads. These fads confuse and mislead people, even doctors. It is so sad because it sounds like good science. Thank goodness we have NutritionFacts.

      In addition to this NutritionFacts website, you can learn a lot about the dishonest practices of pro-saturated fat proponents by listening to Plant Positive’s very scholarly work.
      Here is an article covering Time’s recent promotion of saturated fat:
      Here are talks that specifically cover eggs:

      • chris white

        I appreciate what you shared. I looked at your links and what it had to offer. I’m still learning and getting a better understanding taking information on both sides. I wanted to share these links because I thought you’d might like them

        (health care triage The Evidence for Low-Fat Diets Isn’t Really There)

        • Thea

          chris: I’m a big fan of doing some real research to help someone come to a conclusion. In other words, I appreciate and respect what you are trying to do.
          Here’s my 2 cents: Unfortunately, that approach really only works if all sides are being honest. Or if you are able to review and evaluate/find the flaws in the thousands and thousands of studies yourself. I think the references I provided, along with the great references on this site, show how the sources you provided are not being honest. There is a place for honest disagreement. And then there is deliberately misleading people. I find the latter to be sickening. And that there are a lot of sickening people out there promoting diets that make people sick.
          Of course, you will have to decide for yourself what to believe. I wish you all the luck in your information gathering journey.

  • Orlando

    So as she tries on her new dress she asks,”honey, does this dress make me look fat?” He replies, “No!,your fat makes you look fat!
    He slept on the couch that evening.

  • billy

    So Doctor are you saying a keto diet is not a good diet because it supports high fats med protein and low carbs?

    • Thanks for your comment Billy.

      It seems strange but here is what Dr Garth Davis recently spoke on the topic (find original post here):

      ” I always tell people that it is very difficult to turn carbs to fat, a process called De Novo Lipogenesis (DNL). This is in fact true. In your average person if you eat bread, for instance, your body will store it as glycogen in your muscle or utilize it for energy.

      There is a very important exception to this rule. If you are insulin resistant, then your body will greatly increase conversion of carbs to fat (DNL). So if you are very overweight (my patient population) then you are likely insulin resistant, and therefore, carbs can make you fat.

      Now that does NOT mean you should not eat fruit or carbs. What it means is that you need to address the cause of insulin resistance. Insulin resistance seems to be due to 2 main issues. First, our cells thrive on sugar. cellular metabolism is driven by glucose. Now, to get sugar into the cells, you need insulin receptors. Problem is that certain amino acids and fats cause fat to enter the cell and disrupt the ability of the cell to make insulin receptors. Without insulin receptors the sugar cannot get in the cell to be utilized as fuel. The body will start pushing out more and more insulin in an attempt to get the sugar in the cells. The high insulin suppresses the cells ability to release fat, and more fat is stored in the cells creating a vicious cycle.

      Secondly, the fat that enters the cells creates a problem with storing glucose as glycogen. Fat basically competes for utilization in the cell with glucose. If glucose cannot be stored or transported into cell than you get hyperglycemia and the resulting hyperinsulinemia creates hypertriglyceridemia. Top that off with the fact that the cells aren’t getting their usual fuel and will need t get fuel from fat. Hence there is increase in conversion of carbs to fat.

      This can easily be cured. Exercise greatly improves glucose utilization and insulin receptor production in the cell. Weight loss, obviously, reduces intramyocellular and intrahepatic fat, and thereby increases insulin sensitivity.

      When it comes to diet for insulin resistance there are 2 diets that seem to work. All fat or really low fat. This may sound contradictory, but think about it. If you are eating nothing but fat your odd will run out of glycogen and turn to utilizing fat for fuel. Without eating any carbs, minimal insulin will be secreted. You may still be insulin resistant but if you are not eating carbs, and mainly eating fat, you won’t exhibit high insulin and high sugar.

      As you know, this is not my preferred method of treatment because I find it limits many nutrient dense foods (fruits), may have negative effect as far as cancer, cardiac disease, and inflammation.

      The opposite, a high carb/low fat plant based diet, is my treatment of choice. Basically, by eating a high fiber diet you get slow release of sugar into body and the foods are low in calories so you tend to lose weight. You also are not getting the high amounts of fatty acids and amino acids that enter the cell and interfere with insulin receptor production and glycogen formation.

      Interestingly, it appears, if you are insulin resistant, the answer is in the extremes. You cannot really do some of both. Fat by itself, if not in ketosis, is harmful. Likewise, excessive carbs, in a diet that contains saturated fat, is harmful. The magic seems to be in the extremes.”

      Hope this answer helps.

      • billy

        I am sorry still a little confused. Let me tell you this I am 69 5’10” I weigh 180 lbs have lost 55 libs in the past two years and I have hit the wall I still want to lose weight to 165 lbs I did achieve this but I fudged several times added some things to my diet that caused me to gain ten pounds now I cant get that weight off. I am in good health I exercise everyday 60 minutes on tread mill walking ,lift light weights but I still cant seem to get that 10 or so pounds off . NO sugars, no whites ingredients, only coconut oil in my diet, I follow a pretty strict keto diet. 60% fat 24% protein and 7% carbs is what I am now doing and either I am eating too much food or as I read gut problems something is not working for me. I did fast for four days only chicken broth I lost 4 pounds but after I went back to my regular diet stated above I gained the weight back.. I am really perplexed. I read to try and shock my metabolism fool it so to speak to start burning more. Now what Doctor?

        • Thanks for your comment Billy.

          While I can’t make specific recommendations as I do not know the specifics of your situation, diet and other information. I would like to share some information with you that may be worth considering.

          Here is an article on Ketogenic Diets by PCRM.

          Good strategies for a healthy diet include following Dr Gregers Daily Dozen or the Power Plate by PCRM.

          Hope this answer helps. For further advice I highly recommend you consult a local Registered Dietitian to assess your situation better.

  • Sara

    Has Dr Gregor researched how intermittent fasting affects this issue? Is it valid? The research looks pretty impressive!