What Causes Diabetes?

Image Credit: Sally Plank

How to Treat the Root Cause of Diabetes

After about age 20, we may have all the insulin-producing beta cells we’re ever going to get. So, if we lose them, we may lose them for good. Autopsy studies show that by the time type 2 diabetes is diagnosed, we may have already killed off half of our beta cells.

You can kill pancreatic cells right in a petri dish. If you expose the insulin-producing beta cells in our pancreas to fat, they suck it up and then start dying off. Fat breakdown products can interfere with the function of these cells and ultimately lead to their death. A chronic increase in blood fat levels can be harmful to our pancreas.

It’s not just any fat; it’s saturated fat. As you can see in my video, What Causes Diabetes?, predominant fat in olives, nuts, and avocados gives a tiny bump in death protein 5, but saturated fat really elevates this contributor to beta cell death. Therefore, saturated fats are harmful to beta cells. Cholesterol is, too. The uptake of bad cholesterol (LDL) can cause beta cell death as a result of free radical formation.

Diets rich in saturated fats not only cause obesity and insulin resistance, but the increased levels of circulating free fats in the blood (non-esterified fatty acids, or NEFAs) may also cause beta cell death and may thus contribute to the progressive beta cell loss we see in type 2 diabetes. These findings aren’t just based on test tube studies. When researchers have infused fat directly into people’s bloodstreams, they can show it directly impairing pancreatic beta cell function. The same occurs when we ingest it.

Type 2 diabetes is characterized by “defects in both insulin secretion and insulin action,” and saturated fat appears to impair both. Researchers showed saturated fat ingestion reduces insulin sensitivity within hours. The subjects were non-diabetics; so, their pancreases should have been able to boost insulin secretion to match the drop in sensitivity. But no, “insulin secretion failed to compensate for insulin resistance in subjects who ingested [the saturated fat].” This implies saturated fat impaired beta cell function as well, again just within hours after going into our mouth. “[I]ncreased consumption of [saturated fats] has a powerful short- and long-term effect on insulin action,” contributing to the dysfunction and death of pancreatic beta cells in diabetes.

Saturated fat isn’t just toxic to the pancreas. The fats found predominantly in meat and dairy—chicken and cheese are the two main sources in the American diet—are considered nearly “universally toxic.” In contrast, the fats found in olives, nuts, and avocados are not. Saturated fat has been found to be particularly toxic to liver cells, contributing to the formation of fatty liver disease. If you expose human liver cells to plant fat, though, nothing happens. If you expose our liver cells to animal fat, a third of them die. This may explain why higher intake of saturated fat and cholesterol are associated with non-alcoholic fatty liver disease.

By cutting down on saturated fat consumption, we may be able to help interrupt these processes. Decreasing saturated fat intake can help bring down the need for all that excess insulin. So, either being fat or eating saturated fat can both cause excess insulin in the blood. The effect of reducing dietary saturated fat intake on insulin levels is substantial, regardless of how much belly fat we have. It’s not just that by eating fat we may be more likely to store it as fat. Saturated fats, independently of any role they have in making us fat, “may contribute to the development of insulin resistance and its clinical consequences.” After controlling for weight, alcohol, smoking, exercise, and family history, diabetes incidence was significantly associated with the proportion of saturated fat in our blood.

So, what causes diabetes? The consumption of too many calories rich in saturated fats. Just like everyone who smokes doesn’t develop lung cancer, everyone who eats a lot of saturated fat doesn’t develop diabetes—there is a genetic component. But just like smoking can be said to cause lung cancer, high-calorie diets rich in saturated fats are currently considered the cause of type 2 diabetes.

I have a lot of videos on diabetes, including:

Preventing the disease:

And treating it:

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:


Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.

141 responses to “How to Treat the Root Cause of Diabetes

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  1. What role does raw fish, and cooked, play in this?

    Is it the heated/cooked saturated fats
    causing the issues?

    Were these studies that determined the results you have posted done
    with cooked/heated fats or raw?

    1. Thanks for your question.

      I highly recommend you watch the video below, where Dr Greger talks about the link between fish intake and Type 2 Diabetes:

      Fish & Diabetes

      When it comes to cooking, I am assuming the Advanced Glycation End Products (here) may be the related factor.

      Hope this answer helps.

      1. Gosh Jerry, . . it sounds like you know more than Dr. Greger. Perhaps you should start your own site since you are such an expert.

  2. Once again I am hearing about the benefits of high-quality coconut oil, a saturated fat. Have there been any recent studies on the pros and cons of coconut oil? Does the “plant fat” referenced above include coconut oil?

    1. Thanks for your question Susan.

      A Presidential Advisory from the American Heart Association advised against the use of coconut oil because it increases LDL cholesterol due to its high content of saturated fat (SFA), a cause of CVD, and has no known offsetting favourable effects (1). Furthermore, a recent review of 21 research papers including 8 clinical trials & 13 observational studies also reported that coconut oil generally raised total & LDL-C, but to a lesser extent than butter (2). Another 2017 review has also stated that coconut oil is very high in SFA & therefore, should be avoided (3). Finally, the National Lipid Association also concluded that there is no evidence of any health benefit of coconut oil (4).

      Therefore, the current article also seems to apply to coconut oil

      Hope this answer helps.

      1. I cringe when I think of all the coconut oil I used to take about 3 years ago. I jumped on the band wagon for coconut oil back then by listening to that idiot Mercola. These just goes to show you, that you can’t trust these alternative health gurus like Mercola and David Wolfe who has no credentials at all. All you can really do is to depend upon all of this research that Dr. Greger is providing.

        1. I use coconut oil everyday without any problem and I can feel that it brings benefits to me. Coconut oil is shown to prevent dementia as well as reducing the symptoms of Parkinson’s.

          1. Jerry, please provide the research links to support your claims. This is a science-based website, not an opinion based website.

          1. Very good. HCL way high, Tri way low, LDL moderate in range. And lipid test is just an indication because a lot of people with low cholesterol do get heart attack.

      2. Thank you for your answer! There is so much misinformation circulating that even as a nutrition student I start questioning what I’ve been taught.

      3. I’m confused. I have found many sites that say the opposite (mostly by natural doctors.) This from Dr. Axe: “Coconut oil is high in natural saturated fats. Saturated fats not only increase the healthy cholesterol (known as HDL cholesterol) in your body, but also help convert the LDL “bad” cholesterol into good cholesterols. Jan 16, 2015:

        1. Hey Kriie,

          Thanks for your question. It seems that every ten years, someone new comes out and tries to convince us that saturated fat (SF) is good for us.


          This post (and the meta-analyses included in it) should help to clear up some of your confusion.
          Systematic meta-analyses are the gold-standards of research. In short, they look at all of the major research that has addressed a research question, and analyze the overall results. Individual studies can manipulated to show certain results:
          So, meta-analyses give us a better idea of what the whole of the research suggests. The following studies clearly show that increasing intake SF increases LDL cholesterol, and that LDL cholesterol increases plaque in the coronary arteries (atherosclerosis). Atherosclerosis is the primary cause of heart disease.


          I am familiar with Dr. Axe and his opinions on coconut oil, bone broth, etc. Needless to say, he has a huge financial stake in promoting these products. His stance that SF converts LDL to HDL is not supported by the vast majority of the research on SF.

          I recommend watching these videos as well:


    2. A search will turn out many nutritionist and Dr.’s on the positive reasons for coconut oil, for example
      Dr. AXE, Dr. Hyman.

  3. STOP! I love NF.org and all the work Dr. Gregor does, but this IS complete BS!
    I have been on a super high SF diet (+150 g/day) and my total cholesterol is down to 126 mg/dl where dHDL is now 45 mg/dl, LDL is 69 mg/dl, and triglycerides 62 mg/dl. At 47 years old male 5′ 10″ 165lb with BP daily average is 113/74. I come from a bad place with these numbers and thanks to a very low carb diet my numbers now rival the best! My lipid numbers are check every 6 months and BP is done 3 times per day.

    1. Obviously Chris, your trolling because if you LOVE Dr. G and NF.org so much… and you only have an issue with THIS post…. then you’ve just committed the highest level of contradiction possible.

      1. Hi Casper,
        I have been eating this way for 20 months and I will try and upload my last three lipid panels (I’m on iPad right now)
        I do not consider myself Atkins as my daily protein intake is around 70 g/day mostly vegetable in nature; meat only once a week. I try and consume 5 to 10 servings of vegetables and fruit per day (lesser of fruits). I do understand I could just be a freak of nature.

        1. OK, Chris…. you’re so full of contradictions is hysterical. Listen to what you’re spewing before you spew it.

          You claim to be HSF (150g/day)… So how can your Protein intake be as low as 70g??? lol

          Show us your daily intake… food by food…just a 1 day example…. need to see how this math adds up.

            1. Chris,

              It’s not going to be funny anymore when these high levels of coconut oil intake do enough damage to your Endothelium… something that you cannot normally test unless you’re part of some health trial like Esselstyn ran a few times.

              1. The CAC exam is a non-invasive way to look at damage to the endothelium of the cardiac arteries. The test does expose one to very high amounts of radiation and I feel its premature at this time. Beside I think calcification would show itself in my BP readings.

                1. Just FYI. I’ve had normal BP my whole life (54) and yet, I had to have a stent put in my LDA that was 98% blocked 5 years ago. No warnings, normal EKG, normal BP as I said. The only way to truly test arterial health is by way of stress test and then angiogram.

                  1. Hi Beth,
                    What kind of diet did you eat most of your life? Was it by any chance hi fat and low carb? Most Americans probably still eat hi fat even if lower than year ago, bit most also eat very hi carb along with that fat. IMO ( could be wrong) one of the best test available to gauge heart health is the Calcium Scoring test. My doc talked me into that since my cholesterol numbers had recently gone up, and he was trying to talk me into statin dugs, which I did not want. For one reason because my BP and triglycerides were on the low side, and I had zero symptoms and zero family history, and had frequent stress tests hauling a heavy pack up and down hills. But he said “any other doc would already have you on statins”. I finally gave in and took the test, and scored zero, as low as it goes, which placed me at extremely low risk for CV disease despite my cholesterol readings. And pretty amazing considering all of the fat I have eaten in my life. Even more amazing when I consider how much carbs and sugar I have eaten lifetime, except when I am forcing myself to low carb it. So he let me off the hook for statins for now anyway.

            2. Coconut is demonized because it contains saturated fat and is associated with animal foods (which is harmless too). And so the vegans have to stick with the saturated story to trash animal foods.

          1. In spite of your attacks and because I’m a helpful person I will show you how it’s done:
            One serving of Vegan Protein;
            One serving of Collegen;
            2-3 Tablespoons of MCT oil;
            1 tablespoons of olive oil;
            1 serving of creatine;
            1 serving of powdered greens;
            Add some soy milk for better taste.

            I have this smoothie three times a day , now go and do your math and as mathematician I will grade your work.

            1. Good luck to you and thanks for posting that so everyone can see your dietary plan. Wish you the best. Unfortunately, my attacks only come from a place of trying to help stop the dietary madness.

              I don’t personally see the need for including all those components of your smoothie to achieve what the preponderance of scientific evidence would deem DANGEROUS (that is 150g SF)… but it’s your body. GL to ya.

              1. Casper,

                This is why I measure my as many different metrics as possible to make sure I’m not doing damage. I put this out on chat to see if there are others who might know of a hidden danger in what I’m doing. I feel amazing in the ketogenic state and I have achieved this primarily as a vegetarian. Maybe this is why my numbers are so amazing? With n=1 I need to corobate my results with others. There could be wonderful information hiding out in the open here, but I need verification.

                1. Ok, but how many calories do you consume in your smoothie alone? How many SF grams are in that smoothie? What foods make up the balance to get to your 150 goal?

                  Which foods do you consume for your Potassium? Magnesium?

                  Which foods do you consume for your phytonutrients?

                  How do you get your Vitamin A and/or Cartenoids?

                  How much Fiber do you get per day and from which sources?

                    1. So if you perform OGTT and find out you’re insulin resistance, then what action would you take?

                  1. With all due respect, I have to ask: Does it really matter how he is getting all of those nutrients? By every known metric(at least non-invasive tests) for heart health, he appears to be doing spectacularly well on an absolute basis, and apparently much better than he used to do.

                    Much as has happened to me when I have eaten low carb and hi fat, adequate protein in the past. And as happened my friend who did the same experiment with me(but neither of attempting to do so vegetarian style at that time). We both worked in hospitals so we just ran our own blood tests. So the question for me is: isn’t it considered a good thing if your weight, waist, blood pressure, triglycerides, blood sugar all go down from moderately high levels? Isn’t it a good sign if your triglycerides go from about 200 to 40, as mine did? And if your HDL almost doubles? Aren’t all of those good signs for overall health even if my LDL and total cholesterol went up slightly(obviously the total choles. went up a bit since the “good” HDL went way up)? This happened to me, it happened to my friend, and it apparently happened to Chris. Of course, we could both be trolls and flat out lying, just trying to cause trouble. But if anyone wants to take the trouble to look, there are numerous studies where all of these parameters were improved more with a low carb diet than with a low fat diet, especially if the low fat diet still had plenty of carbs, and even more so if the calories were kept the same, and the fat cut was replaced by carbs. If you want me to I will go find them and post the links here, but there are easily found. Just google low fat vs low carb and heart health and see what studies come up. Many(not all) will support my experience.

                    Now, that does not say anything or make any claim about cancer, does it? It does not even say that just because some of us improved all of those parameters by eating low carb and even high fat, that we will not in fact die sooner than if we had eaten a more vegetarian manner. After all, after years of going back to eating my beloved carbs in abundance, my most recent cholesterol numbers were a bit high(but still ran much lower BP and triglyceride #s than I did 17 years ago when I 1st low carbed), but my doc, concerned with those numbers, badgered me into a Calcium Scoring test, and I scored the lowest possible numbers, best possible score. Which put me in the lowest risk category for heart disease even if including those higher cholesterol #s. So maybe those blood lipid numbers don’t mean as much as they think? Who knows. At least my doc stopped trying to convince me to take statins after that test.

                    But the point is, just because those numbers went down for us does NOT prove eating low carb is the healthiest bet for everyone, or best for fighting every thing that wants to kill us. But it does raise some interesting points for discussion, especially relative to the OP subject of fat, especially saturated fat causing diabetes, more so than carbs and sugar.

                    1. Bill,

                      You’re kind of answering your own questions.

                      To put it simply, LDL is much more an important risk factor than HDL for heart attack. You can be heart attack-proof only if your TBC is below 150. It doesn’t matter how high your HDL is. If your LDL is low (which you said yours is not) and your HDL is also low, then a low-HDL won’t matter because it doesn’t need to carry away as much LDL out of your body.

                      Low Triglycerides as Solomon pointed out, is a result of very low carb diet. But you need to run an OGTT to test for Insulin Resistance.

                      You should also consider some other effects of high Protein/Fat and Low Starch, such as

                    2. Casper, Sorry, there is no reply button showing up by your last response to me, but there is a button by my previous post so maybe you will see this reply. You are right, I am answering my own questions as they are more rhetorical in nature, as the answer is obvious. As for total or LDL being so much more important than HDL, though it is possible you are right, I’m not so sure. I have read from numerous sources over the years that it is the ratio that counts, and I have had blood lipid tests that reported the ratio, and used that ratio to quantify my risk. As Web MD says: “When it comes to HDL cholesterol — “good” cholesterol – a higher number means lower risk. This is because HDL cholesterol protects against heart disease by taking the “bad” cholesterol out of your blood and keeping it from building up in your arteries. A statin can slightly increase your HDL, as can exercise.”. I’m pretty sure fat also raises your HDL. Also, there is this: http://www.pcrm.org/health/health-topics/cholesterol-and-heart-disease “When doctors measure cholesterol levels, they first look at total cholesterol as a quick way to assess a person’s risk. For a more exact guide, they divide the total level by the HDL level. Heart attack risk is minimized by having a lower total cholesterol and a higher proportion of HDL cholesterol. The ratio of total cholesterol to HDL should be less than 4 to 1.”. So, a total of say 190 with an HDL of 50+ would still be a ratio below 4. As was mine after 6 months of low carb eating with probably at least as much fat as I had been eating before. My ratios improved. Conversely, a total of 120 with an HDL of 20 would be a ratio of 6, NOT good. Re: TGLs: Harvard Health says: “high triglycerides are an independent risk factor for cardiovascular disease, no matter what the HDL is.”. I agree with you that low triglycerides are a result of a low carb diet, and as far as I know, bringing them down from a high level is a good thing. But, in my case, I did not do that- or raise HDL a lot- by eating a low fat diet. Closer to the opposite. That is just the facts in my case, as well as some other folks I know of, as well as some studies that exist. These days, I attempt to keep my fat level’s as high as possible and my net carbs low as possible while following some of Dr. Greger’s advice as much as possible: Ground flax seed, walnuts and almonds, avocados and yes, even some coconut, make up a good part of my diet. Another thing is: IMO, if I was to go to a total vegan diet, and accomplish this by eating lots of vegies and even a small amount of fruit, I bet my net carb load(after subtracting indigestible fiber) would still be quite low. And because the carbs would be low, I bet the Triglycerides would be low. And probably also the LDL. But, unless I got a good bit of the few hi fat vegies in there, I’m not sure how the HDL would do. The title of this article from Medscape is: “It’s complicated”. http://www.medscape.com/viewarticle/839360 “In a meta-analysis of over 60 trials, higher intakes of saturated fat were associated with increases in both LDL-C and high-density lipoprotein cholesterol (HDL-C) and decreases in triglyceride levels,…….Although saturated fats increase LDL-C, they reduce the LDL particle number. Total LDL particle number quantifies the concentration of LDL particles in various lipid subfractions and is considered a stronger indicator of CV risk than traditional lipoprotein measures……………What You Replace the Saturated Fat With Counts

                      Cutting back on dietary fat typically means increasing consumption of other macronutrients. The spectacular failure of the Women’s Health Initiative (WHI) Dietary Modification Trial,[17] which showed no reduction in coronary heart disease or stroke in the almost 20,000 postmenopausal women assigned to a low-fat diet, was a blow to the dietary fat/heart proponents. The saturated fat target for the WHI intervention group was 7% of calories; participants got down to 8% of calories by year 1 (from about 13%) but bounced back up to 9.5% of calories by year 6. The clue to the failure of the intervention may be in what they were eating instead.

                      A pooled analysis of 11 prospective studies by Jakobsen and colleagues[18] that included more than 340,000 healthy adults older than 35 years suggests that consuming polyunsaturated fats instead of saturated fat lowers the risk for CAD whereas replacing the saturated fat with carbohydrates may increase the risk.[18] There was no change in the ratio of saturated fat to polyunsaturated fat in the WHI intervention group………..Culprit Carbs and Food Quality

                      Even those not willing to fully acquit saturated fat from the role of CV villain accept that carbohydrate consumption should be moderated. Studies like MESA and EPIC, which have shown worse metabolic and CV outcomes with higher blood levels of even-chain SFAs, implicate carbs because plasma levels of even-chain SFAs correlate more strongly with drivers of de-novo lipogenesis, including alcohol, soft drinks, and potatoes, than with dietary sources such as meat, butter, or cheese.[16] ……………..Among the most touted is the Mediterranean dietary pattern, which is rich in fruit, vegetables, whole grains, fatty fish, lean meat, oils, nuts, and legumes.[21] There are supporting data for this eating pattern, including the PREDIMED trial,[6] in which 7447 men and women free of CV disease but at high CV risk were randomly assigned to 1 of 2 Mediterranean diet groups (supplemented with either olive oil or nuts) or to a low-fat control diet. The primary endpoint of myocardial infarction, stroke, or CV death was reduced by 30% compared with the control group, largely driven by an early reduction in stroke.

                      In the two Mediterranean diets, 9%-10% of calories came from saturated fat, so why the stricter 5%-6% limit in the ACC/AHA lifestyle guidelines? Dr Eckel defends the recommendation, saying that “we have evidence that 5%-6% saturated fat lowers LDL-C maximally.” The strongest data cited in the guidelines are from crossover feeding studies that compared a Dietary Approaches to Stop Hypertension (DASH)-type diet (5%-6% saturated fat) against a diet with 14%-15% of calories from saturated fat and showed reductions in LDL-C of 11-13 mg/dL.[22,23,24]

                      Dr Mozaffarian disagrees with the guideline writing committee’s conclusion. “The DASH diet is an overall dietary pattern that increased whole grain, fruits and vegetables, reduced refined carbs, included dairy. To derive a conclusion that saturated fat should be 5% of calories [from that] is not evidence based.” He believes that there is little benefit to gain by pushing saturated fat below a cutpoint and that we may be better off advising people to simply increase polyunsaturated fat. There is supportive evidence for that strategy from a meta-analysis of 13 published and unpublished cohort studies on dietary linoleic acid and CAD events. Higher intakes of this omega-6 polyunsaturated fatty acid were inversely associated with risk for CAD, whether it replaced carbohydrates or saturated fat”

        2. I have patients with DM and hyperlipidemia who have tried calorie restriction and low fat, vegetarian, and the only diets that have brought about a significant change in weight loss and metabolic profiles are Southbeach and a LCHF (focus on healthy fats, but not excluding animal fat).

        1. Right, Chris.

          You donated and love NF.org SO MUCH that you think this latest (common Dr. G) post is BS? LOL you’re funny man.

          What you’re obviously doing (and all of us can see this) is like me claiming that I LOVE William Davis and Wheat Belly so much… and then I go and jump on his forum and say that his latest article about “evil” gluten is complete BS, and that Davis has gone too far to say gluten is to be avoided…. lol

    2. Thanks for your comment Chris.

      It is great to hear that your health seems to have improved.

      Assuming that this is true, one has to take into account that you may have been a outlier. As in, what has happened to you does not apply to the majority.

      A Meta-analysis of Randomized Controlled Trials concluded that (see here); I quote:

      “Low-carbohydrate diets are associated with unfavorable changes in total cholesterol and LDL-C lev- els, but favorable changes in triglyceride and probably HDL-C values. In the absence of evidence that low- carbohydrate diets reduce cardiovascular morbidity and mortality, such diets currently cannot be recommended for prevention of cardiovascular disease.”

      With this, I am not stating that low-CHO diets may not help people. For example, an Eco-Atkins diet can have a favourable effect on hyperlipidemic subjects (see here). Therefore, it really comes down to the overall choices of food.

      Hope this answer helps.

    3. Lucky you Chris, but it sure doesn’t work for most, just like every smoker doesn’t die from cancer. Eating like that made me diabetic for many years, til I cut all fat, and in less than 3 weeks, no more diabetes. Not BS.

      1. Hi Vegetater,

        Most of my SF is coconut oil and some of its derivatives. Almost all my protein is vegetable with some collegen. Where and what type of fat did you consume? I think the answer might be really important.


        1. There are innumerable people who have done well on vegan diets as well as people who have done well as Chris has. We have different bodies. Please stop attacking him. Many doctors are former vegans who have found that it doesn’t work for their health. Millions find that WFPBD work for them, as I do. Let’s listen instead of attacking. Please phrase questions in respectful tones.
          John S

          1. John S. – Thank you for your post. I am interested in this discussion but Christ and Casper have made it very uncomfortable to try to follow. Casper is so attacking that I am surprised Chris doesn’t just ‘walk away’, so to speak.
            The aggressiveness makes it difficult to want to try to see what someone might have to contribute.
            Could you both please stop?

          2. John S, I agree with you. No need to be attacking just because some of us have had different personal experiences. Like Chris, I follow Dr.G closely, but I have just had a different experience when it comes to fat possibly causing diabetes, or weight gain, or high BP, or worsening blood lipids, with the possible exception of LDL, which showed a slight increase. But against a stout increase in HDL and a spectacular drop in Triglycerides and blood pressure. And there are many studies out there that back up my experience( oh, and my friend who had exactly the same experience, though obviously not every body does). BTW, in a recent attempt to take off some weight via low carb(worked again) but as a prostate cancer patient(doing very well 3.5 years out) also wanting to stick with Dr. G as much as possible, my breakfast several days a week will be strawberries, ground flax seed(see PC cancer), walnuts, maybe some all bran serial, some coconut and a soy(usually) protein shake. It amounts to a high fat(with some saturated), low net carb, high fiber, adequate protein meal which is all non-animal source. Even though other mornings I might have a more animal based breakfast. Weight and BP came down nicely, and PSA test did not increase, although it was only over 3 months.

    4. Thank you Chris, I see you have had pretty much the same experience I have. Due to way too much added on to an already too overweight situation on a recent vacation, I recently bit the bullet and went back to a low carb approach, with lot’s of fat. Now, a lot of that was vegetable fat fund in flax, nuts and coconut(though that is a saturated vegetable fat), but no real effort was made to cut saturated fat. I have not run any blood test this time so far, but I suspect it will be pretty much like last time I took this approach: a great improvement in almost all of the numbers, with triglycerides(blood fat?) in particular being cut in more than half. Way more. Also significant improvements in blood sugar and A1C. But I have not yet bothered to check yet. But what HAS been checked is a shrinking waist, about 18 lbs dropped in a couple of months, and my BP dropping back down once again from 120-130 systolic(admittedly not bad) to 103. Or, about 103/60 to 110/60. I’m like you, I mostly love the info I get from Dr. G, but it is really hard for me to accept that fat- especially fat without carbs- causes diabetes, particularly compared to carbs. Especially considering the fact that in the last 40 years, lots of people have worked hard to lower fat and replace with carbs, during which time the nations diabetes and obesity have both skyrocketed.

    5. Chris, I’m sure I can speak for all of us when I say that we are glad that your numbers look so good. We need more folks like you who are interested in what we do, and who represent a challenge to the science that keep us working towards better understanding of folks who may be outliers. You may have a unique genetic makeup that allows you to thrive on your current intake.
      I would only encourage you to take a more global view of your health. Look outside those numbers. Calculate your micronutrient intake from what you’re eating and see if you’re getting at least 100% of the DRI. Consider that there are many proinflammatory components in animal foods (apart from saturated fat and cholesterol) that cause chronic illness. And keep reading! Thanks for writing in!

  4. LOVED this post Dr. G!!

    I know you’ve covered this from so many different angles, many times over the years… Beautifully summarized, and more Ammo to use against my animal-eating friends who refuse to recognize what you’ve written here.

    1. Ketogenic diet aka Atkins may work for a few weeks or possibly months.

      Then you’ll see a reversal as your LDL levels along with CRP and Homocysteine levels begin to steadily skyrocket.

      You’ll be setting yourself up for a Heart Attack.

      Atkins never ran a mid or long-term trial to prove his ketogenic approach works. That’s because he (like W. Davis) only care about selling books… so they get people excited at first, and by the time people see the deleterious effects of low-carb it’s too late because they’ve already invested in the materials.

      1. Casper,
        Your reply to a keto diet is a half truth. You need to do more research. How are your biometrics? Keto diet does not equal Atkins.

    2. Thanks for your question.

      If you are not eating any carbohydrates, blood sugar levels will drop and hence an apparent benefit to diabetes management will be visible under a ketogenic diet. Regardless of whether one can sustain on a ketogenic diet or not, the underlying cause is not being treated, which is fat in the muscle cells (see here).

      A plant based diet actually helps lower intramyocellular lipid storage (see here).

      Hope this answer helps.

      1. My 35 year old son has been on a ketogenic diet in which he eats primarily saturated fats, low carbs, no sugar. Since being on this diet, he has lost weight, his total cholesterol has gone down, LDLs have gone down, and blood sugar has gone down. This contradicts what has been previously presented here. I’m confused.

    3. Good question. However, any kind of loss of excess weight – keto diet or any other – is known to dramatically improve diabetes, because it reduces the inflammation (fat cells contribute to this) that is an underlying factor in non-insulin dependent diabetes. Burning fat for fuel is a decidedly good alternative to STORING fat (particularly saturated fat) – which is a basic problem that disables the body’s ability to use glucose for fuel (see What Causes Insulin Resistance? at: https://nutritionfacts.org/video/what-causes-insulin-resistance/)

  5. Dr. Sarah Hallberg has made a strong case that it is the excess carbs that are responsible for the increase in diabetes. She treats people for this in her daily practice and is conducting clinical trials.

    Other experts in this field who have experience, who go to conferences, publish papers in peer reviewed medical journals, and keep up with current literature are saying the sugar is the main trigger of the inflammation process, and that , for example with atherosclerosis, it is the trigger inflammation that starts the damage to the lining of the arteries. Certain types of oxidized LDL are clearly implicated in this process, but not all types of LDL. Cholesterol is just ferried to the site of injury to help in repair. I am trying to allude to some of the firmer research that is not the result of carefully cherry picking.

    The main reliable review I read, by Dr. Hyman in his recent book , that reviews big meta-analyses from 2014, 2015, are that saturated fat is protective of heart disease if three factors are accounted for, being high fiber, low carb, and omega3 , omega 6 ratio.

    1. Yea. Try verifying the legitimacy of a single one of his sources. You can’t. Why? Because he either completely misrepresents their conclusions, or the sources don’t exist in the first place.

    2. Thanks for your comment.

      To put this into perspective, I am going to quote Dr Garth Davis:

      “One of the greatest misconception is that carbs cause diabetes. Studies have shown that carbs have little to no correlation with diabetes. BUT MANY different studies correlate animal protein with diabetes. The EPIC study and the Adventist Health Study 2 both have looked long term at diet and diabetes have have shown the correlation of meat to diabetes is strong. And these studies are the tip of the iceberg.
      The science now is showing that insulin resistance is caused by intramyocellular fat. This fat enters into cells after a meal high in animal protein and fat. The fat then interferes with the cells ability to make insulin receptors.
      Now that doesn’t mean candy bars are OK. It seems like it is the insulin combined with the fat that causes this phenomenon. So the protein stimulates insulin which draws fat in. But if you are eating a cake, or candy bar you are stimulating insulin with fat too.
      Why is vegetable protein not associated with diabetes at all? Probably because vegetables are very low fat. It may also have to do with the amino acid profile of vegetables. Certain amino acids that stimulate insulin secretion are lower in veggies than in animal proteins.
      Also, if you actually have diabetes, sugar of any sort will make it worse. The reason is that once your cell is full with fat then the cell becomes insulin resistant and now your body cannot process the sugar you consume.
      A study done by Dr. Neal Barnard randomized diabetics to vegan diet loaded with fruit and grains (including pastas and potatoes) vs the typical ADA diet. The vegans had a 40% better drop in their diabetes.
      The key in life, as I have been saying for a long time now, is natural plant based food. Fruits, vegetables, nuts, and beans. If you look at the Okinawans or the Sardinians or the Seventh Day Adventists they eat 75-80% of their calories from carbs, albeit natural carbs. The Okinawans eat mainly starches like yams and rice. Yet they have very little diabetes.”

      “Ok, get ready for a very long rant, but this is the most important rant I have ever made.
      On the last post I stated that meat causes diabetes. Many responses question the science so I will now present you with an EXTENSIVE review of the research. It is important to understand that this statement is not based on just one study but rather many. It is also important to understand that this statement is based on intensive epidemiological study AND randomized control trials. If you want science, here it is in extensive detail but explained in a narrative.
      I hate to steal the thunder from my upcoming book but I can think of no more important an item to be discussed now. We are in a growing epidemic of diabetes and somehow we think we should treat it with high protein diets, which are likely the reason we are developing diabetes to begin with.
      Meat consumption is a major cause of diabetes, carbs are not. I know, that is a bold statement. I would not have believed it myself several years ago. In fact, the president of The American Society of Bariatric Physicians doesn’t seem to know this, as he actually stated at a recent meeting that we should be telling our patients not to eat fruits for fear of the carbs. Even the American Diabetes Association diet suggests meat be part of the diet, and has patients counting carbs.
      I found this out quite unexpectedly. I was studying the health of the Japanese because, while we are one of the most unhealthy cultures, the Japanese appear to be a very healthy people. I was most interested in the fact that they eat a very carb heavy diet, with lots of white rice. At the time, I believed carbs caused diabetes, so I figured that the Japanese where somehow genetically resistant to diabetes. Interestingly, however, I found that the Japanese have recently had a dramatic increase in diabetes, from 9.9% in 1997 to 15.3% in 2007. Certainly lower than our 20-30%, but the rapid growth is concerning. In fact, the Japanese government was very concerned. The Ministry of Health and Labor and Welfare studied this issue and noted that the Japanese diet is rapidly changing and becoming more westernized. They specifically point out that the increase in meat consumption and the decrease in fruits and vegetables may be the major factor behind the rise in diabetes {Morimoto, 2010 #772}.
      As I continued to research, it became readily apparent that the Japanese do not have a genetic resistance to diabetes, and may actually be genetically susceptible. An excellent study was performed in Brazil looking at Brazilian born Japanese and comparing them to previous generations that had immigrated. They found that second generation Brazilian born Japanese had extremely high rates of diabetes, especially when compared to prior generations { http://www.ncbi.nlm.nih.gov/pubmed/12488952}. The picture became even more clear when I learned that Brazil has one of the highest consumption rates of animal protein. In fact, the Brazilian government has been responding to the excessive meat consumption by releasing suggestions to the public to specifically limit meat intake {http://www.ncbi.nlm.nih.gov/pubmed/22894818}.
      Of course, this is a simple correlation. There can be many other factors that caused the relation. If meat truly has a causative role in the development of diabetes then there would need to be a serious epidemiologic study that shows this correlation while controlling for possible confounding factors. More importantly, one study would not do. There would have to be multiple studies that draw the same correlation after extensive statistical analysis.
      The first place I looked was the EPIC study. The EPIC (European Prospective Investigation Into Cancer and Nutrition) study is one of the largest prospective cohort studies that have ever been done looking at the relationship between nutrition and disease. They have followed 521,000 people recruited from 10 European countries. They have hundreds of top scientists that have used specialized food assessment tools to get a better understanding of how the food people eat affects the likelihood of them developing disease. Indeed, after looking at thousands of people and following for 12 years, the scientists concluded that meat, and especially processed meat (bacon, lunch meats, etc), is significantly associated with the development of type 2 diabetes, and fruits and vegetables are associated with a decrease in diabetes development {http://www.ncbi.nlm.nih.gov/pubmed/22983636}{http://www.ncbi.nlm.nih.gov/pubmed/24196190}. The craziest finding in the EPIC data analysis was the fact that glucose and fructose consumption was actually correlated with LESS diabetes. Many authors, like Robert Lustig, have talked at length about the harms of fructose. Lustig makes these claims largely based on rat studies and overfeeding studies, but in this very well done epidemiological study, looking at real people, if you replace just 5% of the saturated fats in your diet with fructose (presumably from fruits) you reduce your risk of developing diabetes by a whopping 30% {http://www.ncbi.nlm.nih.gov/pubmed/23880355}. This goes against everything you hear about diet in America, but just how great is our diet working for us? We are currently in a diabetes epidemic, and the affected people are trying to eat more meat and actually cutting out fruit to cut back carbs. Are they doing any better? I can tell you that, from what I see in my office, certainly not.
      Now before all the naysayers start screaming that correlation does not equal causation, lets look if this correlation also holds true in America. One of the most fascinating groups to follow is the Seventh Day Adventists in Loma Linda, California. They are fascinating because the religion basically holds that you should treat your body as a temple. Therefore, as a whole, they are very healthy. They do not drink or smoke, they exercise moderately, and they strive to eat healthy. Interestingly, many of them believe that we should not eat animals. Of course, the interpretation of what to eat varies and we therefore get an interesting mix of meat eaters, fish eaters, vegetarians who consume dairy, and vegans. This fairly homogenous group of people living in a similar area with similar habits but different dietary practices makes for a perfect group to study. In fact, the Adventist Health Studies have done just that. They have prospectively followed thousands of Adventists for many years and released many papers. Like the EPIC study they found that animal protein was significantly associated with diabetes. It is quite interesting to note that they found a graduated increase in the risk of developing diabetes depending on the amount of animal protein consumed. Vegans had an extremely low development of diabetes of only 2.9% while vegetarians had 3.2%, pescatarians had 4.8% and meat eaters had a 7.6%. That is a low rate for meat eaters compared to the public, but the Adventists tend to not consume as large a quantity of meat, even if not vegetarian. They did note that weekly consumption of meat over a 17 year period increased the risk of developing diabetes by a whopping 74% over vegetarians {http://www.ncbi.nlm.nih.gov/pubmed/19351712}, {http://www.ncbi.nlm.nih.gov/pubmed/21411506}, {http://www.ncbi.nlm.nih.gov/pubmed/3046303}, {http://www.ncbi.nlm.nih.gov/pubmed/18349528}. This correlation held true even when controlling for weight, which is surprising given vegans weigh less than meat eaters. So controlling for weight means basically just looking at lighter, healthier meat eaters. Yet meat still correlated with diabetes even if not overweight.
      Amongst the largest epidemiologic studies in America are the Nurses Healthy study and Health Professions Follow Up Study done by Harvard. There are 2 Nurses Health study. The original started in 1976 and prospectively followed up 122,000 nurses. The second has followed 116,000 nurses since 1989. The Health Profession Follow Up Study has followed 51,000 male health care professionals since 1986. So what did these studies show about the relationship between meat consumption and diabetes? Once again, there was a significant association between meat, processed meat, and development of Type 2 diabetes. In fact, increasing meat consumption by just ½ serving a day increased risk of developing diabetes by 48% {http://www.ncbi.nlm.nih.gov/pubmed/15534160}, {http://www.ncbi.nlm.nih.gov/pubmed/23779232}, {http://www.ncbi.nlm.nih.gov/pubmed/21831992} {http://www.ncbi.nlm.nih.gov/pubmed/24284436} {http://www.ncbi.nlm.nih.gov/pubmed/11874924} .
      The Women’s Health Initiative looked at 37,000 women over 8 yrs and again showed correlation between animal protein consumption and diabetes, especially the good old all American hot dog and bacon {http://www.ncbi.nlm.nih.gov/pubmed/15333470}. Like the EPIC study, they also found that sugar was not related to the development of diabetes at all {http://www.ncbi.nlm.nih.gov/pubmed/12663565}.
      There are many epidemiologic studies from around the world that further confirm this correlation, as well as many that show that plant based diets protect against diabetes {http://www.ncbi.nlm.nih.gov/pubmed/19662376}, {http://www.ncbi.nlm.nih.gov/pubmed/24523914}. I do not know of a single study showing that people who eat meat are protected from diabetes. Correlation does not equal causation, but you have to admit that this data is certainly compelling, and where there is this much smoke there must be fire.
      So what is causing diabetes? Well, let me start the story by looking at a documentary done by the BBC. They looked at a set of 35 year old twins who went on separate diets for a month. One went on a very low carb diet and one went on a very low fat diet. In the end the low carb brother complained of being constipated, having brain fog, and not having much energy. He did lose more weight but much of it was water weight. Most interestingly the very low carb brother showed increasing fasting blood sugars. This seemed to shock them as they thought that eliminating carbs would improve insulin sensitivity, but in fact it does not.
      The reason is complex but let me see if I can simplify. Our bodies are literally designed to live on sugar. Each cell generates energy by taking in sugar and turning it into energy via a pathway called the Krebs cycle. Whether by divine design or by evolution, we are literally created to process sugar and starch. Insulin is essential to get the sugar into the cell. Yes, we have an emergency pathway for energy if sugar is not available, but we most efficiently function using carbs. It is our brain and body’s primary fuel. I find it ludicrous that people claim that insulin is an evil villain. Why in the world would we evolve such an efficient system that has worked forever? Why would we have insulin in our body to begin with? The craziest thing is that writers, like Robert Lustig and Gary Taubes, who demonize insulin, then suggest patients should eat protein to avoid insulin secretion. Ironically, they seem to have missed the science that shows that animal protein actually causes disproportionately high insulin secretion. Beef actually raises insulin more than pasta {http://www.ncbi.nlm.nih.gov/pubmed/9356547}.
      The problem is not insulin or sugar per se, it is the cells ability to respond to insulin. This is called insulin resistance. The muscle in the body is the greatest consumer of sugar and therefore the site where insulin must work effectively to remain healthy. With a high protein diet you are stimulating insulin. Insulin also has an effect where it prevents break down of fat. If you eat meat, the insulin stimulated will cause the fat, which is consumed with the protein, to be stored in the muscle cells. If you eat an apple or a potato, there is insulin secretion but no fat to be placed into the muscle cell {http://www.ncbi.nlm.nih.gov/pubmed/9516198} {http://www.ncbi.nlm.nih.gov/pubmed/15356006}, {http://www.ncbi.nlm.nih.gov/pubmed/19026935}, {http://www.ncbi.nlm.nih.gov/pubmed/22185843}.
      One of the main factors causing fat to be collected in the muscle is inflammation {http://www.ncbi.nlm.nih.gov/pubmed/21862724} {http://www.ncbi.nlm.nih.gov/pubmed/15836891}. Inflammation causes damage to the muscle cells that result in the accumulation of fat. One of the critical changes that have occurred over the years is that we have evolved away from the bicarbonate producing diet of our ancestors to a modern day, higher protein, acidic diet. Our increased protein consumption leads to increased intake of amino acids rich in sulfur {http://www.ncbi.nlm.nih.gov/pubmed/12450898}. The resulting acidosis leads to disease by inciting inflammation, causing leaching of calcium from muscle cells to buffer the acid, muscle wasting, and causing fat deposition in the muscle cells {http://www.ncbi.nlm.nih.gov/pubmed/21481501} {http://www.ncbi.nlm.nih.gov/pubmed/23841017} {http://www.ncbi.nlm.nih.gov/pubmed/21352078} {http://www.ncbi.nlm.nih.gov/pubmed/11842945} {http://www.ncbi.nlm.nih.gov/pubmed/24232975}. Gary Taubes, the hero of the high protein/low carb movement, recently published his labs in order to show that his lipids are within normal range. Not being a doctor he obviously did not pay attention to the fact that his bicarbonate level was a very low 17 which means he is in a state of acidosis and slowly but steadily hurting his body and creating inflammation and disease.
      Eating meat also causes inflammation because animals are rather dirty. You almost have to wear a hazmat suit to handle a raw piece of chicken because of fear of getting a bacterial infection like salmonella. Cooking will kill the bacteria but it does not destroy the endotoxin produced by the bacteria which is embedded in the muscle(protein) of the animal. When we consume meat, the saturated fat causes the endotoxin to be absorbed into the body and our immune system sets off a state of inflammation {http://www.ncbi.nlm.nih.gov/pubmed/17991637} {http://www.ncbi.nlm.nih.gov/pubmed/19755625}. The inflammation leads, again, to fat deposition in the muscle cell.
      Finally, stress hormones certainly contribute to high sugars and inflammation. There was a study that is often cited by people advocating a high protein diet. The study took 21 overweight adolescents and had them do 3 different diets, each for 1 month. They ate the same amount of calories in each diet but one was high protein/low carb, one was low glycemic index, and one was low fat. I think the authors wanted to show better weight loss with low carb but no such luck. They did note, however, that the metabolic rate dropped the least with the high protein diet and that became their conclusion in the Journal of the American Medical Association. This was met with all kinds of fanfare by the high protein advocates, but what they failed to see is that, in the study, the high protein group had very high levels of cortisol in their urine and higher levels of C reactive protein, which is a measure of inflammation. Cortisol is a stress hormone that counters insulin’s effect and raises blood sugar, and is an independent risk factor for diabetes and heart disease {http://www.ncbi.nlm.nih.gov/pubmed/20660036} {http://www.ncbi.nlm.nih.gov/pubmed/17370058} {http://www.ncbi.nlm.nih.gov/pubmed/20739384}. C reactive protein, due to it significance as a sign of inflammation, has been independently associated with diabetes {http://www.ncbi.nlm.nih.gov/pubmed/14988310} {http://www.ncbi.nlm.nih.gov/pubmed/17696726}. So while they were celebrating the short term slightly better metabolic rate, they missed the fact that the patient was in inflammation that will lead to fat deposition in the muscle and eventual insulin resistance {http://www.ncbi.nlm.nih.gov/pubmed/22735432}.
      Once fat gets inside the muscle cells it interferes with the muscle cell’s ability to develop insulin receptors. With less insulin receptors it becomes more difficult to get sugar into the cell for processing, and the sugar then builds up in the blood. The pancreas then has to churn out even more insulin just to get the sugar into the cells. The very high insulin, which is not normal, will cause even more fat to enter the cells in a vicious cycle.
      Combine this with the fact that iron in the meat causes oxidation, which affects the pancreas’ ability to secrete insulin, and now you have full blown diabetes with high sugars. Meat eaters tend to have higher iron stores which are directly correlated with diabetes formation {http://www.ncbi.nlm.nih.gov/pubmed/23046549} {http://www.ncbi.nlm.nih.gov/pubmed/14871914} {http://www.ncbi.nlm.nih.gov/pubmed/1317328} {http://www.ncbi.nlm.nih.gov/pubmed/23866833}. In fact, simply drawing large amounts of blood out of a diabetic does appear to improve insulin resistance just by reducing the iron {http://www.ncbi.nlm.nih.gov/pubmed/11591239}. Of course, I think it would be easier to just avoid the steak.
      I should note that there is much disagreement at what comes first, the chicken or the egg, ie insulin resistance or insulin hypersecretion. I would note that those who believe that it is hypersecretion first believe it is from reactive oxygen species, created during consumption of meat, and iron, ingested with the consumption of meat.
      So, I hope you can see that the high sugars that define diabetes are not, in fact, the cause of diabetes. Rather, the high blood sugars are an after effect, a symptom. The problem is actually the fat and inflammation that is destroying the body’s ability to utilize the sugar.
      The interesting thing is that people talk about carbs, and specifically wheat, causing inflammation. However, if you actually take a group of people and feed them a high fat meal vs a high carb meal, the high fat meal develops significantly increased inflammation after the meal, the carbs do not {http://www.ncbi.nlm.nih.gov/pubmed/12499333} , http://www.ncbi.nlm.nih.gov/pubmed/14668275, {http://www.ncbi.nlm.nih.gov/pubmed/16219650} {http://www.ncbi.nlm.nih.gov/pubmed/20067961}. The craziest study I have seen is one where they gave a group of people 1.5 liters a day of sugary drinks and compared them to a group drinking 1.5 liters of artificially sweetened drinks. As would be expected, the sugary drink group consumed more calories and therefore gained more weight. Interestingly, even though they gained weight, they did not show any signs of increasing inflammation {http://www.ncbi.nlm.nih.gov/pubmed/16087988}.
      Study after study has shown that people eating fruits, veggies, and especially grains, exhibit remarkably low levels of inflammation. Not only do they have low levels of inflammation but they also have considerably low levels of diabetes. Numerous studies looking at carb and grain intake confirm that the more carbs you eat the less inflammation, and consequently, the less diabetes risk you have {Valachovicová, 2006 #197}, {Cozma, 2012 #775}, {Rankin, 2007 #734}, {Montonen, 2013 #759}, {Barbaresko, 2013 #760}, {Ye, 2012 #762}, {Muraki, 2013 #480}, {Gao, 2004 #242}, {Galland, 2010 #84}, {Ford, 2001 #241}, {Cooper, 2012 #781}, {Brunzell, 1971 #822}, {Christensen, 2013 #821}.
      I have shown you epidemiologic data and studies looking at individual lab values. I have used logic that says, “meat causes inflammation, and inflammation causes diabetes, so meat must cause diabetes”. Certainly the preponderance of evidence points to this effect, but the gold standard in research is the randomized control trial that specifically compares a diet heavy with animal protein compared to a diet without animal protein. Studies on rats have shown that high protein, high fat, and specifically diets that produce ketosis, lead to inflammation and insulin resistance {Flanagan, 2008 #746} {Jornayvaz, 2010 #233}, but we really need to refine the search to humans.
      There are many studies out there comparing low carb to low fat for diabetes. The problems with these studies are the fact that the low fat group is not put on a truly low fat diet, they still eat animal protein, and the end result they look at is blood sugar NOT insulin resistance. If you do not eat any sugar then blood sugar may be artificially low, but a high protein diet devoid of carbs may be causing inflammation and insulin resistance, and this may not be picked up simply by measuring blood sugar alone. Unfortunately there are currently no randomized control trials comparing a plant based diet vs a high protein diet directly with regards to diabetes.
      However, the Imperial College School of Medicine in London did the kind of comprehensive testing that truly measures whether insulin resistance is present in plant eaters vs general omnivores {http://www.ncbi.nlm.nih.gov/pubmed/15523486}. They found 21 vegetarians and 21 omnivores and matched them for age, weight, waist circumference, and activity levels. They followed them for 7 days and made sure they ate the same amount of calories and their daily usual exercise activities were the same. Basically, the only difference between these groups was that one group avoided animal protein. They then did comprehensive testing looking at the amount of insulin produced and they actually did muscle biopsies to look at the amount of fat in the muscle. How they talked people into getting muscle biopsies I do not know. The results showed that despite eating (or maybe because of eating) a far higher carbohydrate load, the vegan group had lower insulin and had less fat in their muscle cells, which I hope you would now expect.
      This study was not however a controlled intervention. It is one thing to compare vegans to omnivores but to actually make a group of people eat either a vegan diet or another type diet is much more difficult. People tend to be set in their ways, and having them stick to a diet plan is not always successful. But, if we are going to prove actual causation, we must show that taking people on a usual diet and making them remove the animal protein causes their insulin resistance to disappear.
      Dr. Neal Barnard did just such a study. He and his colleagues, took 100 diabetic, overweight people, and randomized them from their usual diet to either a vegan diet or a reduced calorie, low fat ADA diet. The ADA diet was purposefully calorie reduced, and was a very moderate diet. It was low in fat and moderate in protein and carbs, leaning to low glycemic carbs. The vegan diet was not limited to calorie intake at all. The subjects could eat as much as they wanted of fruits, veggies and legumes. Oils and nuts were limited. Both group were intensively counseled over a 74 week period. They measured A1C, which is a long term measure of how well blood sugar is controlled. They also looked at weight and LDL cholesterol. My only complaint is that they did not look directly at insulin resistance, but it is difficult to do, and I think Americans are a little less interested in agreeing to muscle biopsies. The results showed that the vegans ended up eating much more carbs, yet they had significantly better blood sugar control compared to the ADA diet. The vegans also had much lower cholesterol. Despite the fact that the vegan group could eat as much as they want, they actually ended up losing slightly more weight too {http://www.ncbi.nlm.nih.gov/pubmed/16873779} {http://www.ncbi.nlm.nih.gov/pubmed/19339401}. It appears that a vegan diet is superior to just a low fat diet in controlling diabetes {http://www.ncbi.nlm.nih.gov/pubmed/10446033}.
      Of course, this study is worthy of the criticism I place on all the low carb studies, which is that they were simply measuring sugar levels. The difference of course is that the subjects were consuming sugars in the forms of carbs and yet they still kept blood sugar levels down. A typical days meal included oatmeals, cantaloupes, pasta, and various other fruits. Thus, the sugar is not falsely lowered and obviously their insulin sensitivity must be improving.
      For the naysayers I offer another interesting prospective study {http://www.ncbi.nlm.nih.gov/pubmed/20815907}. In this study there is no actual control group, rather they use the subjects as their own control, comparing how they do on a vegan diet compared to how they did on their standard diet. In this study they took 43 people and put them on The Daniel Fast, which is essentially a vegan diet, not really a fast. The diet gets its name from the Book of Daniel 10:2-3. Daniel was held in captivity in Babylon but was a valued asset. He was offered the King’s wine and meat, but he refused. He ate only vegetables and pulses and drank only water. The head of security was worried about the fact that Daniel would wither but Daniel suggested that they conduct a little scientific experiment (paraphrasing). He asked that the guards also follow his diet, and after 10 days he and the guards had far superior health and vigor than those who ate the rich food of the king.
      The modern day Daniel diet is rich in fruits, vegetables, beans, seeds, and nuts. All junk food and all animal meats are avoided. The 43 people in this study followed the diet with excellent compliance, showing that it really is easy to do. Despite being able to eat as much as they want, they actually ended up eating less calories. They also ate less protein and a higher percentage of calories from carbs. They ate more fat than in Barnard’s study above, but the saturated fat consumption, found mainly in meat, was obviously low. It does turn out that it is specifically saturated fat that creates the inflammation, not the polyunsaturated and monounsaturated fat found in many vegetables, legumes, nuts, and fruits {http://www.ncbi.nlm.nih.gov/pubmed/24550191}.
      The subjects on this Daniel’s Fast were extensively studied. During their vegan diet they had a substantial drop in their blood lipid values and blood sugar and had trends to lower levels of inflammation and insulin. I find this especially interesting because these were not diabetics. These were basically well people (few exceptions), yet they still showed improvements in their insulin resistance. Like the biblical Daniel, they became healthier during the “fast”.
      Type II Diabetes is a serious disease that has reached epic numbers and is growing. The cause of this disease is complex but the evidence is fairly clear that the typical high meat diet may to blame, and our avoidance of carbs only makes it worse. If we avoided animal protein and instead increased consumption of fruits and veggies we could substantially prevent and treat most of the type II Diabetes we encounter. This may be in part be due to the high fiber in the plants, or the phytonutrients in the plants, but it is also due to the reduction in inflammation by avoiding animal protein {Jenkins, 2003 #150} {Chandalia, 2000 #217} {Watzl, 2008 #351}.”

      Hope this answer helps.

      1. WOW! Ok Mr. darchiterd,
        I certainly want to check and make sure My HF diet is not causing unintended consequences. All the normal metrics look good, if damage is being done where should I look? In other words what test will show my HF diet is causing harm?


        1. Thanks for your reply.

          I hope Dr Garth Davis answer helped, like Dr Greger, he is top. I am not a medical doctor so I am afraid I will not be able to answer with precision to your question. However, I can look it up if it is under my understanding. What are you specifically looking to see?

          1. Just because all the biometrics I’m checking are excellent, there could still be something I’m missing. My question is what test should I be looking at to see if my HF diet is causing harm?
            It looks like C-reactive protein?


              1. Marilyn Kay says:
                July 20th, 2017 at 10:35 pm “Have you done an insulin level test?” Yes that is a good one to check. I would expect it to be quite low on his Keto diet. Chris, if you get insulin checked, let us know!

        2. Hi Chris, if you are eating a low carb diet, a fasting blood glucose test won’t be very useful because you aren’t eating much carbohydrate. An oral glucose tolerance test (OGTT), however, will give you a very good sense of how well your insulin receptors are working. If the high-fat diet is causing insulin resistance “under the radar,” the OGTT will expose it.

            1. Due to the nature of the OGTT (takes several hours), I don’t think you can do this one via the self-testing route. You would need to request it from a doctor. If you do the test, please report back! I’m very curious to know what you discover.

              1. I absolutely will! These are good ideas and I will definitely follow through with the CRP and OGTT. I believe I’m on to something with my HSF-Vegetarian-Keto diet. I’m getting wonderful lipid results along with great blood pressure readings, not to mention mental clarity and energy.


                  1. Solomon,

                    Do you have some articles discussing this?

                    I can’t recall if Dr. G pointed this out in Carbophobia…

                    Also, Chris’s A1C is not exactly low… Sure, 5.6 is really good considering SF intake of 150g, but he’s still only 20 months into this… sometimes it takes a decade or so for the serious effects to kick in. So what’s going on in his Pancreas really… beta cell destruction?

                    I don’t see how it’s worth going against the preponderance of scientific evidence to do some extreme experimentation, to possibly find out 10 years later that you’ve burned out your pancreas.

                    I guess also his CRP and Homocysteine results might offer some evidence soon or in the future of inflammation in the body… or not.

                    1. The high-normal A1c could in fact be a clue that he is insulin resistant; i.e., even though he’s eating low carb, that small amount of glucose is not getting into cells the way it should because the insulin receptors are gummed up. But this is pure speculation. Only the OGTT, where he actually consumes glucose and then monitors how well his insulin is working, can provide an answer as to whether he’s at risk of diabetes.

                    2. Ok but let’s say you take me… my A1C is 4.9. I eat boat loads of Carbs and about 80g fiber per day on average. I’ve always dismissed intraday and postprandial blood sugar testing since I figured I’m going to see horrible results due to eating a HC-Starch based diet. And I’ve just assumed that my A1C should give me the confidence knowing I don’t have sugar/insulin issues.

                      However, do you think I’d do well or poorly OGTT? Should I do it? What what the results tell me? If I did do poorly, should I be concerned even though my A1C had not been above 5% in the past 5 years?

                    3. If your A1c is 4.9, you eat high-carb at 80 grams fiber per day, you should pass any glucose test with flying colors, whether it be postprandial, fasting glucose, or OGTT. There’s no need to do an OGTT. It wouldn’t reveal anything we don’t already know. The reason Chris should consider OGTT is that he’s not eating (much) carb. In low-carb diets, insulin resistance can hide behind normal A1c and fasting blood glucose results.

                    4. Well, I don’t know about postprandial though…. my Fasting is around 80 so what would you expect my PP to be 1 or 2 hours later? Wouldn’t it be natural to see a spike (for example) 120-180 after a meal?

                    5. 80 mg/dL is a healthy fasting glucose number and not indicative that you would see problems on a postprandial test. Based on your A1c number and average of 80 grams of fiber/day, I would expect to see a perfectly healthy postprandial curve. DIsclaimer: I am not a doctor.

                1. I did check A1C with fasting glucose; A1C is 5.6 and fasting glucose was 88 mg/dl. The A1C is with-in normal range but it is the top of the range. I think the OGTT with put my worries to rest.

      2. darchiterd- thank you so much for putting so much useful information in one post. Will be going to your references one by one.
        I have always thought that what is basically a long term trial on diet ( Blue Zones) is information we need to pay attention to. It’s why I have always thought the low carb-no fruit diet is totally wrong. No long lived society eats a high animal protein-low carb diet. Of course neither do they eat refined carbs or processed foods. What is interesting is that they all eat some animal protein, usually dairy, eggs or fish. Understand I’m Not saying this is necessarily good, just stating a fact.
        Anyway, thank you again for your post!

  6. Wow, I’m actually seeing this play out with my octogenarian mother. She’s never been much of a foodie & has always been thin. But now she hardly eats at all because she’s losing her sense of taste (along with her sight & hearing). So while I try to direct her towards fruits & vegetables, these days I’m just happy when she eats anything at all. For the past year or so, her diet has consisted mostly of chicken & cheese, along with fish, other dairy products & eggs. A handful of spinach once a week (with her eggs) was the only vegetable she ate for months. About 6 months ago, a blood test revealed that she’s pre-diabetic. Plus, her WMD, which had previously been under control, went way out of control & she had to start the injections again.

    Since that time, I’ve been pushing her to drink a smoothie every day, & most of the time she’ll drink them. She’s going in for another blood test today. It will be interesting to see the results, but I’m really not hopeful that just a smoothie a day would have an impact. Will keep you posted.

    1. Thanks for your comment Jerry.

      I believe I had answer to your concerns about trans fat in an earlier post, where we show it is also present in animal foods. At NF, we certainly do not advocate any consumption of any type of oil.

      Regarding saturated fat, it is not a misconception, there is a general consensus that it is harmful to health. I will attach the latest Presidential Advisory From the American Heart Association on this subject (see here).

      Hope this answer helps

    2. Jerry Lewis – How would you possibly know what I – or anyone else on this site – eat?

      Would you please take a manners class and participate in some polite discourse rather than this belligerence you bring to the discussion?

  7. I can’t even entertain this Jerry Lewis guy….
    clearly a troll… he always pops on, spews nonsense devoid of evidence.

    Even his name is suspect.

        1. Caspergomez – you don’t help the tone of the discussion much either. Take the same manners class as Jerry Lewis please.
          Thank you.

  8. Should we avoid plant foods with high saturated fat? For example, raw macadamia nuts (USDA 12131) have 12 grams of saturated fat per 100 grams which is higher than some meat:

    AMERICAN GRASS FED BEEF, LONDON BROIL (USDA 45184724): 1.77 grams per 100 grams
    Beef, grass-fed, ground, raw (USDA 13047): 5.3 grams per 100 grams

    Ref: USDA Food Composition Databases

    1. Nope, you don’t need to avoid saturated fat from any sources, animal or plants. However you need to avoid PUFA fat and transfat. Omega 6 fat is OK up to a point, especially if it is balanced by Omega 3 fat.

      Coconut and macademia are made into bad foods although they are plant foods simply because the vegans like to lump them into the same category as animal foods. But when they get old and get Alzheimer’s then I hope they remember my words and tell their kids to feed them with coconut oil.

      1. Yes I agree. Keto is much better than diabetes and brain seizures / alzheimers / sugar spikes.
        The brain is made up of a high % of saturated fat, and the body also needs cholesterol to make hormones.

  9. Certainly flax oil and avocado and nut butters are healthy fats. Yet I’ve read in various sources that saturated fats by and of themselves are not harmful; it’s only when they are combined with high sugar and high processed carbohydrate intake that diabetes and cardiovascular complications arise. For instance, the whale blubber eating Eskimos had virtually no cardiovascular problems until they adopted a Western diet. I have consistently gotten good cholesterol, low high density LDL, high HDL and high Omega 3 readings from eating moderate eggs, meat and cheese regularly and avoiding sugars and processed carbohydrates. I do eat a lot of raw and cooked non-starchy vegetables and low sugar fruits. I take a tablespoon of flax oil daily, and I use no fat Greek yogurt and soy milk every day. I use butter liberally.

    1. Shirlee – your statement: “the whale blubber eating Eskimos had virtually no cardiovascular problems until they adopted a Western diet” I believe is urban myth.

  10. Also – I consume a lot of fiber from the produce and carefully selected super high fiber carb sources (so the net carbs is very low due to the high, high fiber count.) I consume about twice the fiber amount recommended for the average person. Zero health problems, no meds. Exercise daily, light jog, light weights, stretching.

    1. Hi Shirley – I would like to share with you some interesting information. I don’t know if you know/remember who Bob Harper is? he is the celebrity trainer and nutrition expert for the Biggest Loser tv program that aired for many seasons. He loved his work out and often gave lots of nutritional advice. He hate a diet just about like yours – lots of egg (in fact he would have 3 whole eggs and often 3 additional egg whites with vegetables for breakfast daily). For lunch, a meat of some sort with vegg in a rollup of some sort. Dinner was similar. No dairy. Did use butter, a healthy fat according to him. He was basically paleo with very low carbs to keep his trim figure and muscled body.
      This February he had a heart attack. Not just any heart attack but the one called the widow maker – left anterior descending. Completely blocked. He was at the gym in NY, was working out, and the lights went out. There was a physician in the gym who administered the paddles who, at first, had a difficult time getting a sinus rhythm (heart beat). Bob’s heart would not start. (I saw the interview with this doctor, Bob, and others who were present). They eventually did get his heart going again, he was in a coma for a number of days and in the hospital for 8 days. For the few minutes before they got his heart going again Bob was dead -dead.
      I saw this interview on the Rachel Ray show 2 days ago. Bob is now stating that he has completely changed his diet. Although he admits he is still working on changing his diet (as it is a process), he is switching to a completely vegetarian (his words) diet with a small amount of fish only occasionally and only for now. He is using the fish to bridge him to a completely vegg diet. (remember, he never did eat dairy). He has stated that his goal is to get to no animal products. He wants to reverse his heart disease and clean out his blood vessels.
      Bob is 51. Until he had his widow-maker heart attack, he didn’t have any “problems” either and his numbers (blood work) were excellent.
      Made me stop and think . . . . .

      1. That’s the problem with CAD. There are no simple tests for it (stress test then angiogram only) and usually little to zero symptoms/warning. So many people think because they are fit and thin and eating “pretty healthy” that they’re immune. Isn’t heart disease the single most common cause of death in the US? Go figure.

      2. Hi Guest, re: Bob Harper, you say his numbers were excellent until he had the heart attack. As you say: makes you stop and think, doesn’t it? And one thing it makes me wonder is: are these cholesterol numbers we look at actually predictive of anything?
        http://onlinelibrary.wiley.com/doi/10.1002/clc.4960281303/pdf ( SCD = sudden coronary death )

        The incidence of SCD increases 6- to 10-fold in the presence of structural heart disease and
        2- to 4-fold in the presence of coronary disease.

        Nonetheless, in 70 to 80% of SCD cases, ( ! )

        there is no
        identifiable precipitating factor
        and the event occurs without warning
        or preceding symptoms”………………
        “Q I have a relative who had a total cholesterol value of 155, yet he still had a heart attack with 90% blockage in one artery. How could that happen?

        A I understand your confusion, considering how doctors have long focused on the importance of having an optimal total cholesterol level (less than 200 milligrams per deciliter or mg/dL) as a way to lower the chance of having a heart attack. It’s actually the harmful LDL cholesterol value that’s most important in terms of this risk. However, a person with a total cholesterol level of 155 mg/dL probably has an LDL level under 100 mg/dL, which is currently considered a reasonable target for avoiding heart disease.

        In a population, a lower LDL level is—on average—associated with a lower risk of heart attack. But about half of all heart attacks occur in people with “normal” cholesterol levels…………. ”

        “A new national study has shown that nearly75 percent of patients hospitalized for a heart attack had cholesterol levels thatwould indicate they were not at high risk fora cardiovascular event, based oncurrent national cholesterol guidelines.
        Specifically, these patients had low-density lipoprotein (LDL) cholesterol levels that met current guidelines, and close to half had LDL levels classified in guidelines as optimal (less than 100 mg/dL).”

        Lately my numbers have been on the high side(although triglycerides and blood pressure remain great), but oddly my Calcium Scoring Test had the lowest/best possible number: zero. Giving me, according to this computer, a 3% risk of heart attack in 10years.

  11. Isn’t there plenty of saturated fat in fruits and vegetables? Is the main fat in avocados saturated? Should we avoid avocados because of this? And isn’t some fat from animals healthy (wild caught Alaskan salmon)? I don’t think the delineation is between saturated and unsaturated or between animal and vegetable: it’s between healthy fats (some of which is saturated and unsaturated; animal and vegetable) and unhealthy fats (some of which is saturated and unsaturated; animal and vegetable).

    I also have a problem with studies that tests eating factory farmed chicken vs eating organic vegetables. Do these studies tell us where they got the chickens from and what they eat? How about testing 100% pastured free-ranged chickens vs conventional factory farmed (herbicide and pesticide laden) veggies?

  12. If we only create a certain amount of beta cells after we’re twenty, and they support anti-diabetic, good health – how does a whole food, plant-based diet reverse Type 2 diabetes? If we can’t make any more beta cells. I guess depending on how important they are to preventing Type 2 diabetes. How many beta cells do we have? And how many can be destroyed from each high saturated fat meal we eat?

    1. Even though a WFPB diet can reverse type 2 diabetes, it does not cure it. There is no cure, and the second, I mean the SECOND you start eating the bad foods again, it comes back. Take it from someone who knows :-(

    2. As a moderator for NF.org, I wanted to respond to your question.. This is a good example of how our bodies are designed to be efficient with back up capability. We can still perform well with only half our beta cells IF we don’t cause our body to pump out more insulin or we cause massive need for insulin because we’ve overeaten high fat/sugary foods. Our beta cells can become more sensitive to insulin which helps in the recovery process also. I hope this is helpful.
      BTW We have about a billion beta cells to start with. I don’t know exactly how many can be damaged with each high fat, saturated meal. As Dr. Greger pointed out with the example of fat added to beta cells in the lab, the damage can be quick and significant.

  13. Ray Ellis
    Here is a link to a website that gives you lots of information on fat, carb, protein content of just about any food that you can think of. so you can now research this yourself.
    But your question – isn’t there plenty of saturated fat in fruits and vegetables? The answer is no. An apple, which I linked you to, has 3% fat none of which is saturated. Most greens are about 10% fat, none of it saturated. Beef carcass (use the link) is 30% saturated fat and 40% fat overall.
    Vegetables, in general, have 10% or less fat and, IN GENERAL, none of it saturated or very little saturated. Avocados, palm, and coconut are very high in fat but are a few exceptions in the vegetable world. nuts are very high in fat (use the link).

    I have an Italian friend who exclaimed to me: “Once I found out how much fat is in olives I stopped eating them!!” But he pours olive oil all over his food. Want to know how many olives it takes to make 1 Tbs of olive oil? about 44. Olive oil is not a whole food. Olives, even as a high fat food, are a whole food. And, just as a matter of interest, olive oil is about 15% saturated fat.

    As for avocado, of the 29 grams of fat in a typical avocado, 4 grams are saturated. So, no, the majority of the fat in avocados is unsaturated (lacking the hydrogen bond). Of the 322 calories in an avocado, 247 are fat calories (29unsaturated, 4saturated – remember that 1 fat gram is equal to 9 calories). This means that an avocado is 77% fat (mostly unsaturated). Here is the link to the avocado:

  14. Thousands of studies show saturated fats massively increase the chances of Cardiovascular disease yet only a few studies like one quoted (link below) by the ‘National Obesity Forum’ (NOF) state saturated fats are now good for us. Yet when we read who the sponsors of NOF were, it turned out to be vested interests like…

    Roche Products Ltd,

    Slim Fast Foods Ltd,

    Safeway Foods plc,

    Mantis Surgical Equipment Ltd,

    GlaxoSmithKline UK Ltd,

    British Meat Nutrition Education Services.

    Only an idiot would put any trust in those companies as they are the very ones to profit from recommending increased saturated fat consumption. Profit made from from either increased consumption and or from its resulting disease.

    Source: National Obesity Forum

  15. Dr Hyman says eat beans sparingly. Lentils are best. Stay away from big starchy beans :(
    Who is right…Dr Hyman or Dr Greger….I wish this would be settled….once and for all…both cant be right…or maybe they can

    1. Dr. Hyman has turned out to be wrong on a number of things. In fact, we’ve had to remove two things from my company’s website that we initially accepted as consumer education pieces. One of these was his article claiming cholesterol is not harmful (he forgot to mention the other compounds in animal foods that are REALLy toxic: oxysterols, AGEs, etc). Another was his claim that antidepressants don’t work. In fact, they do; they (SSTIs and tricyclics) have anti-cytokine (i.e., anti-inflammatory) effects, and facilitate neurogenesis, both of which explain their benefits.

  16. Hi Dr. G…Love your Stuff. (gotta question for you)
    I started in the Nutrition, Health, and Weight Loss field in 1980.
    My first office was in the Apothocary Drs Park in Bethesda across from NIH.
    I was originally influenced living in Santa Monica 2 blocks from Pritikin.
    Saw the amazing results his people were getting with Diet and Exercise.
    I got into the field as a result of overcoming 2 years of incapacitating emergency room belly pain
    that all the Beverly Hills Muckety Mucks had no answer for…It was later determined
    by a nutrition oriented Dr. that I was allergic/highly reactive to EGGS. No more belly pain
    and off to the races to learn all I could and help others with bad bellies…It later morphed
    into helping people with BIG Bellies :-)
    Here are my questions…
    -Is eating coconut meat ok.
    -Is using coconut milk in coffee ok?
    -Is using coconut oil (approx 1 tablespoon) for brain related issues ok?
    -All above being saturated makes me wonder.
    -Finally is the liquid mct (medium chain trigliceride) oil ok or preferable
    in an effort to improve brain fog/memory issues?
    Thanks for all you do…

    1. Hi LJ: Thanks for reaching out! We have lots of additional info already on the site that will help get you the information you’re looking for. A few good places to start would be here, here, here, and here.

  17. What about coconut oil and avocados? Not supposed to spike glucose and healthy saturated fat.
    I lost over 100# but have a belly that I can’t get rid of. Low calorie intake, walk ten miles a day (walk every 2 hours), got rid of tinnitus – eat mostly plant protein with some eggs and liver once a week.

    Diagnosed with adrenal fatigue – nuts and precursors to healthy hormones recommended by Dr. Eric Berg. Please email me your feedback. rmazelsky@yahoo.com

    Eat mostly spinach, kale, onions, mushrooms, garlic, tumeric, cherries/dark grapes, some apples. Not processed foods or sugar or carbs. Raw yogurt to help gut health and some fiber.

    1. Hi Russell: The healthy fats found in avocado are very beneficial. You can find more info here. Coconut oil is a different story – it’s been shown to increase LDL, or “bad cholesterol”. You can find the latest here.

  18. Stating that we only have as many beta-cells at 20 as we’ll ever have may be the same thing as saying that we are born with only as many brain cells as we’ll ever get, and that we lose these as we age – something which was repeated until it became accepted wisdom . The discovery of neurogenesis (circa1998, I believe) proved that one wrong. I read about two years ago that high intakes of vitamin K were found to increase the number of functioning beta-cells, which explained an association between higher vitamin K intakes or supplemental vitamin K and a lower risk for diabetes and better blood sugar control, respectively. Don’t know if this has been followed up on, though.

  19. During the last few decades, it seems to me most people, on the advice of their doctors, have at least attempted to cut fat and replace with carbs. Now this is just my observation, not scientific at all, but over the years it seems like there are a lot more people telling me they are trying to avoid fat- especially saturated fat- than there are people telling me they are trying to increase fat and/or lower carbs. I really have not encountered that many people who were trying to do Atkins, compared to those trying to cut calories and/or cut fat. Also, in my youth(50+ years ago) I almost never saw adults exercising, and now joggers, walkers and gym rats seem to be everywhere.

    Now, it must be admitted that during these decades the type 2 diabetes rates and the obesity rates have done nothing but go up. So, if it is the fat that is causing diabetes and not people eating more and more carb, what do we blame this increase in diabetes on? Maybe the folks said they were trying to cut fat and replace with carbs, but in reality they were doing the opposite?

    It is just hard for me to make sense of this based on actual observations in real life. Also, does the body produce any insulin at all in response to fat ingestion? I think it produces between low and zero. What about carbs? Double carbs, double insulin, right, more or less? Plus, eat a big carb load and SPIKE your blood sugar AND insulin, right? Yes, much protein raises blood insulin, but it also raises glucagon, which is like the anti-insulin. I don’t see how a lifetime of causing the pancreas being forced to crank out more and more insulin in response to high carbs can be helpful to diabetes patients. This is just one person, but I thought it was interesting: https://diatribe.org/low-carb-vs-high-carb-my-surprising-24-day-diabetes-diet-battle

  20. I am completely confused. I red Fat for fuel book recently. And there is absolutely opposite idea behind it. How can you explain it?

  21. How much avocado is safe to eat a day. I love it so much. I use to eat one a day, but now only half a day. Please tell me I can eat as much as I want. LOL

    1. Sorry friend, we don’t get into the business of putting blessings on excess intakes of any one particular food! Whenever we eat something every day, we run some degree of risk for getting too much of a substance that is in there either by nature’s intent, by contamination, or both. No one can guarantee that you will be free of these potential consequences. As fats go, avocadoes ARE a better choice than animal fats, and they DO seem like a better choice than cooking oils. My advice is to enjoy these in moderation; and a little less if you’re having trouble losing (or keeping off) weight. Also see: https://nutritionfacts.org/video/the-downside-of-green-smoothies/

      1. Thanks for the advice. I am vegan. On August 20th my wife and I will celebrate 5 years. And 11 years without any meats. We started a vegetarians 2006 and transitioned to vegan 2012.
        I have Dr Greger’s book and looking forward to the next one.
        I just recently committed to not using oil in any processed way. That is why I was curious about avocados because the have natural good fats that seem to outweigh the bad fat.
        Anyway, I just thought I’d ask. So looks like I’ll have to use them in moderation (bummer, They really help my skin look better). But I’d like to see more research posted by the Doc.

  22. Since methionine is an essential amino acid for humans, if you tried to starve cancer of it by restricting it in your diet, who would get the methionine you ate first, the cancer, or you the human? Does anybody know? I ask because I have two different kinds of cancer, both labeled incurable, and I recognize that cancers not only require methionine, they require sugars and starches (which become sugar after you eat them) and if you eliminate sugar, starch and protein from your diet in an effort to starve the cancers, what do you have left to eat? Is it possible for a human to exist solely on a diet of green leafy veggies?

    1. Hi Rosalie: This is Dr. Daniela Sozanski, PhD, PScD Naturopath in Atlanta, GA, also Moderator for Nutritionfacts.org.
      Valid and fair questions, here are some thoughts. As you saw in the video https://nutritionfacts.org/video/starving-cancer-with-methionine-restriction/ in question, there is ample evidence that various cancers thrive on methionine. Starving cancer cells thru methionine deprivation is a possible answer, not yet fully utilized by mainstream medicine, just as the concept of sugar feeding cancers had not been for decades, until now. Eliminating protein from your diet is another recognized measure to halt cancer progression, but it has to do mainly with animal protein, carrier of insulin growth factor 1 (IGF-1) https://nutritionfacts.org/topics/igf-1/ which is a promoter of several mechanisms of cancer growth and metastasis; in contrast, plant based protein, found in beans and nuts do not seem to have this negative effect on health.
      I think the jury has decided that a plant based diet is protective to our health. The Methionine findings only add one other dimension to the list of benefits.
      Finally, in true answer to your question, there were many practitioners of the 20th century who successfully utilized a plant based diet for multiple conditions, including diabetes, heart diseases and cancer. One example is Dr. Gerson. Others are Dr. Esselstyn and Dr. Ornish. The underlying thread in their success consisted of plant based diets, such as beans, legumes, nuts, seeds and greens, in the form of whole foods, which represent the plants as they come from the earth, unprocessed, un-extracted and unrefined.
      I hope this helps. Daniela

  23. Nina Teicholz has an article in yesterday’s Los Angeles Times praising butter and declaring it has gotten a bad rap. If Friend Michael Greger doesn’t have time to reply to this, I hope one of you on the staff who is credentialed will do so.

    1. Nina,
      Thank you for your question. I am a family doctor with a private practice in lifestyle medicine. Turns out that Dr. G. has already addressed the issue of butter, in great detail. Here are two videos you should see, which show why the studies that purport to show that butter doesn’t hurt you are poorly done, misleading, and several are funded by the American Dairy Association.

      * https://nutritionfacts.org/video/the-saturated-fat-studies-buttering-up-the-public/
      * https://nutritionfacts.org/video/the-saturated-fat-studies-set-up-to-fail/

      Also, Nina Teicholz is NOT a scientist and is promoting her book: “The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet.” This book is mentioned in her by-line.

      The facts about butter and saturated fat are extremely clear: they substantially raise cholesterol, and contribute directly to heart disease and diabetes.

      I hope this helps.
      Dr. Jon
      Volunteer moderator for NutritionFacts.org

  24. What about the saturated fat found in whole plants like peanuts? It is harmful to eat a high fat diet if it comes from whole foods (not oils) like peanut butter, avocado, seeds, etc?

  25. Yami,
    Thank you for your good question. I am a family doctor with a private practice in lifestyle medicine, and will attempt to answer. There is now abundant evidence that saturated fat raises cholesterol levels and contributes to cardiovascular disease. And saturated fat from any source, including peanuts, should not be eaten in excess.

    However, as Dr. G. is fond of saying, food is a package deal. Whole peanuts have fiber, complex carbohydrates and protein as well as oil. And peanuts help support “good bacteria” in your colon, due to providing short chain fatty acids. Whereas meat, cheese, etc. cause production of trimethylamine oxide (TMAO) which is known to cause cardiovascular and kidney disease.

    So, the answer to your question is that you shouldn’t eat a diet extremely high in peanuts, especially not if you have other risk factors for cardiovascular disease. But eating nuts and seeds in moderation provides a number of good nutrients and is probably not harmful for most of us.

    I hope this helps.
    Dr. Jon
    Volunteer moderator for NutritionFacts.org

  26. Minimizing carbohydrates has been good for me. It’s a shame that this topic inspires personal attacks. I think we all acknowledge that obesity and type 2 diabetes have been on the rise for quite a while. So we should be open to all research. Unfortunately since we’re not all scientists, sorting through the papers and weeding out conflicts of interest and corporate affiliations is a daunting task. Good luck to all of us as we try to get healthy.

  27. I have been following Dr. Greger’s plant based diet for several years – mostly by cutting back on meat, dairy and processed food. My cholesterol levels have dropped significantly over the years but tryglicerides remain borderline high. Is there a connection between plant/fruit based diet and high tryglicerides due to high carbohydrate intake? Thank you for any information you can provide.

  28. There is a connection between carbs and triglyceride levels. What concerns me is your comment that you “cut back” on meat/dairy/processed foods. That sounds like you have not completely eliminated these items from you diet, which you should for optimum health. If you have not eliminated these items then that is likely the cause and will work together with any unprocessed carbs, especially large amounts of high glycemic load fruit, to raise your triglyceride levels. In addition, if you have significant visceral fat, you could have Metabolic Syndrome which would worsen all of the above. I’m intimately familiar with all this because I have the same issues.

    Dr. Ben

  29. Any tips for non diabetic blood sugar level issues? I have thyroid and adrenal problems which are being treated but I believe are contributing. I try to include lots of fiber and non meat sources of protein in my meals..

  30. It’s hard to say without knowing what is happening with your blood sugar and what the testing on your thyroid and adrenal glands show. I’d suggest an endocrinologist for the best advice on the interactions of your glandular function.

    Best to you, Dr Anderson Health Support Volunteer

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