Doctor's Note

The most concerning downside of low-carb diets, though, is heart health: Low Carb Diets and Coronary Blood Flow

This is the first of a 3-part video series on the cause of type 2 diabetes, so as to better understand dietary interventions to prevent and treat the epidemic. Next, in The Spillover Effect Links Obesity to Diabetes, I talk about how that fat can come either from our diet or excess fat stores, and then in Lipotoxicity: How Saturated Fat Raises Blood Sugar, I show how not all fats are equally to blame.

Here are some of my recent diabetes videos with a bunch more on the way:

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 NutritionFacts.org account or with one of the accepted social media logins. Click on Login to choose a login method. Click here for help.

  • BB

    This is an excellent video that gives a clear description of the cause of insulin resistance. I have several family members who are unstable diabetics and they have been advised by their doctors to go the low-carb approach. They try to shun sugar and carbs and often fail, all the while eating lots of fat in the form of oils and animal products. They don’t want to give up the animal products as the belief that they need protein (meat) and calcium (milk) is so ingrained. The only thing that would help them is a comprehensive in-house program such as Dr. McDougall provides. It is not so much what they have to learn as what they have to UNLEARN.

    • I have had the good fortune and remarkably rewarding professional experience to see Whole Foods patients at the McDougall clinic. I have also benefited from Dr. McDougall’s mentoring and information on his website. Immersion programs have the advantage of giving patients a wide range of education… in this case 27 hours of outstanding education by experienced health care professionals like Dr. McDougall, Doug Lisle PhD, and Jeff Novick RD plus practical skills by Mary McDougall and others on cooking and shopping. The environment provides access to exercise and the experience of seeing dramatic results. Additionally they are given delicious breakfasts, lunches and dinners plus 24 hour access to snacks. The challenge comes when the patients go from this nurturing supportive environment to their everyday environment. Many patients don’t have the time or money to attend this type of program. By obtaining the correct information and working with the local resources… family, friends and physicians… they can be successful. Physicians need to be involved especially if someone is on medications. In my experience it is an ongoing journey so it is important to keep up with the science which is always changing. So keep tuned to NutritionFacts.org… encourage your family, friends and physicians to review pertinent posts or subscribe. The beauty of this website is that individuals can go to topics of personal interest but you never know when a video will touch on an issue of importance for you or yours… so keep tuned.

      • G-man

        Don Forrestor MD
        I agree completely with your comments.But what I see as a problem is that most physicians either do not know about
        mechanism of insulin resistance or they never spend time to discuss importance of diet with the patients.Sadly I have
        some of physicians comment that vegan diet may be good but “who wants to live to be a vegan”.
        I have tried to explain to one cardiologist that his job should be to educate patients about diet and let them decide
        whether they can live to be vegan or not.

        • DarylT

          You might also point out that contrary to non vegan expectations, vegans overwhelmingly report loving the food they eat.

          • G-man

            DarylT, you are correct but pointing this out to non vegans is very difficult especially living in south Texas.

          • I’m a vegetarian, I tried to be vegan but giving up cheese just made me sad. (I eat very little cheese) I like almost all vegetables and fruits but I rarely feel satisfied. So now I’m supposed to give up all fat-no avocados, nuts, olive oil for dressings-too??? I don’t want to eat animals, that is why don’t eat meat, but after 6 years of not eating meat, I still miss it. AND I still developed pre diabetes!!!

          • Thea

            Chris: Instead of thinking of it is a diet of restriction (ie, I can’t eat that and this now too!), consider it an adventure in a whole bunch of new and exciting food you can eat. Many people report eating all sorts of new foods that they never ate before they started eating healthy.
            .
            To help you on this adventure, you might consider participating in the free on-line program called “21 Day Kickstart.” This program is run by a group called Physician’s Committee For Responsible Medicine (PCRM), which is headed by Dr. Barnard who has proven his diet prevents and reverses T2 diabetes. What’s more, the program will “hold your hand” for 21 days, including meal plans, recipes, videos, inspirational messages, and a forum (moderated by a very respected RD) where you can ask questions. This program would hopefully help you to understand what you can be eating and get some joy out of it. Just something to think about.
            http://www.pcrm.org/kickstartHome/
            (Click the green “Register Now” button.)
            .
            One more point: While you might do well to avoid having any oil and a whole lot of avocados, having some avocado is probably OK. Also, an ounce of nuts or seeds a day may be health promoting for your situation. Check out the videos on this site for nuts and seeds.

        • I find that many physicians once they find out about NutritionFacts.org become subscribers and then start to use it as a reference. You might suggest that to health care professionals that you know. Remember Michael Greger MD reads in the vicinity of 10,000 articles annually. Health care providers need to be aware of literature covering a wide variety of topics. This is overwhelming… that is why this site is so valuable as it allows easy and quick access to abstracts and articles.

          • G-man

            Don Forrester MD
            Thanks for your suggestion. I had converted three of the doctors to vegan, i have given them the info. re: this website but i seem to be giving 90% of patients the info. re: this website. I practice in relatively small town in south Texas so most of my patients are ranchers who get lot of misinformation from the industry.But i keep working at it in hope that this website will help some of them.I think i need to start to give more physicians the info. about this website.

          • Another way I have found to make a difference is to give educational presentations to physicians. If you are in a position to do I found it was a good way to reach a larger number of health care professionals at one time. In the last 8 years I have done almost 50 CME presentations. I recommend that health care providers first start working with the patients with type two diabetes. Dr. Neal Barnard’s book on Reversing Diabetes is a great resource for patients. My parents were born in Oklahoma and I had relatives in northern Texas so am a bit familiar with the challenges you face. Good luck at spreading the word and keep up the good work.

          • G-man

            Don Forrester MD

            That is great suggestion.I am a general Internist with fairly large Diabetes practice.Before we had an endocrinologist arrive in town I gave several CME presentations about Diabetes and Hypertension but that was several years ago.
            I guess i could restart with nutrition talks any suggestions how I can acquire some slide material or I should prepare my own slides.

          • I would make your own slides and use some of your own patient’s successes as case studies. I would be glad to send you my most recent reference list for my Medical Staff presentation on Diabetes/Obesity. I have found combining the topics is better. I do a separate Medical Staff presentation on Arterial Disease where I talk about hypertension which is a follow up to the first. I have also found letting several months go by between talks. I would be glad to share some other information and suggestions for your presentations and practice if you like. Best would be to contact me directly at donforr@gmail.com.

          • G-man

            Don Forrester MD
            thanks for your kind offer. I will take you up on it.

          • sottolaw

            Please record and post your CME presentations to YouTube!

          • Jim Felder

            G-Man. I have lots of family in Texas where BBQ as a sport is only surpassed by football. My suggestion is to not recommend a totally WFPB diet immediately, especially to ranchers for whom beef eating is the source of their livelyhood. Instead I would use the visual idea of “turning your plate inside-out”. By that I mean move the plant foods to the center of the plate and the animal foods to the side or as flavoring. Don’t try to get them to not eat bacon, but suggest that one or two slices can flavor an entire pot of beans rather than eating four slices at one sitting (along with a couple eggs and a mess of hashbrowns cooked in the bacon fat). A way to reinforce that is to suggest that the first question they ask themselves when planning a menu is not “beef, chicken, pork or fish?”, but “potato, rice, pasta, etc.” and then “kale, broccoli, huge salad, etc.”. Stress that they these foods are where all the nutrients come from and that it is healthy as well as filling to eat a large amount of these. And then stress that they can have steak, or a pork chop, or bit of fish as long as it is there for flavor rather than the primary thing they fill up on.

            Also most people focus most of their culinary efforts on the first item on the menu with the rest of the items usually being much simpler dishes. So having the vegetable/starch be the first item on the menu means that they will put more time into it and so are likely to fix something tasty with vegetables/starches rather than the usually spoonful of steamed peas with butter on the side when the meat dish is primary.

            After eating this way for awhile they will realize that plant based foods are tasty and filling in their own right and that they don’t need meat to make something taste good or to fill them up. The biggest trouble I have found is convincing people to eat enough. The “carbs are evil” message is so strong that even people who don’t eat a low-carb diet feel uncomfortable eating high carb foods as more than side dishes. Eating side dish amounts vegetables and starches with an ounce or two of meat leaves them so hungry they start seeing this as punishment they have to endure to try to get healthy and will likely revert to their previous diet.

            Good luck!

          • G-man

            Thank Jim,
            I do follow some of what you are suggesting and have been successful getting people to eat less meat.
            The key has been that once they try eating more plant based diet they are impressed by change in Cholesterol and A1C that makes them more convinced.But problem is to get them to start.

          • Joseph Gonzales R.D.

            Jim, I think this can be great advice! Thanks for helping people make a transition toward healthier eating. So good to hear!

            Joseph

          • Patty Pom

            Dr. Forrester, you can tell them about my husband, who is in remission from Stage 4 Pancreatic Cancer for 3-1/2 years now. He changed his diet immediately when he was diagnosed and it has saved his life. Going Vegan is the answer to cancer! Detoxing by eating organic, nonGMO, preservative free, dye free, MSG free is the answer.

        • Mark G

          One of my ex-doctors told me that he would never recommend a heart healthy book, like those by Pritikin, McDougal, etc, because they are dangerous diets. I asked what about them is dangerous. He said, “because most people won’t stay on them.” Huh? So I guess it’s better to stick with a deadly diet and not try it than to try it and go back to some degree.

          Doctors have been amazed by my annual lab results. One even suggested I blog about my diet. But I’ve been suggesting to all my doctors for over 25 years that they suggest a vegan heart healthy book to their patients with severe cardio or metabolic diseases. All have declined. None want to read one themselves.

          In my 20s, I told one that my cholesterol test would come in low because of my diet. Later, he skipped over my cholesterol in my lab results. When I asked about it he told me it was low. When I kept pressing to know the number he angrily said, it’s 117 total cholesterol, satisfied? I said, yes, I’m satisfied. Then I got a new doctor. The sad thing is, he was otherwise a nice guy and a very young doctor, but committed to drugs that he gave out like lollipops. He saw diet as quackery. I wish I had also know then what I know now: that I have low cholesterol with HDL higher than LDL, in spite of genetic tests indicating that my genes show I’m prone to high cholesterol. My dad died of a heart attack at 64 and my brother had his first of two at 48. I won’t be going the way of my family.

          • I remind myself that these physicians are products of their environment. Most haven’t been exposed to nutrition in their training and even if they had it is difficult to keep up. I would suggest that they try subscribing to NutritionFacts.org for regular exposure to the most practical and useful articles in nutritional science.

          • Anne|Craving Something Healthy

            So true! We’re all products of our environment and we all like to do what we know best, and is easiest. For too many people, that means taking a pill so they can go about their regular routine – or prescribing a pill because it’s easier. Hopefully those of us who go into healthcare to learn and change with the research can gradually influence not just our patients, but also medical professionals who clearly need to be updated! Change takes time…

          • Thea

            Mark G: re: “because most people won’t stay on them.” Wow. I agree that’s pretty crazy. At first I was thinking, that that’s some pretty fuzzy thinking. But then I wonder if he was thinking, “If I *only* recommend diet and the patient doesn’t stay on it, then the patient will be in trouble. Whereas, I know they will take this little pill that I can prescribe.” That interpretation gives the doctor the benefit of the doubt, but doesn’t help a hole lot to make him/her look better. That reasoning supposes that there are only two options: only discuss diet or only discuss pills. Seems crazy not to have a full discussion with a patient and then let the patient make an informed decision. Doing that would not be not dangerous. That would be called responsible.

            Anyway, I wanted to thank you for sharing your story. It was a lot of fun to read. (Though I am sorry to hear about your dad and brother. That part, of course, was not fun.)

          • Barbara Wagner

            Patients are more willing to comply to a plant based diet than many providers realize! Providers need to be more proactive
            in recommending lifestyle changes. In Dr Esselstyns recent work published in the The Journal of Family Practice | JULY 2014 | Vol 63, No 7 (“A way to reverse CAD?”), several remarkable findings were revealed. First, and quite compelling, is that 89% of patients
            were willing to make a substantial lifestyle transition to plant-based nutrition and sustain it for an average of 3.7 years (for some patients up to 13 years). Patients can and will make lifestyle changes if given the option.

        • Patty Pom

          ok so just throw in the towel and die at a young age? How ridiculous! I enjoy being a vegan, because I learned how to prepare meals, how to make an awesome “kitchen sink” salad, and how to shop. And BTW, my husband reversed Stage 4 Pancreatic Cancer by going on a 90% vegan diet (sometimes we have cheese and eggs). I can show you the CT Scans, and I can show you the blood work. He was also pre diabetic. He reversed that too.

      • Judy Fields Davis

        thanks

    • Thea

      BB: re: “unlearn”
      Well said. I don’t have any trouble convincing people that veggies are good for them. It’s helping them to see that meat, dairy and eggs are bad for them that’s the hard part. And one of the reasons for that difficulty is the need to unlearn what they have been taught from the very beginning of their lives.

      I like the part of Dr. Forrester’s reply that it is possible to be successful outside of a program like Dr. McDougall’s. It gives people hope and an understanding of what is helpful to have in place in order to be successful. But as many on this site have acknowledged, there is only so much a person can do to help someone else. They have to want to be helped to make much progress. Good luck.

  • Darrell Kent

    Is it any fat that is leading to type 2 diabetes or is it saturated fat in particular?

    • Jane’s Addiction

      Under “Doctor’s Note” above, it says that this is the 1st part of a 3-part video series and that part 3 is all about saturated fat raising blood sugar. I’m assuming then that it’s just saturated fat (and probably trans fat and cholesterol) that has this insulin-resistance effect, but I’ll admit I’m a little nervous about eating my avocado today!

      • I’m not worried about a couple of ounces of avocado a day. Avocados come from an area of the world where obesity and diabetes have had low rates historically.

      • 7in1

        Me looking down with a suspicion at my flax crackers too!

      • Zuppkko

        Dont be. If you eat an avocado every few days you still get less than 10% calories from fat.

    • I believe it is any fat. When advising patients with type 2 diabetes the first thing is to avoid animal products and refined oils. This dramatically reduces the fat in the diet. I have patients monitor their am fasting blood sugars to reinforce success and help them move from diabetes to prediabetes to “normal” to even “more normal”. It is important for patients to work with their physicians as patients on diabetic medications can drop their sugars too low. The same can be said for monitoring blood pressures in patients on blood pressure medications. Most physicians haven’t had experience with intervening with appropriate nutritional therapy. This is not a new approach see the video on the Kempner Rice Diet… http://nutritionfacts.org/video/kempner-rice-diet-whipping-us-into-shape/. Physicians aren’t generally aware of the science because the research is buried in lots of articles focused on treatments with drugs and procedures. It is important to give patients realistic time frames as it may take months to reach normal blood sugars. Exercise and activity can be helpful and affects how rapid is the improvement. Of course it is always better to intervene earlier in the course of type two diabetes then wait until complications set in. Once again important to gather the correct information and if on medications work with your physicians to obtain the best medical advice for you.

      • eric

        It’s good to see another doctor that embraces food as medicine.

      • Guest

        The chart displayed at 3:00 shows free fatty acids activated to become Long chain acyl-Co-enzyme A. This would indicate that fatty acids with a backbone of at least 14 carbon molecules would adversely affect insulin receptors. For example, myristic acid, palmitic acid, stearic acid (saturated fatty acids) along with linoleic, linolenic and oleic acids (unstaturated fatty acids). Long chain fatty acids are the most common fats in our food, found to some extent even in coconut and palm kernel oil. So it seems that virtually all foods containing fat would have this effect. Of course, the quantity of fat is important. If we want to limit ourselves to 10% of our calories as fat, as recommended by many life style doctors, two tablespoons of whole flax seeds and one ounce of walnuts (14 halves) would put us about there. So would an avocado and 1 1/2 tablespoons of whole flax seeds.

      • sf_jeff

        “It is important to give patients realistic time frames as it may take months to reach normal blood sugars.”

        Lol. From the first half of the sentence I was more expecting to hear it followed by “…as it may take years to reach normal blood sugars [from a diabetic state]” If you can do that in months, then that’s impressive.

    • Joe Caner

      The sited study in this video showed 40 grams of fat for a base line 2680 Calorie diet for the lowest fat intake group which comes out to be about 13.4% of calories coming from fat which is positively liberal by Pritikin and Esselstyn standards although it is considerably lower than most westerners are accustom to. I am of the opinion base on the studies I am familiar that refined oils and fats are a much greater risk than fats that one ingests with fiber in a whole foods plant based form. Refined oils are to fats as refined sugars are to whole foods, full fiber forms. The fibers in whole foods ameliorate nutrient absorption rates eliminating spikes and normalizing serum levels enabling the body to better cope while extending satiety duration from a given meal. An ideal diet would be one devoid of any refined foods.

    • Ramiclimber

      Stay tuned for Friday! Saturated fat is indeed the culprit more so than unsaturated.

    • stevebillig

      Good question. Here is a study that says it indeed is saturated FFAs (stearic and palmitic, which are the kinds of fatty acids the body makes and stores when it has more calories than it can use) that are the culprit. Omega 3,6 and 9 (mono and poly unsaturated) FFAs did not impair glucose metabolism or mitochondrial function. http://www.ncbi.nlm.nih.gov/pubmed/19780047 Which means avocado (84% unsaturated, 16% saturated) is OK, in moderation.

    • Marco Gorelli

      In part 3 he makes it clear that it’s saturated fat that’s the problem and that unsaturated fat may even be beneficial to insulin resistance.

  • Arjan den Hollander.

    This is what I call solid work towards upping the value per minute watched, very good work on this much easier sell.

    And they ask you to fast before testing, while one should be imbibing a standard solution before.
    Caregiver level medicine just well ………. sigh ahh never mind!

  • guest

    Excellent, excellent. Thank you for clearly and succinctly explaining insulin resistance. Another example of why I looking forward to your book

  • jms

    People with Type 2 Diabetes receive insulin injections to lower their after eating blood sugar spikes. Are these temporary spikes harmful? Can diabetics safely eat sugary food so long as they control their blood sugar with insulin injections?

    • Tom

      Those with type 2 diabetes don’t need more insulin; they need to use insulin more efficiently. Injecting more insulin doesn’t address the metabolic causes of insulin resistance and may be harmful. Eating healthy whole foods (not sugary ones), exercising, maintaining normal weight, along with stress reduction and anti-inflammatory spices and supplements can all go a long way to curing type 2 diabetes.

    • Jen

      If people with TIIDM are getting insulin that means they’ve have DM for so long they’ve destroyed at least part of their pancreas. They effectively become Type 1 diabetics if they don’t change anything. If they eat less fat, they will be better able to use insulin, whether they’re injecting it or not.

  • Matt K

    How does one stay sated for hours after a bowl of oatmeal (low fat)? I’m ravenous after 15 minutes, even if I eat a large bowl. Whereas if I were to have steak and eggs, I can last until lunchtime.

    • Brian Humphrey

      Try adding 1 to 2 tbsp of ground flax seed, 1/2 to 1 cup berries, and a glass of a plant milk (coconut, almond, soy…).
      Still hungry? Break out a skillet with 1 tbsp of olive oil or spray add 3 to 4 oz firm or extra firm tofu.
      Next add turmeric, black pepper, baby spinach, a pinch or cayenne pepper, and some peppers (frozen are ok)
      Break up tofu with spatula while cooking for 5 to 15 mins on med high.
      Top with favorite salsa and/or nutritional yeast. ;)

      • MarkG

        Brian, coconut milk is very high in saturated fat, which Dr Greger keeps warning against in the research he presents. A glass full of the stuff seems to hold exactly what this video is warning against.

      • Jennifer

        Have you seen this video on Coconut Milk? I found it to be very thought provoking. As much as possible, eating the whole food, rather than the more processed version is better because you retain the fiber.

    • b00mer

      Hi Matt, it seems oatmeal just doesn’t work for you since you posted a very similar comment on the last diabetes video. If oatmeal doesn’t keep you sated, despite it’s objectively high satiety rating, how about trying some other plant foods for breakfast? Different preparations e.g. granola, different add-in’s as have been suggested both times, different grains, beans for breakfast as they do in the UK, breakfast potatoes (boiled potatoes having the highest satiety index rating). Think outside the box. If you try everything and nothing but unhealthy foods keeps you at a level you consider satisfied, maybe you need to eat more healthy foods more often.

      Another thing to consider is that sensations and perceptions of hunger change when you change your diet. If you were to go on a low fat whole foods plant based diet, you may feel what you consider “hunger” for the first day or so, since your fat receptors aren’t getting what they’ve been accustomed to getting, and gastric emptying occurs faster with lower fat foods. However if you were to stay on this diet for a longer amount of time, you may find your perception changing. I remember what I used to consider “full” feeling on a non-vegan diet, and now it’s a feeling I can’t stand. Now if I eat a high fat plant meal I still get that overly full sensation and it remains for inordinate amount of time. If I go out to eat for lunch and have french fries, I won’t be hungry for the rest of the day. That doesn’t convince me that french fries are the healthier or more natural type of food to eat. Perhaps what you currently interpret as “ravenous” is just a lack of excessive fullness. It sounds like you want encouragement to eat objectively unhealthy foods, but I’m afraid I don’t think you’ll find it here. You will find plenty of suggestions if you really want to give it a go though.

    • We used to feel exactly the same until we started fasting for longer periods. It really helps with balancing hormones and getting on top of what are true hunger feelings and what is just addictive patterns of eating. :-)

    • KWD

      Matt K, I have steel cut oats 3 or more days a week and add ground flax regardless of the preparation. The savory version always has beans and salsa and I like to add cilantro. The sweet version always has almond milk and a variety of nuts and seeds (walnut, chia, sunflower, pumpkin) with the sweet coming from dark berries, currants and/or goji as well as date sugar. Even still, I’ll have steamed greens as an accompaniment (usually about two cups worth) regardless of which version I’ve prepared.

      Personally, I’ve found I eat a greater volume of food overall as a mostly plant-based foodie and that I eat more often throughout the day.

      • Charzie

        Good to hear someone else enjoys a savory version of oats! Though I usually end up with old fashioned rolled oats, I have come to love the savory versions so much more than I ever did the sweet ones, especially in the morning….beans and greens or whatever veggies I have on hand, usually with turmeric and other spices and cooked with some broth. I let it cool down a bit (so the good microbes don’t get cooked) and add either miso or one of my ever present fermented concoctions for my daily probiotics and added flavor!
        Speaking of concoctions, this year I had a blast with the usual dreaded surplus of zucchini we usually run out of ideas for! I simply
        grated it, sea salted it to taste and added a varied mix of herbs and spices to each jar, and in about 4-5 days here in Fl I had some amazing stuff for the cost of a few minutes of my time! I’m not sure what to call it but I use it in and on everything and anything! One of my favorites was the lime-cumin-cilantro-garlic-chili combo! Spread on a toasted tortilla it makes a great, healthy, and filling snack when the crew is munching those deep fried unmentionables! In fact, I made some unlikely converts! LOL!
        Recently I have been foraging for nopale cactus and have just included them diced up in a fermented salsa! Awesome! Free food on a fixed income is always welcome, especially when it is health promoting!

        • KWD

          Great ideas, Charzie. I need to experiment with making my savory oats more diverse.

    • MAP

      I had the same experience with oatmeal for breakfast. This is what I eat now while waiting for my steel cut oats to cook: small bowl of raw greens (baby kale, spinach, sliced rainbow radish) drizzled with lemon juice, cup of rooibos green tea, two whole walnuts. I also add a little unsweetened almond milk to the oatmeal.

      Other hot, filling breakfasts:
      Cooked roasted buckwheat (vegan bouillion added while cooking for more flavor), steamed greens, lentils or beans or tempeh (I drizzle a few drops of lignan flax seed oil and red pepper flakes on the greens, and black pepper on the buckwheat).

      Also: Raw green salad again, followed by two slices of toasted quinoa/millet bread (nongluten, nonwheat), with about a quarter of an avocado.

      Experiment!

    • Enthusiast

      You’re going from extremely calorie dense foods to oatmeal… even a huge bowl of oatmeal only has about 300 calories. Unless you’re just eating a 3 oz steak and a single egg, you’re not getting the same number of calories. Also, 15 minutes isn’t enough time for the oatmeal to leave your stomach. I’m thinking what you’re feeling isn’t really hunger. I don’t know what it is, but I used to get a feeling very much like hunger almost immediately after eating an apple or carrots. Goes away after eating healthy for a while.

      As others have suggested, add some flax seeds and some fruit. Maybe have a bowl of oatmeal made with soy milk instead of water and a banana. Or take a cue from Mexico and England and have beans for breakfast. You’ll get more protein, which might work better for you.

    • donmatesz

      Sounds to me like you need to try a bigger bowl of oatmeal. A typical bowl (8 ounce volume) of oatmeal has only ~160 kcal. 100 g of sirloin steak and 2 poached eggs would have more like 525 kcal, assuming lean steak with no visible fat and little fat used in cooking the eggs. You might need to eat 3 times as much oatmeal, or more. Use an app like cronometer.com to track your caloric intake. When you eat whole plant foods low in fat, you have to eat larger volumes of food to meet caloric needs.

    • Matt K

      Thanks for the feedback, everyone! I do find eating some raw food prior to a meal very helpful. I’ll take all of your suggestions into consideration for breakfast tomorrow :)

      • Jennifer

        I too find eating raw prior to a meal to be very beneficial and satisfying! Have you seen the video on Raw Foods? It’s an older video but a good one!

    • dogulas

      It takes three months to become neuro-adapted to a low-fat lifestyle if coming from a typical lifestyle. You can eat all you want but your brain is so used to the fat sensors being fully stimulated that it thinks something is missing. Just keep eating if you feel famished, and soon you’ll adjust and feel fully satisfied.

    • Joe

      Fat is 9 calories per gram – carbs are 4. This is why fat gives you that satiated feeling sooner – because it’s more calorically dense. It can be difficult getting enough calories on a plant based diet – and I’m sure that’s where most people run into problems. I find I’m more satiated after sweet potatoes and (properly prepared) beans than oatmeal. Perhaps satiety is more complicated than just calories – I could potentially see it involving any nutrient we are in need of.

      I avoid soy – it’s generally gm and heavily processed, and interferes with thyroid function. The industrial extraction of the milk from a soy bean is not something I want in my body. I do eat traditional fermented soy like Tamari though – especially sprayed on lightly toasted pumpkin seeds. My favourite snack right now!

  • Leslie

    Can too much nuts and seeds create this fat-induced insulin issue?

    • I haven’t seen anything in the literature to say it would be a problem. I typically don’t eliminate nuts and seeds initially as they typically make up a small percent of fats in the diet. I think initially limiting to 1-2 ounces a day would be a prudent. Oils… all oils including olive and canola are a much bigger problem along with the high fat in dairy and animal products. It may be that nuts like fruit are not as much a problem due to the company they keep as a whole food… see the video… http://nutritionfacts.org/video/if-fructose-is-bad-what-about-fruit/ . I have seen patients where fruit can be a problem. However it is possible so if patients aren’t progressing restricting nuts and fruits might be beneficial.

      • Leslie

        Any idea why the fruits would be causing an issue in some of your patients? Would it be directly caused by the fat consumption, or is it just an inability of body, in these select patients, to handle these kinds of carbs and sugars?

        • I would guess it is due partly due to individual variation in metabolism and partly due to the amount consumed. The issue was a significant elevation in triglycerides with alot of fruit intake. It was not fat consumption as the patients were on a less than 10% fat diet.

          • Nicola

            Triglycerides… this is what fructose gets converted to in the liver when certain thresholds are overridden. No wonder here.

            And for some individuals we are talking even above 20g fructose per day.

      • James

        Dr Neal Barnard MD author of Dr Neal Barnards Program for Reducing Diabetes feels that avocados and nuts shoulds in general should also be be limited due to the role of fat in insulin resistance.
        And olive oil is a big no no…

        if your goal is to regain as much insulin sensitivity as
        possible, you will want to eliminate not only animal fats but also added
        vegetable oils. Cleaning the animal fat out of your cellular “locks” does no
        good if you are going to clog them with vegetable grease.

        Barnard, Neal (2006-12-26). Dr. Neal Barnard’s Program for
        Reversing Diabetes: The Scientifically Proven System for Reversing Diabetes
        without Drugs (p. 50). Rodale Books. Kindle Edition.

      • Jennifer

        At one time I thought it was important for patients to stay away from too many nuts because I believed they would aid in weight gain (and more insulin resistance!). Have you seen this remarkable video on Nuts & Weight Gain?

    • Darryl

      A recent review

      Many recent studies have focused on the potential effect of nut consumption on inflammation and insulin resistance. Through different mechanisms, some components of nuts such as magnesium, fiber, α-linolenic acid, L-arginine, antioxidants and MUFA may protect against inflammation and insulin resistance.

      While some fatty acids, like the saturated fat palmitic acid and its preferential metabolism to ceramide may be particularly hazardous, others, like the oleic acid that predominates in almonds, hazelnuts and pecans may have a beneficial effect.

      • Are you familiar with stem cell biologist Bruce Lipton’s book, “The Biology of Belief”? He talks about cell “mem-brains” and how they’re the interface between a cell and the environment, sort of a satellite dish for receiving and sending signals both within and among cells.

        The membranes are composed of a layer of fat encased in proteins, and from what I understand (and correct me if I’m wrong), dietary fat pretty much gets directly deposited in those membranes. (In contrast, our bodies have to break down proteins and carbs to use them.) You eat butter, you get hard buttery membranes. It could be worse. You could be eating Crisco!

        Saturated and trans fats–hard fats saturated with hydrogen atoms–muck up those membranes and make them insensitive to insulin. PUFAs and MUFAs do not; in fact they (or some of them) may increase sensitivity. That’s my understanding thus far from lots of reading– Is it accurate? It makes sense that the more liquid fats would not destroy the function of cell membranes like hard sat fats do.

        • Darryl

          Dietary fatty acids are indeed taken up by cell plasma membranes, and the composition of red blood cell membranes offers a better measure of dietary intake than plasma fats, especially for the fats we either don’t produce (trans-) or produce little of (DHA). In general, the more saturated fat, the stiffer the membrane, and the less saturated the more fluid – cold-water algae and fish need highly unsaturated n-3 PUFAs like DHA in to prevent membrane crystalization in their environment.

          Some studies have found membrane saturated fats positively associated with, and polyunsaturated fats negatively associated with metabolic disease (1, 2, 3, 4, 5, 6)

          • And how does dietary cholesterol relate to the cholesterol composition of our cells?

          • Darryl

            Cholesterol doesn’t offer markers of its origin: the cholesterol synthesized by our cells is indistinguishable from that found in chicken or shrimp. In general, endogenous cholesterol synthesis (700-900 mg/d) is greater than the amount absorbed from diet, though the liver does produce less when dietary intake is high. There’s a constant turnover as the liver synthesizes and uptakes cholesterol in LDL particles, and as bile acids are formed from cholesterol, secreted into the intestines, and reabsorbed. Certain saturated fats (12-16 carbons long) interfere with LDL reuptake in the liver and elevate blood levels.

          • And could you explain “rafting” in lay terms?

          • Darryl

            A lipid raft is simply a patch of plasma membrane where receptors and other transmbrane proteins are held in close proximity (increasing the likelihood they’ll bump into each other and pass their message on). Think of how coconuts might “raft” together in gentle waves.

          • This is the sentence I’m trying to better understand: “Besides imparing signalling diffusion by membrane bound molecules & enzymes downstream of the insulin receptor (eg PIP3, Akt), high saturated fat membrane content may cause rafting of other signalling molecules involved in metabolic syndrome and inflammation. ” So is this a correct understanding? Sat fat in membranes a/ impairs cell signalling, thus leading to insensitivity to insulin, and b/ can cause cells in the membrane to stick together in close proximity, thus allowing them to feed off each other’s inflammatory messages. I really have no idea if that is a correct paraphrase.

          • Darryl

            The rafting comment mostly cites this and related papers, where saturated fatty acids enhanced, and highly unsaturated fatty acids disrupted, the rafting between membrane proteins involved in inflammatory response. An analogy might be saturated & trans fats are shaped like toothpicks, and cis-unsaturated fats curl like pencil shavings, and its much easier to stack toothpicks compactly.

            There are more competing theories of how fatty acids impair insulin signalling. The primary one covered in this video (diacylglycerol, acyl-CoA and ceramide metabolites accumulate, activate PKC and JNK, which in turn phosphorylate and inactivate insulin receptor substrate-1) doesn’t appear to rely on rafting effects, but other theories (inflammation as above, or endoplasmic reticulum stress) may.

          • And might lipid rafts also block the signals that proteins are attempting to pass on?

            I’m wondering about why whole milk appears to be protective against development of prostate cancer in that recent meta-analysis but low fat milk appears to increase risk of getting prostate cancer. Could that difference, assuming it’s real, have anything to do with the lipid rafts’ effects on leucine signalling? Or maybe there’s more Vitamin D or CLA in the whole milk? And whole milk also appears to increase risk of dying after diagnosis of prostate cancer. Any thoughts on the mechanisms behind these distinctions? Here’s the link to the abstract: http://www.ncbi.nlm.nih.gov/pubmed/25527754

    • stevebillig

      It’s saturated fat that is the problem with insulin resistance. Nuts and seeds have relatively small amounts of saturated fat, so they are OK In fact, they are excellent. But they are still high in calories so keep it to 1/4 to 1/3 cup a day, about 1 oz.. Mixed (for variety) and not salted or oil roasted is best.

    • Amy Johnson

      My understanding is that nuts and seeds still contain fat and are very high in calories. Fat will cause you to gain weight and the added fat in body can “gum up” the cells causing insulin resistance.

  • elsie blanche

    Dr. G and any of the other folks in the know here, what do you think about the information in the link below
    attributing avocado consumption to impaired insulin ability/functioning? Seems, according to this, that
    consumption of avocados leads to higher blood sugar levels. Tell me this isn’t so!

    http://blog.sethroberts.net/2010/09/21/avocado-raises-blood-sugar/

    • dogulas

      It’s the fat.

  • Wegan

    If you are having trouble sticking to the program try reading this: http://www.truthdig.com/report/item/all_forms_of_life_are_sacred_20150104

    • Jocelyn

      Hey, thank you for this post.

  • Merio

    Pathways like the insulin one are my daily bread… :-)

  • RC Conklin

    Five years ago lab tests showed that I was pre-diabetic and my doctor prescribed the usual medications. I did not like my future prospects of increasing medications and the inevitable physical decline. Fortunately I found: “Dr. Neal Barnard’s Program for Reversing Diabetes” book. In that book Dr. Barnard talks about the same thing. Now, as a striving vegan, I am synonym free. This has not been easy. I live in a very meat centered area and all of my relatives are such. NutritionFacts is my ammunition for fighting back.

    • Thea

      RC Conklin: Thank you for your post. I’m a huge fan of Dr. Barnard and that book. It’s great to hear your story, and also feedback about NutritionFacts.

      I also wanted to say, “Good for you!” for taking responsibility for your health even though it is hard. I can understand how it can be so hard without emotional support. I don’t know if this is possible or of interest to you, but thought I would recommend that you check out the Meetup.com site. They have vegan (or at least vegetarian) groups all over. You may think you are the only person trying to eat healthy in your area, but you may be surprised to find others. If you can hook up with a new class of friends, at least some of the time, it can go a long way making life easier. Good luck!

    • Briana

      This is my story as well! Although, I did not find out about Dr. Barnard until after I was vegan. Instead, I had done some research on an alkaline type diet and have been living the lifestyle for a few years now! It’s quite amazing!

      • RC Conklin

        My only experience with the alkaline type diet is when I looked at raw vegan. Raw is a part of my diet but not a major part. My problem with raw and now the alkaline diet is stomach acid: it all get broken down the same way. I like John McDougall’s “Starch” book. Simple and inexpensive. As Paleo is a commercial scam, one must be careful about the same thing in the Vegan world.

    • Charzie

      I can relate RC, as I went the same route. I’ve posted about it here before, and don’t exaggerate when I say being diagnosed with diabetes probably saved my life. It saddens me though to watch the decline of loved ones who chose the other way…even when I made it clear there are better options. Frustrating!

  • Great video as always! Looking forward to parts 2 and 3.

  • Lyndon

    Thank you for these videos on diabetes! Telling me the truth on how to reverse my type 2 diabetes.

    • Matthew Smith

      For diabetes, this site recommends hibiscus tea, cinnamon, flax seed meal, amla, and beans

      Thule has produced another list of recommendations from this site:
      Indian gooseberries (amla), coffee, soy, flaxseeds, green tea, pulses (dried beans), chamomile tea, purple potatoes, sprouts, whole grains, vinegar, and beans.

      This site strongly recommends a vegan low-fat diet for those with diabetes.

  • RIchard Feinman

    The failure to understand that a high fat diet in the presence of high carbohydrate is very different from a high fat diet in the presence of low carbohydrate is the reason there is so much confusion. Because of the lack of agreement on definitions, a “high fat diet” can still have high carbohydrate. Carbohydrate, directly or indirectly, via insulin and other hormones, is catalytic, that is, it encourages deposition of fat. It is fatty acid in the blood that is the trigger for insulin resistance but that is not directly tied to dietary fat. In the classic study by Volek, et al., people with metabolic syndrome ate a very low carbohydrate diet with 3 times the saturated fat as those on a low-fat diet but after 10 weeks, saturated fat IN THE BLOOD, was actually lower in the low-carb group compared to the low-fat group. How is this possible? Well, that’s what metabolism does. Saturated fat in your blood is more under the control of dietary carbohydrate.

    Low-carbohydrate diets are effective because they redirect fat to oxidation rather than storage. In terms of heart disease it is established that the biggest risk of CVD in people with diabetes is HbA1c, that is, the diabetes itself. That is better treated with low carbohydrate than anything else. Everybody agrees that low-carbohydrate will lower your blood glucose and that is still the main thing. We’ve laid out the case in a multi-authored paper at http://bit.ly/1tyFh89. Possibly also of interest in which I explain this further is my book “The World Turned Upside Down. The Second Low Carbohydrate Revolution” http://nmsdocs.com.

    • Barry Erdman

      For lacto ovo vegetarians (not vegans) eating high good fats in conjunction with very low carb and moderate protein is a very viable approach to managing diabetes and eliminating insulin resistance. Also see the facebook group, “The Vegetarian Low Carb Diabetic Healthy Diet Society” (veglowcarb).

      • guest

        restricting carbs is a terrible idea… Good carbs like rice and potatoes should make up 80% of your diet. Turns out high fat, high protein diets will open you up to chronic disease in the long run regardless of how it affects blood glucose. All that fat will take it’s toll on blood capillaries as seen here. https://www.youtube.com/watch?v=3igKW6bl3FE

        • Barry Erdman

          Guest, are you diabetic? Have you ever tested your blood sugars in half hour intervals after eating rice and potatoes? What did you find?

          • Adrien

            Blood Sugar is supposed to rise after eating.. Did you know that ? Rice and potatoes don’t cause diabetes, nor high blood sugar nor insulin resistance. People eating the most rice and potatoes have the lowest rate of diabetes in the world. Keep in touch as you learn more on the science behind this observation.

          • Barry Erdman

            Try finding and replying with one source that will validate your claims.

          • guest

            Just trying to help Barry. I have first hand experience and knowledge of diabetes. My father was diabetic and I would sit at the breakfast table and watch him prick his finger every morning just before he ate his eggs and bacon. He died at 58 after a quad bypass. Also, I was pre-diabetic myself when I ate fats and oils. My fasting glucose was 110. It’s now 80 after I removed the fat and upped my good starchy carbs. You need to hear this if you think low-carb is a cure for anything.

            Truth is… a HIGH carb-plant based diet CURED me just like Dr Greger said it would. Did you watch the above video? Did you see the part about capillaries size and fat in the blood? Low carb is a terrible diet for long term health. You are doing much more harm than good eating low-carb.

            Bottom line… Low carb diets can CONTROL blood sugar levels like medications, but that stratagy does not CURE the underlying problem… It only masks the insulin resistance… Whereas a LOW-FAT diet devoid of animals and oils CURES the condition by removing the fat that is interfering with insulin’s ability to let sugar into the cells. Is that really that hard to understand? Have a good day.

          • Barry Erdman

            Would you advise the same for type 1 diabetics?

          • Guest

            Not directed to me but….
            Type 1 Diabetics usually have a problem with insulin. So, they must make sure their bodies use it very efficiently (high insulin sensitivity).
            Yeah, a diet for this cases should be foods with a low glycemic load, but mostly carbs (little fats).
            Really, insulin sensitity skyrockets on a WFPB diet, and insulin sensitivity is a very important topic for people with type 1 diabetes.
            So, I would advise the same type of diet (of course, trying to avoid high glycemic foods). You just mentioned rice and potatoes, two very glycemic carb foods.
            There are LOTs of other foods with a low GLoad, packed with carbs, vitamins and minerals.

          • Barry Erdman

            Please name one low glycemic food that is packed with carbs please!

          • Guest

            Vegetables. Carrots. Broccoli. Spinach. Kale. Seriously. Go into any diabetic 1 forum and you’ll see that most have problems with fatty meals. A lot of them say it messes their control of sugar for 12 hours. A lot of them tolerate oats and whole grains. A lot of them tolerate beans. Most cannot tolerate milk.

            It all depends on how serious is the thing. But i would’t give a type 1 diabetes person a diet that is known to cause type 2 diabetes. Insulin resistance + diabetes 1 = double diabetes. Not a very good combination.

          • Barry Erdman

            By definition one cannot have a high carb food and also be low glycemic food at the same time. Carrots? Well, I must say this has all been very fascinating and entertaining, but also a very sad, uninformed, and misleading dialogue.

          • kylemeister

            One might then wonder how the Merck Manual (which has been reputed to be the world’s most widely used medical textbook) can speak of “carbohydrates with a low glycemic index.”

    • Wegan

      In the classic study by Volek, et al., Low fat was 24% that’s not exactly low fat. I didn’t read the study, what were the carbs? Whole grain or white flour? Let me guess, did Volek, et al. Have an agenda? Do you?

      • I got as far as the Beer Knowledge part:

        “RDF wrote the original draft and incorporated changes and corrections from
        the other authors. All authors approved the final manuscript. AA is consultant/member
        of advisory boards for the Dutch Beer Knowledge Institute, NL,
        Global Dairy Platform, USA, Jenny Craig, USA, McCain Foods Limited, USA,
        McDonald’s, USA, and Gerson Lehrman Group, USA (ad hoc consultant for clients).
        He is recipient of honoraria and travel grants as speaker for a wide range
        of Danish and international concerns. He has conducted research funded by a
        number of organizations with interests in the food production and marketing
        sector. RDF writes reviews for Fleishman-Hillard, whose client is the Corn Re-
        finers Association and he has received grant support from the Veronica and
        Robert C. Atkins Foundation. EJF has received grant support from the Veronica
        and Robert C. Atkins Foundation. TK sits on an advisory board for Eli Lilly and
        gives lectures for Lilly about the diabetic diet. NW has written popular-audience
        books on low-carbohydrate diets and is a consultant and promoter for Leberfasten/Hepafast,
        a specific low-carbohydrate meal replacement program. JW is
        on the Scientific Advisory Board of Atkins Nutritionals Inc. with paid retainer,
        honoraria, and travel costs. None of the other authors have anything to declare.
        * Corresponding author. Tel.:þ1 917 554 7754; fax:þ1 718 270 3732.
        E-mail address: richard.feinman@downstate.edu (R. D. Feinman).”

    • NFc

      In the Volek study you’re referring to, plasma saturated fat was only very slightly lower during the low carb phase than the highest carb feeding phase and it also correlated with weight loss, so it’d be misleading to imply you’d lower your plasma saturated fat by eating more saturated fat. At best you could say that in obese diabetics, there’s no immediate benefit in the way of insulin sensitivity to eating junk food carbs over saturated fat in the context of an already fatty diet. With diabetes already being a risk factor for heart disease, telling people the best option to treat it is eating a lot of saturated fat rather than healthy carb sources that can improve insulin sensitivity and lower cholesterol sounds like the worst possible option.

      You may have more luck shilling your book on a low carb or paleo website.

    • guest

      I’m sorry but your post is one big SPAM advert for your unhealthy and dangerous fat-atarian keto book. High fat diets are unhealthy and cause a marid of health problems such as insulin resistance.

      Please have a read through plant positives site so you know what you’re up against. This is an educated bunch and we definitely don’t buy into the Keto con job. Get the animal fat and protein out of your diet and watch your health improve.

      Knowledge is power… https://www.youtube.com/watch?v=6bSdnQ1MKGo

      Don’t be dupped by the great Keto Con… (eat healthy whole grains, bean, seeds, nuts, fruit and veg) no meat, eggs, dairy and keep fat under 10% for optimum health.

  • Plantstrongdoc M.D.

    The explanation is so simple and straightforward and likewise the treatment – yet scientists and government spends millions of $ and € trying to identify the genetic cause of type 2 diabetes, so they can find a cure (a pill) with tons of side effects, but you can keep eating your greasy burgers, butter, cheese, pizzas, chips and so on, and you can become even fatter than your fat dad, without becoming diabetic! Oh yes – science is doing so much good for mankind….

    • Arjan den Hollander.

      I would blame that on money, status and inadequacy issues more than I would on science.
      Science itself well … pretty nice me thinks :)

    • Brigitte

      Just the new politically correct form of slavery! Money over life and compassion.
      Education based on science is the tool needed to counter this. Thank you so much Dr Greger and team, and commenters!

  • Han

    Awesome video! Is there an evolutionary reason why this happens? Does it also happen in carnivores and omnivores?

    • dogulas

      Good question. The last video on Paleo diets showed that carnivores like dogs don’t develop atherosclerosis from high-cholesterol diets. But I have heard of dogs getting diabetes. Apparently dogs typically get a form of diabetes similar to human type 1 diabetes, where they don’t produce enough insulin. This would to me suggest it is more of an autoimmune disease promoted perhaps by leaky gut. I don’t think there have been any studies on why dogs get “type 1 ish” diabetes.

  • Just the facts? I can read the transcripts but until I SAW that cartoon I didn’t really connect the dots. WOW and thanks once more for this motivating work.

    An artist is great when hir work changes changes people…for the better. The same can be said for a researcher. How many lives have you improved, we can not know but the numbers continue to grow. Sincere thanks Dr. G. Can we get this into our local skools?

  • Linda N

    It says it all on the last part. This elevation is found on a “ketogenic diet.” A ketogenic diet is a very high fat diet with practically no carbs whatsoever. This is not a normal diet with moderate levels of good fats! I can only imagine the amount and type of fat given these test subjects to get these types of results. (With no doubt, practically no veggies or fruits to get them into ketosis, and having, as a result, the diet “quality” being totally unbalanced and atrocious.)

    Triglycerides can also be raised by eating way too much refined starch and simple sugars over time. (white sugar, white flour, desserts, pastries etc., and isolated fructose seems to be a huge contributor/offender here.) High triglycerides can also cause insulin resistance. And a few weeks study probably isn’t going to show this. We are not talking about a whole foods plant-based diet here. We are talking about such a high saturated fat intake that ketosis is induced. And to do that the veggies and fruits and whole grains have to be severely limited or eliminated altogether.
    When the pancreas has to over produce insulin to compensate for a high refined grain/sugar diet year after year after year to low the blood sugar, the insulin receptors get pounded and eventually they “turn off” to the insulin stimulus

    “Even if people have not been diagnosed with triglycerides outside the normal range, if they eat too many simple sugars (refined grains, added sugars and alcohol) their triglycerides will
    2
    increase. Everyone – whether or not they have high triglycerides — should focus on fiber-rich complex carbohydrates, such as vegetables and whole grains, instead of simple sugars.”
    https://my.americanheart.org/idc/groups/ahamah-public/@wcm/@sop/@smd/documents/downloadable/ucm_425988.pdf
    “No other food types yielded significant individual associations with diabetes prevalence after controlling for obesity and other confounders. The impact of sugar on diabetes was independent of sedentary behavior and alcohol use, and the effect was modified but not confounded by obesity or overweight. Duration and degree of sugar exposure correlated significantly with diabetes prevalence in a dose-dependent manner, while declines in sugar exposure correlated with significant subsequent declines in diabetes rates independently of other socioeconomic, dietary and obesity prevalence changes. Differences in sugar availability statistically explain variations in diabetes prevalence rates at a population level that are not explained by physical activity, overweight or obesity”
    http://www.ncbi.nlm.nih.gov/pubmed/23460912
    And here are some more links on the impact of refined sugar and carbs on triglycerides and the incidence of diabetes.
    http://healthyeating.sfgate.com/can-high-intakes-carbs-cause-triglyceride-levels-rise-2495.html
    http://ajcn.nutrition.org/content/86/4/899
    http://authoritynutrition.com/11-graphs-that-show-what-is-wrong-with-modern-diet/
    http://www.ncbi.nlm.nih.gov/pubmed/23594708
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2673878/
    The cherry picking continues. On both sides of the isle.

    • Palmer Harsanyi

      Well said! I was thinking cherry picking when I saw the title of the video. Very happy to see someone on this site who pays attention, can see nuances and hate cherry picking as much as I do. Al though Dr. Greger has some pretty good info some of the time, cherry picking happens quite often as well, as with followers of other dietary camps. So I very much appreciate your comment and the links to the articles.
      Although, I don’t quite understand why triglycerides (and that includes MCT as well) is a problem when running the body on ketones, as some children with epilepsy – as far as I know – have lived healthy lives without seizures, while being on ketogenic diet.
      • “The total diet duration is up to the treating ketogenic diet team and parents; durations up to 12 years have been studied and found beneficial.” http://en.wikipedia.org/wiki/Ketogenic_diet

      • b00mer

        You were already thinking cherry-picking before you saw the video? Do you see any irony there?

        • Palmer Harsanyi

          Not really, given the track record I have seen so far on subjects regarding ancestral health on this site, and the debunks I have posted on YouTube regarding some of these. (Although I haven’t seen them appearing on the comment feed for some reason, so I stopped posting.) If I were a newbie and didn’t have any prior experience with videos covering subjects like these made by NutritionFacts.org /Dr. Greger, you would have been right.

      • Guest

        me thinks you need to scrap those ” cherry picking” fingers at the real cherry pickers. the meat, eggs and dairy funded keto studies. you wanna see real cherry picking and misleading manipulated data? look no further than your typical low carb keto site.

    • b00mer

      First arguing that refined sugars and grains are unhealthful is a bit of a red herring. It is not within the realm of possibility that both refined sugars and high fat consumption can be detrimental?

      Second, if you object to results using a ketogenic diet in the initial graphs, you should enjoy the subsequent graphs which show continual improvement at every step:

      carbohydrate increased from 19 → 30% (fat reduced from 70 → 58%)
      carbohydrate increased from 30 → 41% (fat reduced from 58 → 47%)
      carbohydrate increased from 41 → 52% (fat reduced from 47 → 36%)
      carbohydrate increased from 52 → 63% (fat reduced from 36 → 25%)
      carbohydrate increased from 63 → 75% (fat reduced from 25 → 13%)

      The results of the 1934 study which every subsequent study is trying to elucidate the exact mechanisms for, were obtained using dietary mixtures of fresh cabbage, oats and bran, and soy bean meal, which actually does represent a pretty decent whole foods plant based diet.

      Nearly every other study is using the “gold standard” clamp test and/or NMR to determine insulin resistance as a result of lipid infusion or correlate insulin resistance with intramyocellular lipid content.

      Most of the research accepts lipid-induced insulin resistance as an established phenomenon, as shown in the quotations below, all provided as background material in the sources cited. To insinuate that the lipid-insulin resistance connection exists only as a result of one man’s cherry-picking is to ignore an entire landscape of meaningful and high quality diabetes research. Critiquing exact diet composition is fair, as often the means to distinguish between the effects of fat and carbohydrate involves diets quite poor in nutritional quality, and we see that in many nutritional studies. However wholly and summarily dismissing nearly 90 years of research is unfortunately incurious as well as disrespectful to a large number of competent researchers, and discrediting the person presenting it as nothing more than a “cherry-picker” is a bit dishonest as well.

      ___________________________________________________________________________

      “It is now established that the sugar tolerance is impaired by starvation or the taking of diets with a high content of fat, whilst it is
      improved by taking diets containing an excess of carbohydrate.”

      “To examine the mechanism by which lipids cause insulin resistance in humans”

      “Skeletal muscle is the primary site of the FFA-mediated decrease in insulin-stimulated glucose uptake. Lipid accumulation within muscle cells (intramyocellular lipid, IMCL) is associated with insulin resistance”

      “The initial effects of free fatty acids (FFAs) on glucose transport/phosphorylation were studied” [to contrast with the possible pyruvate dehydrogenase inhibition mechanism]

      “Recent muscle biopsy studies have shown a relation between intramuscular lipid content and insulin resistance.”

      “Here we examine the latest evidence as to why lipids might accumulate in muscle and the possible mechanisms for lipid-induced insulin resistance.”

  • donmatesz

    From the data in the table from the Sweeney paper, the best glucose tolerance was achieved with diet 7 which was ~13% of calories from fat, and diet 6, which was only ~25% fat resulted in significantly lower tolerance and glucose stability. The full article is behind a pay wall so I am not sure what type of fat was used in diet 6, but from the data appearing in this video it appears that consuming more than ~15-20% of calories from fat will result in significant impairment of glucose metabolism.

  • Rob

    Dr. Greger, where can I find the studies that you have on this video so I can read them myself? You did not say anything about the type of fat. Thanks.

    • Thea

      Rob: To the right of the video is a button called, “Sources Cited”. Click that to see a list of the studies referenced in the video.

    • Just to the right of the video is a click-able “sources cited” listing

      Oop, Thea just said that :)

      • Rob

        Thanks. Silly of me to not see that button.

  • vegank

    Oatmeal is supposed to be low G.I ., slow releasing but I find that after about an hour or two my energy seems to plummet. Dried fruit is also a problem because of the sugar spike I seem to get.
    I find that beans on the side or Tofu in Miso with steamed sweet potatoes work best. For me fat is not likely to be the culprit as I am on a very low fat PBWF diet but more likely to be the issues Dr Forrester suggested Re:some people having problems with fruit.
    The tricky meal is lunch, as we often do not have the time, and need something quick and ‘portable’ rather than a meal we sit down to eat. Maintaining a stable glucose level seems more difficult in the afternoon for some reason, I don’t know if anyone else finds this too.
    In a nutshell Yes! we need to experiment until we find what is right for our individual needs.
    Thank you Dr Greger for this excellent presentation. The visuals worked for me.

  • cameron

    I was just wondering what type of fat really shows to cause the most insulin resistance, because avocados, nuts, and other plant based fats play a good role in health.

  • David

    I shared this video with a friend at work and he sent me this link: http://www.livestrong.com/article/472539-will-fats-raise-my-blood-sugar/. It says “While eating fat does not directly raise your blood sugar, it may play a positive role in glucose metabolism”. Then the article has a heading “I Can’t Believe It’s Butter”. I believe Dr. Greger’s videos, so I’m wondering about the conflicting information.

    • largelytrue

      “Nutrition and Metabolism” has been criticized as a low-carb-biased source by Plant Positive:

      https://www.youtube.com/watch?feature=player_embedded&v=LsZgTtqfV5k#t=275

      I will only sketch an idea about how the findings might be reconciled, without digging into the potentially dubious source behind LS’s ambiguous citation. The increase in intramyocellular lipid was found to increase insulin resistance in as little as 3 hours. However, over the short term, fat is transported to tissues as fat; it doesn’t transform into glucose, so neglecting other issues about calorie balance, it doesn’t raise blood sugar over the short term. And indeed, fat mixed with carbs may slow the absorption of the carbs somewhat, lessening the peak level of blood glucose in that three hour window.

      However, the peak level of blood glucose is not really what diabetics want to control in managing their disease symptoms: the area under the curve also matters, meaning that simply smoothing out the blood sugar spike by eating more fat may not be so great. Moreover, given that type II diabetes is fundamentally a disorder of advanced insulin resistance, it seems that restoring insulin sensitivity would be the ideal goal, since this would tend to roll back all the other metabolic problems which flow downstream of insulin resistance. Regardless, improved insulin sensitivity of value to all diabetics with irreversible insulin-dependence, and especially valuable to nondiabetic people who don’t want to get even near the risk of diabetes.

      • Thea

        largelytrue: Thank you for this thoughtful response. I hadn’t thought before about the concept of “the area under the curve”. I have previously only heard about people being concerned with flattening out peaks. Thanks for giving me something to think about/look into.

  • Barbara Shea Tracy

    I have to respectfully disagree with you. I work with diabetics and have found the low carb, high fat way of eating to be exceptional! Many of my patients are off oral diabetic meds and one came off insulin. I work with a lipidologist who completely agrees. My patients’ lipid profiles are excellent and I use the VAP cholesterol profile. I follow the LCHF way of eating and have never felt better. My labs are perfect. I’ve been able to get patients off statins with this way of eating.

    • largelytrue

      If you’re going to be detailed enough to mention the method of cholesterol profiling, you should also include numerical information about those ‘perfect’ labs, and give us some idea what you mean by an ‘excellent’ lipid profile.

    • Guest

      low carb high fat diets have been shown to feed heart disease. do you care about that? low carb diets also increase all cause mortality and lead to a shorter sicker life. you should probably be more up front with your patients about the dangers and risks involved with low carb diets before you put people on them. i wonder how great your patients would do if you stopped harming them with low carb diets and put them on a better high carb plant based diet to cure thier t2d.

  • Judy Fields Davis

    thanks so much!

  • Maxine

    When you say fat do you mean “saturated” or all good fats as well.

  • Mathias Luz

    No matter what kind of fat ( saturated or unsaturated) is it anyways detrimental for insulin sensitivity? Thanks!

    • Daniel Wagle

      This study http://www.ncbi.nlm.nih.gov/pubmed/15297079 states, “Insulin sensitivity is also affected by the quality of dietary fat, independently of its effects on body weight. Epidemiological evidence and intervention studies clearly show that in humans saturated fat significantly worsen insulin-resistance, while monounsaturated and polyunsaturated fatty acids improve it through modifications in the composition of cell membranes which reflect at least in part dietary fat composition.”

      • Mathias Luz

        Thank you so much @danielwagle:disqus

  • mlev5

    I have a question… If fat causes blood sugar to rise, and thereby contributes to diabetes, then why do pistachios help to lower blood sugar? don’t pistachios have lots of fat? see link: http://www.ncbi.nlm.nih.gov/pubmed/25396407

    • Linda Lawrence Beeker

      Good question. Not all fats are created equally and pistachios have good fat. According to the USDA National Nutrient Database, 100 grams of pistachios have 23.8 grams of monounsaturated fat, 13.7 grams of polyunsaturated fat, and only 5.6 grams of saturated fat. Check out Dr. Gregor’s video Lipotoxicity: How Saturated Fat Raises Blood Sugar for more information.

      • mlev5

        Thanks Linda.. I will check out the video.

      • Jim Felder

        Also pistachios are a whole food and more than just their fat content. In fact their health promoting effects might be do to everything they contain but the fat. Or it might be the fat in combination with all the thousands of other nutrients in whole food that is the source of their good effect so defatted pistachio flour might not be effective either. Beware reductionist thinking.

  • sf_jeff

    Great video! Any chance we can have that quantified? What is a “high fat diet” leading to the short term insulin resistance above? 40/30/30 (fat/protien/carbs)? 50/30/20?

  • Interesting but based on this information how do you explain the apparent success of the Atkins diet?

    • largelytrue

      Success at what?

    • Lawrence

      Hi Darren, The HCG Diet? Seriously? I think you may have come to the wrong forum to sell either ketosis or the HCG Diet. Buyer Beware!
      http://www.mayoclinic.org/healthy-living/weight-loss/expert-answers/hcg-diet/faq-20058164

      However, to answer your question, please 1) watch all three of Dr. Greger’s Nutrition Year In Review presentations found at the bottom of this site’s home page and 2) watch the following lecture by Dr. McDougall. Thanks for the question and keep coming back.
      https://www.youtube.com/watch?v=iosoXlr3ZVI

      • Lawrence, I am not trying to sell anything, and think you should be a bit embarrassed by your response. I asked about Atkins, which, by the way I do not “sell”, and you respond about hCG, what are you selling?

    • Lawrence

      Hi Darren. Normally, I don’t get involved with back-and-forth postings. But, in this case I am making an exception.
      Are you not the Medical Director of the Vibrance Medical Group?
      http://bevibrance.com/
      Does not the Vibrance Medical Group sell the Vibrance SHAPE Program that promotes the HCG Diet?
      http://bevibrance.com/our-services-2/hcg-weight-loss-program/
      Has not the FDA declared HCG Diet products to be illegal?
      http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm281333.htm
      Q.E.D.
      http://en.wikipedia.org/wiki/Q.E.D.
      Re Atkins, it is simply a losing proposition. Drs. Greger and McDougall are quite explicit on this. And none of us who put their teachings into practice will waste their vitality on ketogenic diets, I’m fairly certain.
      Thank you for your reply and keep coming back.

    • MyDiabetesisCured

      I would like to try and answer your question. I did atkins for over 2 years, as well as plant based whole food for 2 years. Excess dietary fat blocks insulin receptors from responding correctly. If you remove the carbs from the equation, the insulin receptors remain blocked, however the lack of carbs keeps blood sugar stable, helps with weight loss, and temporarily seems to make diabetics feel better. Unfortunately, as the excess fat continues to build, over time blood sugar is stable, but continues to rise higher and higher. Low carb high fat diet actually made my type 2 diabetes more severe over time, and other health conditions developed. In the beginning, I felt better because my blood sugar was no longer swinging back and forth, but overall made things much worse because it was making me more and more insulin resistant over time. I still required metformin to keep my blood sugar down and my A1C gradually rose to 7.4 on a low carb diet. When I changed to a whole foods plant based diet and brought my fat % down to 10%, my blood sugar normalized and I was able to get off the metformin in only 10 days. By clearing out the fat, my insulin response returned to normal and my last A1C was only 4.7. Atkins diet affected more than my blood sugar, it caused me to have yeast issues, autoimmune disease, acne, constipation, and high cholesterol. All of those problems went away quickly by switching from atkins to plant based. So in conclusion, Atkins temporary hides the symptoms, while making the cause worse, and any success on Atkins is only temporary. In the end, it raises the risk of many other diseases and is not worth it.

      • Thea

        MyDiabetesisCured: This is such a great post, because it not only gives a personal story, but also includes a very easy to understand explanation of what was happening and why. Thanks for this post! I hope others can learn from your experiences and avoid the first mistakes.

  • adaprincess2

    Can getting tired after you eat cause Insulin Resistance or just being overweight in general? I’m vegan and have gone down 4 sizes now but still low energy esp after eating. I do a smoothie for my first meal with nuts usually. A meal is usually cooked veggies with potatoes. I’m thinking it just from still being overweight.

    • Linda Lawrence Beeker

      Congratulations on taking control of your health and improving your diet! Improving your diet should lead to more energy, not less. Is it possible that you are not getting enough vitamin B12? Check out Dr. Gregor’s answer to What is the best way to get vitamin B12? for more information.

      • adaprincess2

        I take 250mcg a day like Dr. Greger suggests :) I’ve check my sugar too and everything is normal esp after eating.

        • Linda Lawrence Beeker

          Wonderful! So, on to the next question: Do you eat a variety of plant-based foods? Many deficiencies can lead to ill health and a variety of food is needed to obtain a variety of nutrients. Some of the nutrients that come to mind are Iron, Vitamin C, and the other B Vitamins. Check out these videos and let me know what you think:
          Apples and Oranges: Dietary Diversity
          Risk Associated With Iron Supplements

          • adaprincess2

            I thought I ate a variety of veggies lol. I was thinking of adding a b complex supplement though. I know I get enough iron we use a cast iron pan & vitamin C we drink juice & eat a lot of broccoli. I will do some research on it though. I’m bound to find a link. Thank you so much Linda for helping me. You are very kind to help :)

  • Ken Thomas

    This is the presentation I have been longing to see for the past twenty six years. My disappointment is that this has not been
    common knowledge for such a long time. From personal experience, insulin resistance should not be such a mystery. Type-1 diabetics are the perfect study subject because they cannot produce insulin and thus have to inject it on their own. This means insulin requirement relationships per food intake is very obvious – without interference from a functioning pancreas. As a Type-1 diabetic, I learned about the relationship between fat and insulin twenty six years ago. Even though the effect is 100% repeatable and obviously documented in my diabetic logs, I still suffered resistance from my doctors about my diet.

    I truly hope this video- this information – gets widely dispersed and accepted. There are millions of diabetics, not to mention the average American, suffering from needless ignorance and misguided by established medical practice.

    If interested, I have been posting my Type-1 diabetic story and blogs about insulin resistance on the Starch-Smart.com website. (https://www.starch-smart.com/blog/blogger/listings/kenscircus)

    • Thea

      Ken Thomas: Your post was so interesting to me because you have Type-1, which is often given a backseat on the research it seems to me. (Or maybe just what I know of the research.) But your idea of using a Type-1 person to do certain types of research that might inform us how to proceed with Type 2 is very intriguing.

  • Why is it so difficult to answer my question? What has anything to do with Vibrance have to do with my question? Do you only take seriously people who agree with your opinion? Please do not forget, Lawrence, doctors in the past have been persecuted for suggesting things like the importance of hand washing so your condescending obsession with Vibrance is totally inappropriate. I am trying to understand the science behind the weight loss achieved on an Atkins type diet which is high in fat and so should cause insulin resistance and weight gain yet does seem to cause weight loss.
    Never mind, I am not interested in learning anything from someone with as closed a mind as yours. I will not be responding anymore.

    • largelytrue

      Darren, could you please repost your comment so that it is a reply to Lawrence, if Lawrence doesn’t respond to you within a few days? You are addressing him most directly and continuing the earlier discussion, but by not responding in the thread notice won’t get notice of your comment in Discus.

      When you restrict your definition of ‘success’ to weight loss I am a bit puzzled why you are unaware of plausible explanations. Cannot a high-fat diet result in calorie restriction, especially when compared with the baseline diets of the highly obese? Wouldn’t this result in weight loss, at least initially? I’m fairly confident that ketogenic and near-ketogenic diets have an appetite suppressant effect during weight loss, e.g. http://www.ncbi.nlm.nih.gov/pubmed/25402637

      Also, what has you so confident that increased insulin resistance would have a large obesogenic effect in those who are already obese, or that the partial effect of increased dietary fat on insulin resistance would be large in an obese person? Have you seen the next video in which weight loss itself is suggested to reduce insulin resistance?

  • Matthew Smith

    Drinking vinegar can help with blood sugar and insulin resistance, see this link. http://care.diabetesjournals.org/content/27/1/281.full
    There is a review at this site: http://nutritionfacts.org/video/is-vinegar-good-for-you/
    Perhaps Amla is more powerful when taken with meals.

  • DStack

    Is it true that IGF-1 also factors into insulin resistance?

  • SeveralOfUs

    Several people on my forum are debating this video. One said the following and others of us would like Dr. Greger’s response to this. Thank you.

    This [lecture by Dr. Greger] is based on old, discredited science bought by drug manufacturers.
    One of those papers linking intramyocellular lipids to insulin
    resistance that proliferated in the late 90s contained this delightful
    footnote:

    “All authors are employed by and hold stock in Aventis Pharma, which
    manufactures and markets pharmaceuticals related to the treatment of
    diabetes.” (http://m.diabetes.diabetesjournals.org/content/52/1/138.full).

    Specifically, which pharmaceuticals? Glad you ask. Many of these
    late-1990s studies were advertorials for rosiglitazone, aka Avandia, a
    drug that killed thousands before being outlawed in most of the world
    (but not in the US, which is cool because unlike those foreigners we
    have the FDA to keep us safe).

    You might find this 2012 revisit of the 1999 study Mr. Gregor goes on about interesting:

    “In the mid-1990s, researchers began to re-examine type 2 diabetes from a
    more ‘lipocentric’ perspective; giving strong consideration to the idea
    that systemic lipid imbalances give rise to glucose dysregulation,
    rather than vice versa. At the forefront of this paradigm shift was a
    report by Krssak and colleagues (Diabetologia 1999; 42:113-116) showing
    that intramyocellular lipid content, measured via the (then) novel
    application of proton nuclear magnetic resonance spectroscopy, served as
    a robust indicator of muscle insulin sensitivity in healthy
    individuals. A subsequent wave of investigations produced compelling
    correlative evidence linking ectopic lipid deposition within skeletal
    myocytes to the development of obesity-associated insulin resistance.
    But this relationship has proven much more complex than originally
    imagined, and scientists today are still left wondering if and how
    the intramyocellular accumulation of lipid droplets has a direct bearing
    on insulin action. Originally viewed as a simple storage depot, the lipid
    droplet is now recognised as an essential and sophisticated organelle
    that actively participates in numerous cellular processes. This edition
    of ‘Then and now’ revisits the connection between intramuscular lipids
    and insulin resistance and looks to future research aimed at
    understanding the dynamic interplay between lipid droplet biology and
    metabolic health.” (http://www.ncbi.nlm.nih.gov/pubmed/22660796)

    This kind of propaganda would be fascinating indeed, at least in the way
    Jackass movies and YouTube motorbike wheelies crash videos are, if some
    folks didn’t ruin their health watching them.

    • I tried to open that last link you posted–and the article did not appear. Would you mind re-posting the link?

    • JackXXL

      OK the link worked on my second attempt.

    • Gene

      your forum? im guessing some paleo blog site? dr greger advocates a high carb plant based diet devoid of animal products to cure diabetes t2 not statins. lipotoxicity is widly accepted in the medical world. how do you think it got the name “lipotoxicity =toxic fat”? trying to discredit dr gregers work by claiming old data and industry ties is laughable and grasping at straws.

  • Jopowilson

    Do all fats work the same way once they reach the bloodstream? Would trans fats and ground flax seeds have the same effect on blood sugar?

  • I’m a type 1 diabetic who eats entirely vegan, but I talk with many, many type 1’s who eat ketogenic, and I know what they would say. They’d say that because they’re eating so few carbs, there is less glucose at the door of the cells, so it doesn’t matter that the fat causes insulin resistance.

    • Thea

      Food and Loathing: Here’s what I would say back: “Suppose I agree with you that insulin resistance by itself is no problem because you aren’t eating carbs. It’s still a very bad idea. Ketogenic diets are associated with other health problems, such as lower cognitive performance, kidney damage, osteoporosis, etc. And if the fats you are eating include any significant amount of saturated fats and/or a large omega 6 to omega 3 ratio, you are setting yourself up for heart disease down the road. What is the point of eating in a way that helps you manage your diabetes, but gives you long term poor health and increases chance of early death?”

      • dogulas

        I don’t see how it would ever be a natural diet, and I would never advocate it, but have there been any studies on high-fat whole-food plant-based diets and diabetes? Does it really matter all that much what the source of fat is, when it comes to the reduction of insulin insensitivity? For example if someone at a diet that was at least 50-60% fat, chalk full of nuts and avocados, would they still develop or maintain type-2 diabetes? See, that much fat is clearly not good for the heart and cardiovascular system. We know that. So of course, there’s no reason to advocate such a diet. But people still bring this up regarding diabetes, so it would be cool to have an answer.

        My current answer is, “Who cares?! If it isn’t a good idea for other facets of health, it doesn’t matter. Even if an avocado and coconut-based diet were fine for diabetes (which I doubt it is), you’ll have cardiovascular disease. So the question is a fairly irrelevant.”

  • marisaji

    thanks for this video dr Greger.
    As I understand from this video, high fat and ketogenic diets increase insulin resistance. How would you explain a certain Dr. Attia, that was included in a Mercola’s article, who consumes 80 percent of his calories from fat and
    continuously monitors his metabolic markers (blood sugar, percent body fat, blood pressure, lipid levels). He has done that for 10 years, and he reports lower fasting blood sugar (75-95 compared to starting 100, and increased insulin sensitivity by 400%). This are completely opposite findings, that makes me really confused :( http://articles.mercola.com/sites/articles/archive/2014/02/02/ketogenic-diet-health-benefits.aspx

    • Diabetecured

      High fat diet does block insulin receptors from working properly. However, if the person is not eating any carbs at all, the blood sugar may still remain low. 90+ fasting blood sugar is still considered insulin resistant. It may work as a bandaid for some people. In my experience in eating a very low carb diet for over 2 years, my blood sugar no longer was swinging up and down, but gradually over time, my blood sugar and triglycerides rose a lot. I would like to have that person eat a plate of spaghetti and see what happens. He also may be eating less calories, exercising more, and possibly taking medication to lower blood sugar Personally, my results are great with eating low fat vegan. I have increased my calories, but my fasting blood sugar went from 220 down to 80. Body fat% from 33% down to 20% (lean for a woman). Waist from 29 down to 27. Blood pressure down to 105/71. Triglycerides from 200 to 86. So you see, my change is greater than his when going from low carb high fat to a low fat vegan diet.

      • Roger

        attia himself admits that much of his work is funded by industry and he is beholden to them like his research partner gary taubes who was paid 700k to write a pro atkins type book. both attia and taubes have been critisized for mileading information.

  • Alex

    Would a patient with type 2 diabetes/insulin resistance and strong will power likely cure themselves within a day by drastically reducing their fat intake? My understanding had been otherwise.

    • JackXXL

      How about a couple of months? In that case, quite a lot would no longer show symptoms of diabetes but remember that most T2 diabetics have lost half the beta cells in their pancreas by the time they are officially diagnosed. So their ability to produce insulin is much reduced. The beta cells have burnt out trying to keep up with the apparent need for more insulin. In fact their blood insulin levels were probably off the charts for a decade before their diagnosis, which is a great shame because that can be easily tested but usually isn’t. However, if they live a 100% low fat, plant-based diet then they will not need that much insulin and therefore could remain symptom-free. The other factor though is obesity. There is another video on this site that uses the same principles shown in this one but further suggests that (in simplistic terms) that the fat cells of obese people are full to overflowing and this allows free fat to get into the bloodstream and float around – not packaged into lipoproteins like LDL – and that this fat can get into the muscles and cause insulin resistance too, regardless of diet. I’ll try to find it.

  • dluzader

    Good video, but is there another reason for insulin resistance? According to Dr. Jason Fung insulin causes insulin resistance and Type 2 diabetes can be cured by fasting or bariatric surgery. The surgery outcome has been documented as eliminating Type 2. Since for most people with type 2 would not opt for the surgery a fasting program is the next best option. I would like to see another video on the cause of insulin resistance showing this research. This was a YouTube video and I thought it was very good. Jason Fung was speaking to an audience of doctors. https://www.youtube.com/watch?v=4oZ4UqtbB_g

    Any thoughts?

    • Teddy k

      depends on if this guy understands and accepts “lipotoxicity”. Being that when we remove saturated fat from the diet, insulin sensitivity is normalized. if he is not looking at fat as the cause of t2d then he is offering only symptom masking.

  • JackXXL

    The quoted studies refer to animal fat sources. What about vegetable oils – olive oil in particular? Do they also promote insulin resistance?

  • Margie
    • Roger

      i wouldnt trust that site. its just another low carb blog by a industry backed front group. we need to get the word out to be leary of cholesterol denialists like at guy.

  • walterbyrd

    Is it dietary fat, or body fat, that causes the insulin resistance? Does body fat cause fat to get in your muscles and resist insulin? Or does eating a fatty meal cause fat to get in your muscles, even if you are thin?

  • Zach

    Hello, I have a question regarding what is called ‘carb cycling.’ I haven’t been
    able to find studies about it, but there are many people who claim that carb cycling
    improves metabolic function. The basic idea is to alternate low carb days with high
    carb days. There are many variations of this. There could be, for example, two low
    carb days followed by a high carb day, etc. However, a problem is that when going
    low carb for a day or more, and then introducing carbs the next day, there is an
    abnormally high blood sugar spike. This is because going low carb, even for a day,
    increases insulin resistance, especially if this low carb day is high fat. However,
    what about alternating high carb days with reduced carb days, but not low carb days?
    For example, a person could alternate a 400g net carb day (high carb day) with a
    150-200g net carb day (reduced car b day). The reduced carb days would probably not
    be enough to cause insulin resistance. Do you think this would have any benefit to
    the metabolism, or would there hardly be any effect one way or the other, neither
    positive nor negative? Thanks!

  • DanielFaster

    Triathlete/weight loss surgeon Dr. Garth Davis just posted a fantastic detailed blog on diabetes being caused by animal protein, cured by carbs https://www.facebook.com/drgarth/posts/942670975753811

  • baggman744

    “Lower the level of fat in people’s blood and the insulin resistance comes right down…” If that were true in most cases, wouldn’t medical treatments like statins raise insulin sensitivity? Or, is it because statins sourly work to lower LDL cholesterol.

  • Brandi

    Does this apply to all fats (think nuts and avocados as well as animal-based)?

  • Bob413

    What causes insulin resistance? Easy.

    Think of insulin as this really annoying fellow knocking at the door. Think of your insulin receptors as the person who opens the door. The more the person knocks at the door, the more the person inside is less inclined to answer it. So the more insulin in your system, and the more it comes knocking at the door, the more likely your receptors will ignore the knocking.

    Ideal situation, it’s a simply a suttle knock that your receptors are excited to hear and open the door (insulin sensitivity).

    Now go to your glycemic index and either avoid or minimize the foods that cause greatest amount of insulin release: Sugars, pop, candy bars, rice, pasta’s, potatoes, fruit, and grains.

  • Bobby5939

    I’ve seen Dr McDougall mentioned quite a few times in this article so I figured I should step in. Dr McDougall has been diagnosed with a fatty liver due to his diet. He also looks like he is on his death bed because his thyroid is suffering.

    Whatever diet he is following should be avoided like the plague. I know his diet and what he preaches, things like starches and grains need to be avoided.

  • This is a over simplistic view of insulin resistance. Yes fat is associated with insulin resistance but the fact that you simply eat more fat and you’ll have insulin resistance is misleading. Fat is not absorbed into your blood stream after you eat. At least not all types of fat. Saturated fats or short chain fatty acids are not absorbed and are digested. Long chain fatty acids such as hydrogenated oils are digested like carbohydrates and enter the blood stream. But the main mechanism for fat production which could possibly cause the “cell gumming” refereed by Dr Greger is the carbohydrate digestion which causes spikes in insulin production therefore causing it to store fat since one is one the chief functions of insulin. http://www.diabetesreviewer.com

  • edGill

    Excellent and Kudos

  • Jack

    Show me articles that confirm that fats are the cause of insulin resistance; I’ve seen nothing. All I have seen are just correlation not causation. No one knows how insulin resistance really works.

    The problem with all these diets is that there is really no scientific basis. All are based on conjectures and no scientific proof. That’s why you have so many diets that works with some but not everyone.

    For me I follow the Gerson therapy as it is the only one so far that works for my type 2 diabetes. That and hiking in mountain trails of Arizona 5 days a week.

  • ale granados

    hey! I have insulin resistance, I do track and field and I have 15 years old, I really want to go vegan or vegetarian, it is good for me to go vegan or vegetarian? it will help me?

    • Thea

      ale: I think it is great that you are thinking about going vegan (or vegetarian)! There is every reason to believe that you could really help your insulin resistance by doing so. Here is a wonderful book about healthy diets for diabetics and pre-diabetics if you are interested. This book also includes recipes in the back.
      http://www.amazon.com/Neal-Barnards-Program-Reversing-Diabetes/dp/1594868107/ref=sr_1_1_twi_pap_1?s=books&ie=UTF8&qid=1441409277&sr=1-1&keywords=prevent+and+reverse+diabetes

      Note that the “devil is in the details”. In other words, it is not sufficient to just go vegan, it’s *how* you go vegan that matters. The trick is not just to leave out the meat, dairy, and eggs, (an processed oils), but to make sure you take in plenty of the foods that are good for you – specifically, *whole* plant foods in these categories: fruits, veggies, legumes, whole intact grains along with some nuts/seeds and also some cooked mushrooms if you like those. Don’t forget to take a B12 supplement.

      Here’s a website that talk about how a teen can eat a plant based diet and do well:
      http://www.vrg.org/family/kidsindex.htm

      If you scroll down on the page, you will even see that they have a whole document about vegan teen athletes.

      I have lots of links/stories about very successful vegan athletes. Let me know if you want that information. I can also give you some more advice on the practical how-to side if you want. Do you need some meal plans/recipes?

      And good luck! I hope you win a lot of races!

  • ale granados

    hey! I have insulin resistance, I do track and field and I have 15 years old, I really want to go vegan or vegetarian, it is good for me to go vegan or vegetarian? it will help me?

  • Natasha Catherine

    So is it a problem to eat healthy fats (i.e. nuts rather than oils or animal fats) combined with fruit? It sounds like that combination is just asking for insulin resistance. Or is this only an issue with unhealthy fats & sugars?

  • Sasha

    Dear DR. Michael ….. does that mean that I cant use flax and walnuts in my fruit blend?

  • Andrea Crous

    I was diagnosed with insulin resistance on n very low fat “healthy” carb diet. I was put on medication for diabetes for two years. Once I changed my diet to a low carb high fat diet all my problems with insulin resistance has gone away, my blood sugar is normal, I feel great, my cholesterol levels are normal. This was the best decision I have made, I have been following a low carb high fat life style for almost three years now, and all my problems are gone.

    • Guest

      give it time, low carb/ketosis is a state of sickness and your body will start breaking down the longer you subject it to the stress and damage of carb restricting. this site cautions to stay away from fad keto diets, they are not good for long term heath and are associated with higher all cause mortality, meaning they shorten your life.

  • Liz Pagán Lugo

    Very informative, Thabnk you. But is insulin resistance problem if the person is eating alow carb diet anyway? I mean the hig fat paleo diet folks may develop insulin resistance, but it doesnt matter because they are low carb right?

  • Celina

    Hi there, please note that the first link in the cited resources does not take you to the correct resource – H P Himsworth. The dietetic factor determining the glucose tolerance and senility to insulin of healthy men. Clinical Science 1934; 2, 67—94.

  • David
  • carolyn bishop

    I can’t read through all the comments to see if this has already been covered. Does anyone know if they have studied natural/unprocessed PB fats for contributing to insulin resistance? Since so many of the other concerns for different aspects or components of foods don’t hold up for the vegan counterpart, I am wondering if it could hold true to fats as well, as in fats like avocados, nuts, fatty seeds, etc. and unprocessed olive oil, for that matter (all of which I love and gravitate toward) and have heard it suggested that these are healthy for us and necessary- that there is a good reason we gravitate there; our body needs those fats to build healthy cell walls, etc. I would be VERY interested to know the answer to this as I am trying to make the very best food choices and do well for my waistline.

  • Brock

    Hi, considering our bodies will weaken certain part’s we do not use much, i.e bones and muscles, I just watch a program where Prof Tim Noakes was showing how fat does not spike your insulin and that sugar does, of course I realize that’s exactly what sugar supposed to do, however I was wondering if you go on a high fat low carb diet long term if it would weaken you’re pancreas ability to create insulin due to a long term lack of need to create much insulin, much like not using muscles weakens them?

  • P_a_u_l

    Unfortunately there is so much out there in popular literature that claims just the opposite. See:
    http://articles.mercola.com/sites/articles/archive/2014/02/02/ketogenic-diet-health-benefits.aspx
    It is great that Dr. Greger presents the facts but sadly, that is not enough – there is a battle of misinformation that needs to be engaged. Just putting out info and sitting back as if it will “sell itself” is wishful thinking. Hopefully Dr. Greger will debunk these claims.
    My pre-diabetic brother watched Dr. Greger’s video and then Dr. Mercola’s completely contrary claim – which one do you think he prefers?

  • Mark Spencer

    Why do keto diet proponents say that insulin resistance and diabetes in general can be resolved on long term ketogenic diets…? In other words they say they have to go through this initiation phase where they reach the “magical” ketone producing phase of the diet after say about a month…and then the body normalizes…I find it hard to believe myself, but it seems to be popping up everywhere lately….

  • alegranados

    hey, so, I’ve been diagnosed with hyploglycemia and insulin resistence, do you think a vegan diet can help me?

  • Lorraine Taylor

    yes, but what about the fact that insulin CREATES and helps store fat? Anybody?

    • Cathleen_NF_Moderator

      Hi Lorraine- strictly speaking, insulin does not create fat, but you’re right, it is absolutely involved in the pathway that leads to the body making and storing fat. As shown in the video, insulin signals cells to take in glucose. Once the cells have enough glucose for their immediate needs, the excess is stored as fat. Another reason to be cautious of eating too much fat or just too much in general! I hope that answers your question and thanks for contributing.

  • Tom Goff

    Some new research suggests that genetics plays an important role both Type 1 and Type 2 diabetes:
    ” Our research finds that genetics is critical for the survival of beta cells in the pancreas — the cells that make insulin. Thanks to our genetic make-up, some of us have beta cells that are tough and robust, while others have beta cells that are fragile and can’t handle stress. It is these people who develop diabetes, either type 1 or type 2, while others with tougher beta cells will remain healthy even in if they suffer from autoimmunity or metabolic dysfunction of the liver.”
    However, even here, the diet plays a key role. Adrian Liston (VIB/University of Leuven): “While genetics are really the most important factor for developing diabetes, our food environment can also play a deciding role. Even mice with genetically superior beta cells ended up as diabetic when we increased the fat in their diet.”

    Sounds to me like our keto diet friends are really working very hard to develop diabetes.

    And, since the food environment appears to have a “deciding role”, all of us should be keeping fat in our diet very low if we don’t want to trigger T2D
    https://www.sciencedaily.com/releases/2016/03/160321123544.htm
    http://www.nature.com/ng/journal/vaop/ncurrent/full/ng.3531.html

  • crescendo

    While this makes sense, I read an article saying that it is not so simple. Here is the quote, “Although athletes have elevated levels of intramyocellular lipid (IMCL) they usually are very insulin sensitive. So, the relationship between lipid storage in skeletal muscle with insulin sensitivity is unlikely to be causal. This has led to the suggestion that lipid intermediates, like DAG and ceramides, are able to interfere with myocellular insulin signaling, and that increased IMCL is merely a surrogate measure of the presence of elevated DAG or ceramide levels.

    The higher levels of lipid intermediates in insulin resistant subjects could be a consequence of a lower fat oxidative capacity, which is low in insulin resistance. This blunted oxidative capacity is due to fewer mitochondria and/or compromised mitochondrial function. In combination with an elevated IMCL content, mitochondrial dysfunction could result in increased availability of lipid intermediates.

    In contrast, endurance trained athletes have a high capacity to oxidize fat and have elevated IMCL storage, serving as a readily available energy source during exercise. Thus, if lipid turnover is high and fatty acids can be readily oxidized, the toxic effect of lipid intermediates is likely limited. An imbalance between ATGL and HSL activity, which in principle could raise DAG levels, has been suggested for the insulin resistant state [3].

    In cellular systems, it has been shown that these lipid intermediates interfere with insulin signaling and reduce insulin stimulated glucose uptake. Diacylglycerol inhibits the insulin signaling via PKC, which inhibits the insulin signaling cascade downstream of the insulin receptor. Induction of insulin resistance in healthy lean subjects by lipid infusion resulted in an increase in DAG and PKC levels [4]. In line with this, weight loss or exercise reduces DAG content in skeletal muscle and improves insulin sensitivity in obese subjects [5][6]. However, the reductions in DAG content due to exercise interventions were not associated with improvements in insulin sensitivity.

    Paradoxically, athletes can have higher total DAG levels compared to obese insulin resistant subjects [7]. This suggests that total DAG in itself cannot deteriorate insulin sensitivity. However, DAG presents as 3 different isoforms, or optical isomers, with a wide range in chain length and level of saturation of the fatty acids making up the DAG pool. Particular DAG species, like saturated DAG, and DAG at specific locations in the cell are particularly potent to interfere with insulin signaling.”

    And this article says, “To summarize, the association between lipid storage in skeletal muscle and insulin sensitivity is not straightforward. Although bioactive lipids like DAG indeed can impede insulin signaling in cell systems, it is not yet clear if this also holds true in the human in vivo situation. Moreover, the debate on the putative role of different DAG isoforms and subtypes and subcellular location with respect to their insulin inhibiting potential has only recently been initiated. It seems safe to state that in sedentary people excess IMCL directly or indirectly impedes insulin sensitivity. On the other hand, improvements in myocellular insulin sensitivity can be achieved without noticeable or consistent alterations in IMCL or bioactive lipids.” I am confused a bit. Anyone can help?

  • Pat

    What is the ketogenic diet? My dad is on it and he is a diabetic, type 2. He clearly believes it is helping him lose weight and he is reducing his insulin injections. I think he is stubborn because I keep telling him that all the animal products will eventually catch up to him. Any research on the ketogenic diet?

    • Thea

      Pat: A ketogenic diet is a diet that is so high in fat and so low in carbohydrate, that your body changes how it gets it’s energy. If I understand correctly, ketosis is generally the state a person’s body goes into when they are in starvation mode. Ketosis can help people who have epilepsy. But for everyone else, eating a ketogenic diet is UNhealthy.

      Why do I think that a ketogenic diet is unhealthy? Well, a ketogenic diet typically includes a lot of animal products (because animal products are usually so high in fat). And as you know from watching this site, animal products are just not healthy. Also you know from watching this site, lots of carbohydrates (from whole plant foods) are especially important for a healthy diet. Basically, a ketogenic diet is the opposite of a healthy diet for most people. Rami, one of our knowledgeable moderators, did a great post a long time ago about the scientific evidence of even the known short term problems with a ketogenic diet. You can see that list below.

      But before I show you that scientific evidence, I think we also need to address the T2 diabetic issue. T2 diabetes is caused by having too much fat in your cells. I believe this NutritionFacts page has the video which explains how T2 is caused. So, eating a diet high in fat is especially problematic for T2 diabetes. Since people can lose weight on just about any diet, as your dad is experiencing, he may be seeing some temporary improvement regarding his insulin injections. But long term, he is shooting himself in the foot. He would be better off losing weight the healthy way. Dr. Barnard was able to clinically prove that eating a low fat, whole plant food diet can reverse T2 diabetes – not just slow down the symptoms. And the diet is 3 times more effective than the ADA diet. For more information, including scientific information, meal plans and recipes, see: http://www.amazon.com/Neal-Barnards-Program-Reversing-Diabetes/dp/1594868107/ref=sr_1_1_twi_pap_1?s=books&ie=UTF8&qid=1460155202&sr=1-1&keywords=barnard+diabetes

      ———————————

      Here is the information from Rami from several years ago:

      Ketogenic diets (very low carb, high fat) have been shown to be helpful with children with epilepsy for the short term. All other aspects of the diet for the short term show ill health effects. Its not something you want to put your body through. I will share the SHORT TERM evidence below. The long term evidence is also damning, but here is short term data.

      “Cognitive Effects of Ketogenic Weight-Reducing Diets,” researchers randomized people to either a ketogenic or a nonketogenic weight loss diet. Although both groups lost the same amount of weight, those on the ketogenic diet suffered a significant drop in cognitive performance.After one week in ketosis, higher order mental processing and mental flexibility significantly worsened into what the researcher called a “modest neuropsychological impairment.”
      http://www.ncbi.nlm.nih.gov/pubmed/8589783

      A review over low carb diets revealed that “Complications such as heart arrhythmias, cardiac contractile function impairment, sudden death, osteoporosis, kidney damage, increased cancer risk, impairment of physical activity and lipid abnormalities can all be linked to long-term restriction of carbohydrates in the diet.”
      http://www.ncbi.nlm.nih.gov/pubmed/14672862

      Low-Fat Versus Low-Carbohydrate Weight Reduction Diets
      Effects on Weight Loss, Insulin Resistance, and Cardiovascular Risk: A Randomized Control Trial

      This study looked at 24 people who were overweight/obese and divided them into 2 groups. One group was low carb, high fat and the other high carb, low fat.
      High carb group: 20% calories from fat/60% calories from carbs
      Low carb group: 60% calories from fat/20% calories from carbs
      In addition, the study was designed so that participants would lose 1 pound per week, so calories were reduced by 500 per day.

      Volunteers were given pre weighed foods given as daily portions and were assessed by a dietician to make sure that they were adhering to the diet. After 8 weeks, this is what was found to be significant between the two groups. The low carb, high fat group experienced arterial stiffness which basically means impaired arterial function. What this means is that the people on this diet experienced low grade inflammation which can lead to the growth of atherosclerotic lesions and can become heart disease. “It is possible that the high fat content of a low-carbohydrate diet exerts detrimental effects on endothelial function, which raises concern s regarding the long-term safety and efficacy of low-carbohydrate diets…Currently, supported by evidence from long-term trials, we believe that a low-fat diet should remain the preferred diet for diabetes prevention.”
      http://diabetes.diabetesjournals.org/content/58/12/2741.long

      Benefit of Low-Fat Over Low-Carbohydrate Diet on Endothelial Health in Obesity
      20 subjects participated in this study. “The [low carb] diet provided 20 g of carbohydrates daily, supplemented with protein and fat content according to the Atkins’ diet recommendation.19 The [low fat] diet provided 30% of the calories as fat, modeled after an American Heart Association diet.” I wouldn’t exactly call the low fat diet “low fat”, but regardless, its far less fat then the low carb diet. Both groups were given 750 calories less with pre made meals so they would stick with the protocol.
      After 6 weeks, there were significant differences between the low carb and the low fat group. The researchers performed a brachial artery test which basically tests to see if arterial function is impaired or not. Typically, the arm is cut off from circulation for about 5 min., then they release the arm, and measure how dilated the blood vessels are. If the blood vessels are constricted, it represents arterial impairment whereas dilation indicates good arterial health.
      On week 2 of the diet, both low carb and low fat groups had poor arterial health and were not significantly different, but by week 6, those on the low carb diet had far worse arterial health then before, and those eating low fat had far better.
      (See figure 1: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2702133/figure/F1/ )
      This again shows that this type of diet is promoting heart disease risk.
      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2702133/

      Low carbohydrate, high fat diet increases C-reactive protein during weight loss.
      Unfortunately, I was unable to find the full text of this study so it is difficult for me to view the details and all I can do is base my conclusions of the study based on the abstract which is not something I like to do. Regardless, the study revealed a very interesting finding. It showed that when subjects of the study went on a low carb, high protein diet for 4 weeks, they had a 25% increase in C-reactive protein. C-reactive protein is a marker of inflammation which basically means that this group of people were promoting the development of a chronic disease. In contrast, the high carbohydrate subjects decreased their levels of C-reactive protein by 48%.
      http://www.ncbi.nlm.nih.gov/pubmed/17536128

      Comparative Effects of Three Popular Diets on Lipids, Endothelial Function, and C-Reactive Protein during Weight Maintenance
      This study is quite interesting. It examined 18 adults aged 20 or over for 6 months. The aim of the study was to examine their health when on 3 diets, the Atkins diet (high fat, low carb), the South beach diet (Mediterranean) and the Ornish diet (low fat, high carb). They found no significant differences between the 3 diets in terms of calories consumed. The results are interesting as seen in table 1 of the study.
      They found higher LDL in the Atkins diet and lower LDL in the low fat Ornish diet. They also found significantly higher levels of C-reactive protein in the atkins diet as opposed to the Ornish diet. What was also found was that the atkins diet had poor results for the Brachial Artery test which again shows impaired arterial function. “High saturated fat intake may adversely impact lipids and endothelial function during weight maintenance. As such, popular diets such as Atkins may be less advantageous for CHD risk reduction when compared to the Ornish and South Beach diets”
      http://engine2diet.com/usrfiles/files/publishedstudies/obesity/comparative-effects-of-3-diets.pdf

  • Evy

    Hi, is it possible that when you have a high (LDL) cholesterol, because it runs in the family (!!), that you are insulin resistance? (even on following a diet like yours = low fat!). If so : question 1: what should you eat : breakfast/lunch/diner + 2 snacks? Question 2: can you have the sugar that’s in fruit, grains, potatoes etc. Thanks !!!

    • Thea

      Evy: Your first question is interesting. I had to think about it for a bit. Then I had my answer: Consider the subject of the video on this page: insulin resistance is caused by fat buildup in your cells. And we also know that eating excess fat, especially saturated fat, causes LDL to get high. I believe we also know that T2 diabetic people (people who insulin resistant) are at high risk for heart disease. So, I think that it is reasonable to believe that if you know you have high LDL, then it is quite possible (not a sure thing, I’m sure) that you also have insulin resistance.
      .
      The good news is that it really doesn’t matter whether your are insulin resistant or not. The same diet that is good for lowering LDL is also good for improving insulin sensitivity. It’s a win-win when you eat healthy = a low fat whole plant food diet. Other good news is that in the context of a low fat whole plant food diet, fruit, *intact* grains, and potatoes are all on the menu! For proof and details on this point, I recommend the book: Dr. Neal Barnard’s Program for Reversing Diabetes: http://www.amazon.com/Neal-Barnards-Program-Reversing-Diabetes/dp/1594868107/ref=sr_1_1_twi_pap_1?s=books&ie=UTF8&qid=1459907823&sr=1-1&keywords=barnard+diabetes That book explains the diet, along with recipes, that is clinically proven to be 3 times more effective at dealing with T2 diabetes than the ADA diet.
      .
      If you want to first learn more about lowering cholesterol and still want recipes, check out this book: http://www.amazon.com/Prevent-Reverse-Heart-Disease-Nutrition-Based/dp/1583333002/ref=sr_1_1_twi_pap_1?s=books&ie=UTF8&qid=1459907954&sr=1-1&keywords=prevent+and+reverse+heart+disease. If reading books are not your thing, I can make some recommendations for free online help if you are interested. Good luck.

  • Gunther

    What can I eat when I have hyperinsulinemia? Thanks.

  • waleed mahmoud

    أعرض هنا خطتي الذاتية للشفاء من مرض السكري النوع الثاني……المقال موجه فقط لذوي الاختصاص وسوف اعرضه مبسطا قريبا جدا للعامة.

    The cure lies within the endurance of hunger inflicted on a person after subjecting him to a sudden and severe hypocaloric condition ((without attempting to lower insulin levels and in some cases purposely increasing insulin levels )) to remain in such hunger zone (deprivation mode ).
    when the rate of demand of energy is significantly higher than the rate of supply provided by all available glucose and fat stores, the cells are forced to turn to the IMCL droplets to augment their requirements.
    IMCL droplets are within the boundaries of the cells, therefore not affected by the laws of insulin. whether high or low levels of insulin will neither speed up nor slow down its accessibility. They may be used for energy only when all other energy sources cannot meet the cells’ energy demand.
    Slow weight loss may not achieve the reversal result because it allows the body to gradually adapt to lower calories without needing to rush to IMCL stores.
    Hypocaloric ketogenic diets and even water fasting don’t also help because they don’t put the cells in a severe deprivation mode.
    In the Newcastle trial, the participants were asked to stop all diabetes medications and insulin. For those whose endogenous insulin secretion is already weak, there bodies were able to turn to the available abundant visceral fat stores and did not feel deprived enough to resort heavily to IMCL droplets. But for those who still had relatively adequate residual insulin secretion, such insulin level deprived them from the advantage of having abundant visceral fat stores and moved them to the deprivation zone accompanied by extreme hunger causing there cells to forcefully use the IMCL stores.
    In my view, starvation mode is different from deprivation mode in the sense that in starvation mode the body is deprived from external energy intake while muscle cells are not. While in the deprivation mode the cells are deprived from sufficient energy intake.
    It is in the deprivation mode that reversal of diabetes and probably many other conditions may be achieved.
    It's not possible for all type 2 diabetic patients to enter into the deprivation mode because there deteriorated weak insulin secretion will allow the cells to turn to burning fat. However by resorting to exogenous insulin administration sufficient to neutralize or at least mitigate visceral fat breakdown, the deprivation mode can be superimposed.
    In my opinion. The required exogenous insulin required to achieve the above outcome should be equal to the healthy basal insulin needs at all stages of weight changes.
    The above reasoning explains why diabetes resolves after bariatric surgery in some obese patients so quickly but not in all. I would guess that those who reverse the condition must be having adequate endogenous insulin residues to inflict a severe hypocaloric state.
    It also explains why sprinting, not aerobic exercise, is far much better in improving therapeutic outcome of diabetes, blood pressure, atherosclerosis, and many other conditions. Such conditions are also expected to improve in the deprivation mode.
    Although the above method requires the patient to perform a very difficult task. Any future pharmaceutical intervention will not help in my opinion. Type 2 diabetes is a manifestation of the body trying to get rid of excess energy. If this gate is closed the body will either dump the excess energy as fat in the organs and arteries of the patient, or other disorders will appear.
    In my opinion, insulin resistance is a direct consequence of overeating and is a healthy mechanism to store energy. It’s only when excessive calories are eaten and excessive IMCL droplets form, that infest the liver and the pancreas that those organs along with other organs start to wane down and down regulate there activities. The pancreas at this juncture is in a deadlock; if it increases its insulin production in response to dietary stimulants in the absence of a calorie deficit, this may serve to exacerbate the IMCL content in it, which progressively make things worse. On the other hand, if the pancreas decreases its insulin secretion for lack of stimulants, visceral fat stores will be liberated into the blood circulation, putting more load on the oxidation process of fat within the cells and again exacerbating the ICML content. This presents as a paradox that cannot be solved by conventional dieting and current therapeutic procedures.

    • gongigongi

      So what is the best way? Fasting and restricting calories in take to 500 cal/day or so?

  • Awmessage

    https://youtu.be/pNwq_uSv9kA

    I am totally confused by what I have heard and read from both doctors. Please~~ What is right??

    • Rami Najjar – NF Moderator

      Hello Awmessage,

      The ketogenic diet does not actually cure diabetes, it treats the SYMPTOMS of diabetes. Carbohydrate consumption will not spontaneously result in insulin resistance. The mechanisms for insulin resistance revolve around fat metabolites inhibiting cellular enzymes that are responsible for insulin signalling as well as mitochondrial dysfunction resulting from excessive saturated fat oxidation. The disease of type 2 diabetes is a disease of fat.

      The ketogenic proponent will put the diabetic on a ketogenic diet that lacks carbohydrates and the individuals blood sugars will be low. The proponent may declare that the diabetic is cured. Well, no. Their blood sugar is low because they are not eating carbohydrates. If you were to give them carbohydrates blood sugars will spike again because the underlying cause of the disease, namely insulin resistance, was never resolved. This is severe ignorance on the part of the ketogenic promoter whether willful or not. I recommend viewing some of these other videos to clarify the issue for you further.
      http://nutritionfacts.org/video/the-spillover-effect-links-obesity-to-diabetes/
      http://nutritionfacts.org/video/lipotoxicity-how-saturated-fat-raises-blood-sugar/
      http://nutritionfacts.org/video/reversing-diabetes-with-food/
      http://nutritionfacts.org/video/diabetes-as-a-disease-of-fat-toxicity/
      http://nutritionfacts.org/video/what-causes-diabetes/
      http://nutritionfacts.org/video/plant-based-diets-and-diabetes/
      http://nutritionfacts.org/video/plant-based-diets-for-diabetes/

      • Daan

        Dear Rami,

        I understand the explanation that cutting carbohydrate consumption is treating only the symptoms of diabetes. However, in this regard the study by J. Shirley Sweeney from 1927 doesn’t make sense to me any longer because if less carbs are consumed, more fat is most likely included in one’s diet. According to Shirley Sweeney, this would cause even higher spikes in blood glucose as the study showed that the fat group had higher blood glucose levels than the carb group. Dr. Sarah Hallberg (see her TedTalk) also advocates for less carbs and more fat, which produces positive results for her patients. How could this be explained? Again, I understand it is treating the symptoms, but consuming more fat would be even more detrimental according to the study by Shirley Sweeney.

  • MariaF

    My doctor just said that I have insulin resistance after looking at my higher than normal fasting insulin levels. I have been vegetarian for 15 years (I am 33) and vegan for a year. If eating meat is one of the causes of insulin resistance, how come I have it if I do not eat meat since ages? I would like to know what to do, because I am sure once my doctor knows that I am vegan she will say that being vegan is the cause and probably recommend me to eat meat again, something I definitely wont do. You show a plant based diet as a solution to insulin resistance, but it seems that it is not working for me. And I am definitely not a junk-food vegan. I am not in the USA, I am in Colombia, and if there exists some difficulties getting accurate information in the USA, just imagine how it is here.

    • Thea

      MariaF: What a bummer. I’m sorry you are facing these difficulties.
      .
      Here are some ideas that might help you: If you review this video, you will see that the video is not saying that meat causes insulin resistance. It is saying that fat does: “The key is there, but something’s gummed up the lock. This is called insulin resistance. Our muscle cells become resistant to the effect of insulin. What’s gumming up the door locks on our muscle cells, preventing insulin from letting glucose in? Fat. Intramyocellular lipid, fat inside our muscle cells.” Meat is high in fat. As is most dairy. This is one reason that meat and dairy should not be consumed and why it contributes to T2 (type 2) diabetes.
      .
      I understand that you are not a junk food eater, but there are lots of people who eat a lot of oils and other high fat vegan foods and don’t consider those foods to be junk food. I wonder how high in fat your diet has been? The key to fixing T2 diabetes is to eat a *low fat*, *whole plant* food diet.
      .
      Do you have a good sense of what a low fat whole plant food diet looks like? I wonder if you could ahold of Dr. Barnard’s book in Columbia. Dr. Barnard used just such a diet in a clinical trial to reverse T2 diabetes. The diet is proven to be three times more effective than the ADA diet. And, to the point here, the back of the book includes meal plans and recipes. That would get you an idea of what a diet good for beating pre-diabetes looks like. Just in case you could get the book, here is a link so you can see the title and look at reviews: http://www.amazon.com/Neal-Barnards-Program-Reversing-Diabetes/dp/1594868107/ref=sr_1_1_twi_pap_1?ie=UTF8&qid=1461728071&sr=8-1&keywords=barnard+diabetes
      .
      If getting the book is not an option or if you prefer something else, Barnard’s group, PCRM, offers a free “21 Day Kickstart” program which is also recommended by Dr. Greger. This program would give you lots of recipe ideas and offer encouragement and a free forum to communicate with others who are going through the same program. If you are interested, click the green ‘Register Now’ button on the following page: http://www.pcrm.org/kickstartHome
      .
      Hope that helps!

  • Mike

    Do you know if Plant based fat sources can contribute to insulin resistance? I feel like I’m battling prediabetes (due to cramping muscles, swollen veins, dizziness when eating lots of sugar) and as I exercise more I seem to get better.

    However, I love peanut butter, and avocado, etc – should I ease off these foods whilst I try to burn the fat off of my body and replace with muscle? Or will these foods help? I can’t find answers anywhere…!

    • NFModeratorKatie

      Hi Mike – avocados and nuts/all-natural nut butters can be a really healthy part of the diet, in the right portions. Have you been tested for prediabetes? If not, I would suggest a follow-up with your doctor to get a definite diagnosis. Considering the symptoms you described, you just want to make sure you know exactly what could be going on. Best of luck!

  • Marty Kendall

    If someone keeps their glucose and insulin levels low via a low carb diet but sees a greater rise in glucose (due to physiological insulin resistance) if they were to eat a lot of infrequently once off are they still at a greater risk if their insulin levels and blood glucose levels are very the majority of the time? http://wp.me/p5VAQF-Fk

  • NickP

    What are your views on the vegan ketogenic diet, and specifically for control of cancer? Many thanks.

  • Very skinny pre-diabeti person

    I understand the lowering fat in the blood will increase insulin sensitivity. But what about the relation between fat in the blood and dietary fat intake? Some study shows there is no relation between dietary fat intake and fat in the blood. On the contrary when you eat less fat, your liver even pumps more fat to the blood. That’s why when you are on high fat diet, your liver produces less fat, which increases your insulin sensitivity. Isn’t that true?

  • Please explain it to me like I’m 5 years old. I gave up sugar and high glycimic foods, reduced meat intake and now I’m supposed to reduce fat? What’s left? Protein? Good luck getting through the day on a high protein diet from vegetables. I wouldn’t be able to be more that 5 steps from a toilet! I’m serious what are we supposed to eat?
    By the by I’ve still got high BP and cholesterol. I’m doing my best to follow your advice, but something is still off.

    • Thea

      KumoBob: A healthy diet, one that is great for reversing Type 2 diabetes, is full of a wide variety of delicious food. This diet is called a Whole Plant Food diet or Whole Plant Food Based (WPFB) diet. WPFB consists of intact whole grains, beans, veggies, fruits, and mushrooms, plus a small amount of nuts and seeds and a vitamin B12 supplement. The diet is very simple and very filling and satisfying. When done correctly, the WPFB diet meets your overall nutritional needs better than any other diet. The diet ideally contains *no* meat, dairy, eggs, extracted oils, or highly processed junk foods.
      .
      Note that if you absolutely have to eat Aunt Amy’s ___ on a special holiday once a year, that’s not likely to be an issue for most people. The ability to *occasionally* stray from the optimal diet is one reason why the word “Based” is sometimes part of the diet description. However, for most people, the straying is a slippery slop or happens too often for health benefits. So, for most people, it is best to just avoid these foods completely.
      .
      In practical terms, how does one do a WPFB diet? There are several resources available to show you how to put this into practice. Consider checking out one or more of these:
      > Since you are posting under a video about insulin resistance, check out this book by Dr. Barnard on preventing and reversing diabetes, https://www.amazon.com/Neal-Barnards-Program-Reversing-Diabetes/dp/1594868107/ref=sr_1_1_twi_pap_1?ie=UTF8&qid=1467581142&sr=8-1&keywords=prevent+and+reverse+diabetes . The book not only explains the clinical evidence on how to reverse type 2 diabetes, but has meal plans and a bunch of recipes.
      .
      > If the book idea does not appeal to you, consider jumping straight into Dr. Barnard’s PCRM (Physician’s Committee for Responsible Medicine) free on-line 21 Day Kickstart program. It’s 21 days worth of hand-holding, with meal plans, recipes, grocery lists, and an RD moderated forum. If interested: https://secure2.convio.net/pcrm/site/SPageServer/;jsessionid=8DC45DBCD7501DBF34D021A03064A560.app20101a?JServSessionIda003=upegog3qg1.app234c&pagename=21day_vegan_kickstart
      .
      > Dr. Greger has spoken highly of the 21 Day Kickstart program, but if you want to stick strictly with Dr. Greger’s material, consider getting Dr. Greger’s new book, How Not To Die. The entire second part of the book is all about practical advice on how to put the science into practice by following Dr. Greger’s Daily Dozen. https://www.amazon.com/How-Not-Die-Discover-Scientifically/dp/1250066115/ref=sr_1_1_twi_har_1?ie=UTF8&qid=1467581653&sr=8-1&keywords=how+not+to+die
      .
      > And if that book/Daily Dozen does not work for you, consider checking out the options listed on this page where you can go straight to getting recipes: http://nutritionfacts.org/2016/06/30/not-die-cookbook/
      .
      Does this help?

      • Thanks for your reply. I guess it helps. Two years ago we have drastically changed our eating habits by cutting a lot of sugar, carbs, and meat. My wife lost 30 pounds, and I lost 40 without even trying, But without a lot of nuts, cheese, and some eggs and meat I would loose my mind to hunger. Vegetables alone leave me very VERY unsatisfied. After going a day with only vegetables they begin to nauseate me and offer no relief to my hunger. Literally my stomach will feel stuffed, but I will still be hungry.
        The book is priced low enough that I’ll consider buying it. Maybe I’ll find some recipes that work for me. Thanks for your thoughtful reply.

        • Thea

          KumoBob: I’m so with you. Vegetables alone leave almost everyone *very* unsatisfied. That’s why I made a point of listing the food groups that are good for you. You had mentioned cutting carbs. That means different things to different people, but often means cutting out starchy foods like intact whole grains and beans. Intact whole grains and beans should make up about half (or more than half according to some people) of your diet. And those are the foods that will feel filling. Veggies are very important. But the problem with eating only veggies is that while they are bulky, they are not as calorie dense as the *intact* grains and beans. Thus, to get proper calories and feel satisfied, most people need a mixture of both the starch foods and non-starchy veggies. (And then don’t forget the fruit and limited nuts and seeds and perhaps some delicious mushroooms).
          .
          What I found encouraging about reading your post (and the reason I wanted to reach out) is that a) both you and your wife have already made sweeping changes to your diet in an effort to get healthy, b) many of the changes were actually a step in the right direction (as opposed to the wrong direction that so many people seem to get caught up in), and c) you have already seen some positive effects from your diet change. From my perspective, you are on the right path and sound ready to take the next step. Given what you have done already, I know that you will be able to make the next step if it’s something you decide to do. I’m in your corner.
          .
          I greatly admire people who are willing to take their health into their own hands and make hard changes when necessary. You have my respect, and I wish you both the greatest of luck.

          • Thanks for the reply. You’re right we have not been eating many beans and your advice makes a lot of sense. We really do want to get away from eating meat everyday because I don’t believe it’s healthy and I hate the idea of killing and raising animals for food.

  • Sonya

    Do fat cells have different insulin receptors than muscle cells?