Flashback Friday: What Causes Insulin Resistance & Diabetes?

Flashback Friday: What Causes Insulin Resistance & Diabetes?
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Prediabetes and type 2 diabetes are caused by a drop in insulin sensitivity blamed on “intramyocellular lipid,” the buildup of fat inside our muscle cells. Saturated fat can be toxic to the insulin-producing beta cells in the pancreas, explaining why animal fat consumption can impair insulin secretion, not just insulin sensitivity.

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Studies dating back nearly a century noted a striking finding. If you take young, healthy people and split them up into two groups, half on a fat-rich diet, and the other half on a carb-rich diet, within just two days, this is what happens. The glucose intolerance skyrockets in the fatty diet group. In response to the same sugar water challenge, the group that had been shoveling in fat ended up with twice the blood sugar. As the amount of fat in the diet goes up, one’s blood sugar spikes. It would take scientists nearly seven decades to unravel this mystery, but it would end up holding the key to our current understanding of the cause of type 2 diabetes.

When athletes carb-load before a race, they’re trying to build up the fuel supply within their muscles. They break down the starch into glucose in their digestive tract. It circulates as blood glucose—blood sugar—and is taken up by our muscles, to be stored and burned for energy.

Blood sugar, though, is like a vampire. It needs an invitation to come into our cells. And, that invitation is insulin. Here’s a muscle cell. Here’s some blood sugar outside, waiting patiently to come in. Insulin is the key that unlocks the door to let sugar in our blood enter the muscle cell. When insulin attaches to the insulin receptor, it activates an enzyme, which activates another enzyme, which activates two more enzymes, which finally activate glucose transport, which acts as a gateway for glucose to enter the cell. So, insulin is the key that unlocks the door into our muscle cells.

What if there was no insulin, though? Well, blood sugar would be stuck out in the bloodstream, banging on the door to our muscles, and not able to get inside. And so, with nowhere to go, sugar levels would rise and rise.

That’s what happens in type 1 diabetes; the cells in the pancreas that make insulin get destroyed, and without insulin, sugar in the blood can’t get out of the blood into the muscles, and blood sugar rises.

But, there’s a second way we could end up with high blood sugar. What if there’s enough insulin, but the insulin doesn’t work? The key is there, but something’s gummed up the lock. This is called insulin resistance. Our muscle cells become resistant to the effect of insulin. What’s gumming up the door locks on our muscle cells, preventing insulin from letting sugar in? Fat. What’s called intramyocellular lipid, or fat inside our muscle cells.

Fat in the bloodstream can build up inside the muscle cells, create toxic fatty breakdown products and free radicals that can block the signaling pathway process. So, no matter how much insulin we have out in our blood, it’s not able to open the glucose gates, and blood sugar levels build up in the blood.

This mechanism, by which fat (specifically saturated fat) induces insulin resistance, wasn’t known until fancy MRI techniques were developed to see what was happening inside people’s muscles as fat was infused into their bloodstream. And, that’s how scientists found that elevation of fat levels in the blood “causes insulin resistance by inhibition of glucose transport” into the muscles.

And, this can happen within just three hours. One hit of fat can start causing insulin resistance, inhibiting glucose uptake after just 160 minutes.

Same thing happens to adolescents. You infuse fat into their bloodstream. It builds up in their muscles, and decreases their insulin sensitivity—showing that increased fat in the blood can be an important contributor to insulin resistance.

Then, you can do the opposite experiment. Lower the level of fat in people’s blood, and the insulin resistance comes right down. Clear the fat out of the blood, and you can clear the sugar out of the blood. So, that explains this finding. On the high-fat diet, the ketogenic diet, insulin doesn’t work as well. Our bodies are insulin-resistant.

But, as the amount of fat in our diet gets lower and lower, insulin works better and better. This is a clear demonstration that the sugar tolerance of even healthy individuals can be “impaired by administering a low-carb, high-fat diet.” But, we can decrease insulin resistance—the cause of prediabetes, the cause of type 2 diabetes—by decreasing saturated fat intake.

After about age 20, we may have all the insulin-producing beta cells we’re ever going to have in our pancreas, and 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 do it right in a Petri dish. Expose human beta cells to fat; they suck it up and then start dying off. A chronic increase in blood fat levels is harmful, as shown by the important effects in pancreatic beta cell lipotoxicity. Fat breakdown products can interfere with the function of these cells, and ultimately lead to their death.

And not just any fat; saturated fat. The predominant fat in olives, nuts, and avocados gives you a tiny bump in death protein 5, but saturated fat really ramps up this contributor to beta cell death. Saturated fats are harmful to beta cells; harmful to the insulin-producing cells in our pancreas. Cholesterol too. The uptake of bad cholesterol, LDL, can cause beta cell death as a result of free radical formation.

So diets rich in saturated fats not only cause obesity and insulin resistance, but the increased levels of circulating free fats in the blood, called NEFAs, non-esterified fatty acids, cause beta cell death and may thus contribute to progressive beta cell loss in type 2 diabetes. And this isn’t just based on test tube studies. If you infuse fat into people’s bloodstream you can directly impair pancreatic beta cell function, and the same 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, but these were non-diabetics, so their pancreas should have been able to boost insulin secretion to match. But insulin secretion failed to compensate for insulin resistance in subjects who ingested the saturated fat. This implies the saturated fat impaired beta cell function as well, again within just hours after going into our mouth.

So increased 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.

And 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 almost universally toxic, whereas the fats found in olives, nuts, and avocados are not. Saturated fat has been found to be particularly toxic to liver cells in the formation of fatty liver disease. You expose human liver cells to plant fat, and nothing happens. Expose liver cells to animal fat, and a third of them die. This may explain why higher intakes of saturated fat and cholesterol are associated with nonalcoholic fatty liver disease.

By cutting down on saturated fat consumption we may be able to help interrupt this process. Decreasing saturated fat intake may help bring down the need for all that excess insulin. So either being fat, or eating saturated fat can both cause that 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. And 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 of making us fat, may contribute to the development of insulin resistance and all its clinical consequences. After controlling for weight, and alcohol, and smoking, and 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. Now just like everyone who smokes doesn’t develop lung cancer; everyone who eats a lot of saturated fat doesn’t develop diabetes—there’s 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.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

 

Images thanks to Wess via Flickr.

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Studies dating back nearly a century noted a striking finding. If you take young, healthy people and split them up into two groups, half on a fat-rich diet, and the other half on a carb-rich diet, within just two days, this is what happens. The glucose intolerance skyrockets in the fatty diet group. In response to the same sugar water challenge, the group that had been shoveling in fat ended up with twice the blood sugar. As the amount of fat in the diet goes up, one’s blood sugar spikes. It would take scientists nearly seven decades to unravel this mystery, but it would end up holding the key to our current understanding of the cause of type 2 diabetes.

When athletes carb-load before a race, they’re trying to build up the fuel supply within their muscles. They break down the starch into glucose in their digestive tract. It circulates as blood glucose—blood sugar—and is taken up by our muscles, to be stored and burned for energy.

Blood sugar, though, is like a vampire. It needs an invitation to come into our cells. And, that invitation is insulin. Here’s a muscle cell. Here’s some blood sugar outside, waiting patiently to come in. Insulin is the key that unlocks the door to let sugar in our blood enter the muscle cell. When insulin attaches to the insulin receptor, it activates an enzyme, which activates another enzyme, which activates two more enzymes, which finally activate glucose transport, which acts as a gateway for glucose to enter the cell. So, insulin is the key that unlocks the door into our muscle cells.

What if there was no insulin, though? Well, blood sugar would be stuck out in the bloodstream, banging on the door to our muscles, and not able to get inside. And so, with nowhere to go, sugar levels would rise and rise.

That’s what happens in type 1 diabetes; the cells in the pancreas that make insulin get destroyed, and without insulin, sugar in the blood can’t get out of the blood into the muscles, and blood sugar rises.

But, there’s a second way we could end up with high blood sugar. What if there’s enough insulin, but the insulin doesn’t work? The key is there, but something’s gummed up the lock. This is called insulin resistance. Our muscle cells become resistant to the effect of insulin. What’s gumming up the door locks on our muscle cells, preventing insulin from letting sugar in? Fat. What’s called intramyocellular lipid, or fat inside our muscle cells.

Fat in the bloodstream can build up inside the muscle cells, create toxic fatty breakdown products and free radicals that can block the signaling pathway process. So, no matter how much insulin we have out in our blood, it’s not able to open the glucose gates, and blood sugar levels build up in the blood.

This mechanism, by which fat (specifically saturated fat) induces insulin resistance, wasn’t known until fancy MRI techniques were developed to see what was happening inside people’s muscles as fat was infused into their bloodstream. And, that’s how scientists found that elevation of fat levels in the blood “causes insulin resistance by inhibition of glucose transport” into the muscles.

And, this can happen within just three hours. One hit of fat can start causing insulin resistance, inhibiting glucose uptake after just 160 minutes.

Same thing happens to adolescents. You infuse fat into their bloodstream. It builds up in their muscles, and decreases their insulin sensitivity—showing that increased fat in the blood can be an important contributor to insulin resistance.

Then, you can do the opposite experiment. Lower the level of fat in people’s blood, and the insulin resistance comes right down. Clear the fat out of the blood, and you can clear the sugar out of the blood. So, that explains this finding. On the high-fat diet, the ketogenic diet, insulin doesn’t work as well. Our bodies are insulin-resistant.

But, as the amount of fat in our diet gets lower and lower, insulin works better and better. This is a clear demonstration that the sugar tolerance of even healthy individuals can be “impaired by administering a low-carb, high-fat diet.” But, we can decrease insulin resistance—the cause of prediabetes, the cause of type 2 diabetes—by decreasing saturated fat intake.

After about age 20, we may have all the insulin-producing beta cells we’re ever going to have in our pancreas, and 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 do it right in a Petri dish. Expose human beta cells to fat; they suck it up and then start dying off. A chronic increase in blood fat levels is harmful, as shown by the important effects in pancreatic beta cell lipotoxicity. Fat breakdown products can interfere with the function of these cells, and ultimately lead to their death.

And not just any fat; saturated fat. The predominant fat in olives, nuts, and avocados gives you a tiny bump in death protein 5, but saturated fat really ramps up this contributor to beta cell death. Saturated fats are harmful to beta cells; harmful to the insulin-producing cells in our pancreas. Cholesterol too. The uptake of bad cholesterol, LDL, can cause beta cell death as a result of free radical formation.

So diets rich in saturated fats not only cause obesity and insulin resistance, but the increased levels of circulating free fats in the blood, called NEFAs, non-esterified fatty acids, cause beta cell death and may thus contribute to progressive beta cell loss in type 2 diabetes. And this isn’t just based on test tube studies. If you infuse fat into people’s bloodstream you can directly impair pancreatic beta cell function, and the same 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, but these were non-diabetics, so their pancreas should have been able to boost insulin secretion to match. But insulin secretion failed to compensate for insulin resistance in subjects who ingested the saturated fat. This implies the saturated fat impaired beta cell function as well, again within just hours after going into our mouth.

So increased 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.

And 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 almost universally toxic, whereas the fats found in olives, nuts, and avocados are not. Saturated fat has been found to be particularly toxic to liver cells in the formation of fatty liver disease. You expose human liver cells to plant fat, and nothing happens. Expose liver cells to animal fat, and a third of them die. This may explain why higher intakes of saturated fat and cholesterol are associated with nonalcoholic fatty liver disease.

By cutting down on saturated fat consumption we may be able to help interrupt this process. Decreasing saturated fat intake may help bring down the need for all that excess insulin. So either being fat, or eating saturated fat can both cause that 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. And 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 of making us fat, may contribute to the development of insulin resistance and all its clinical consequences. After controlling for weight, and alcohol, and smoking, and 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. Now just like everyone who smokes doesn’t develop lung cancer; everyone who eats a lot of saturated fat doesn’t develop diabetes—there’s 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.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

 

Images thanks to Wess via Flickr.

Doctor's Note

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

I mentioned low-carb diets in the video. For more on their potential health effects, see videos like Low-Carb Diets and Coronary Blood Flow.    

Here are some of my most popular diabetes videos, for those who want to do a deep dive:

What we can actually do about preventing it:

And treating it:

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

186 responses to “Flashback Friday: What Causes Insulin Resistance & Diabetes?

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  1. That means buttered/fried potatoes and white bread with butter, cheese based deserts and ice-cream are some of the most dangerous foods to eat. They also block our arteries faster.

  2. It’s just sinking in for me that saturated fats kill insulin producing beta cells, as many as half of them by age 20. Plant fats don’t do the damage that saturated animal fats do. I like plant fats (peanut butter, nuts) because I am used to being a few pounds above bone skinny and because some fat on my body helps keep me warm in the winter and because I think fat helps with my available energy output. Surely I am just wrong on some of my instincts but I will be sure to think closer about my fat intake, even though it is from plant sources.

    1. Dan,

      Saturated fats tend to be solid at room temperature, whereas unsaturated fats tend to be liquid at room temperature. Most plant oils are mostly unsaturated, which is why they are liquid at room temperature; the exceptions are coconut oil, and palm and palm kernel oil, which are solid at room temperature. It’s wise to avoid these. And purified plant oils are highly processed, a concentrated source of calories without the vitamins, minerals, and other phytonutrients present in the source plant, so I understand it’s also wise to avoid these. But oils in whole plant foods come packaged in the original plant, so they are fine. Though maybe not if eaten to excess.

      As for me, I love peanuts and peanut butter!! Other nuts, too. And I have discovered that the thinner I am, the colder I am during winter weather. I wonder if I’m less hot during the summer months? Because I love summer, too! Or, this all could be because I am older.

        1. I saw a Nova program on hibernating bears. The bears don’t drink or eat, have normal metabolism and their tissues do not atrophy. Science is clueless. NASA has a strong itch on this one.

      1. Dr. J, it’s agreed, summer is great for older folks. Here is some summer prose to warm everyone up.

        7-22-1999 Dog Days of Summer

        Long, quiet, hot days of summer
        When dogs (and may I say cats too) lay listless and with no effort
        Cicadas sing their rhythm brought on by the hot air
        And leave their shells behind on trees
        There is a magical quality about these days
        So quiet and peaceful
        With the serenity of a desert
        These are days when the mind can wander
        And feel the eternity of time

    2. The fat on a person’s body does not neccesarily keep one warm ~ I’m on a weight regimen & have so far lost over 105 lbs ~ however when at my heaviest & now after some weight loss I still do not stay warm as I’ve got low BP & my husband who tends to have higher BP & is not obese stays warmer than I do & this sometimes creates the issue of lowering the heat for him while I use a sweatshirt & a quilt ~ so not all fat people’s fat keeps them warm ~ just saying……….

      1. Marji,

        Way to go! Congratulations!f

        Your comment about keeping warm was so interesting to me; my husband has very low BP, and is warmer than I am, with normal BP. I always thought it was because he’s bigger and has more muscles than I do. We are both now slimmer, having lost even more weight when we transitioned to whole plant food eating from eating vegetarian — and I thought that we were at healthy weights before. We weren’t trying to lose weight, and we didn’t increase our activity levels; if anything, they’ve gone down a bit. Maybe we need to ramp our activity level, and our muscle mass, up a bit more.

    3. Dan,

      Actually, we seem to stop making new pancreatic insulin-producing beta cells by about age 20, and by the time T2 diabetes is diagnosed later in life, about half the beta cells might have already been destroyed. (Chapter: “How Not to Die from Diabetes,” p 109, in “How Not to Die”)

      I’m re-reading this chapter; it seems to take more than one reading to remember all this information. It’s a great chapter — actually, they all are, in the book “How Not to Die” by Dr. Greger. And all this information is in there. If you haven’t looked at this book, I highly recommend it.

      1. Dr. Greger’s information continues sinking in the 2nd, 3rd and continuing times around. Our brains function to make some kind sense out of information the first time around but so much winds up on the cutting floor.

    1. Eating exclusively WPFD works even more efficiently than periodic fasting to increase insulin sensitivity, and it is a lot more fun than starving ever so often.

      1. Did you have a link for that Marcy? ie the idea that wfpb diet works more efficiently than periodic fasting to increase insulin sensitivity?

        It’s not often we see a trial featuring wfpb diets.

      2. How about WFPB diet AND periodic fasting? Of course, not everyone wants to put up with the discomfort of fasting, but for those who don’t mind it, and if, in fact, there are benefits, then why not? I do agree that WFPB diet is the first and most important step, however.

        Here is a paper entitled “Effects of intermittent fasting on health markers in those with type 2 diabetes: A pilot study.”

        https://www.ncbi.nlm.nih.gov/pubmed/28465792

        1. Of course, one wishes that such studies would involve people on healthy WFPB diets! The “normal” diet, as we know, is unhealthy and so confounds anything we might learn.

        2. plant_this_thought, interesting link! Though it was a short intervention, I was amazed how quickly some of these people responded. They all were very heavy, and I found it interesting they all chose to have their eating ‘window’ start in the late afternoon! hmmm maybe they need to check out Dr Greger’s chrononiology series?
          I have been eating wfpb a very very long time. Fairly recently I tried the IF idea, 2 or 3 meals in an 8 hr window, 8am to 4pm (sometimes 5pm) . Great benefits so far, and I would like to add four or five days fasting per month, or season, and see how it goes.

          1. Yes, they would have been better off moving their eating window to the morning.

            The regimen you describe if very close to the one I use. I try to stop eating by 2pm and keep the eating window 8 hours or less. For the last year and a half I have been fasting 7 days per lunar cycle (29.5 days). I believe all of this has had positive effects, both physically and mentally. My weight has stabilized to a BMI of 23 or so. The 7 day fast is hard, but I feel a tremendous sense of accomplishment in addition to the aforementioned benefits. It took me a number of fasting cycles to build up to 7 days.

        3. ‘In order to investigate whether an intermittent fasting diet could also generate damaging free radicals, Ana Bonassa and colleagues, from the University of Sao Paulo in Brazil, examined the effects of fasting every other day on the body weight, free radical levels and insulin function of normal, adult rats, over a 3-month period. Although the rats’ body weight and food intake decreased as expected over the study period, the amount of fat tissue in their abdomen actually increased. Furthermore, the cells of the pancreas that release insulin showed damage, with the presence of increased levels of free radicals and markers of insulin resistance were also detected.

          Ana Bonassa comments, “This is the first study to show that, despite weight loss, intermittent fasting diets may actually damage the pancreas and affect insulin function in normal healthy individuals, which could lead to diabetes and serious health issues.”‘
          https://www.eurekalert.org/pub_releases/2018-05/esoe-cif051618.php

          This was only a rat study and may not be applicable to humans. On the other hand, we don’t appear to have information on the diabetes rates/risk of people practising fasting for long periods of time.

            1. Thanks Barb. he notes

              ‘Storing fat in your belly, rather than your hips, increases your risk for diabetes because it shows that you are storing fat in your liver. When blood sugar levels rise too high, your pancreas releases insulin which lowers blood sugar levels by driving sugar from the bloodstream into the liver. Fat in your liver prevents the liver from accepting sugar from the bloodstream, so blood sugar levels stay too high. Almost everyone with a large belly and small hips already has high blood sugar levels and is at high risk for diabetes and heart attacks. In one study, intermittent fasting markedly helped decrease belly fat (Translational Research, October 2014;164(4):302–311).’

              In that extract I posted above, the researchers found ‘Although the rats’ body weight and food intake decreased as expected over the study period, the amount of fat tissue in their abdomen actually increased. ‘ Whether this fat was visible or not I do not know – it is possible to have fat in the abdomen around organs etc (visceral or intra-abdominal fat) and still not have a swollen belly..

              The Mirkins are probably OK since they do a lot of exercise
              https://www.hopkinsmedicine.org/gim/core_resources/patient%20handouts/handouts_may_2012/the%20skinny%20on%20visceral%20fat.pdf

              Whether other alternate day fasters who do not exercise (to the sane extent) would also be OK or would in fact be at increased risk is I think still an open question.

              1. One must distinguish between the acute effects (muscle and other tissue loss) of periodic prolonged (>48 hours) fasting and the long term effects. Dr. Longo’s studies suggest that fasting causes increased apoptosis (cell death), but during refeeding there is an upsurge in stem cell production. In the complete fasting cycle, then, old damaged cells are replaced by new ones. It is obviously impossible to fast all of the time, nor would one want to. The benefits seem to come from the combination of occasional prolonged fasts with judicious refeeding and, of course, a healthy baseline diet.

                Dr. Longo distinguishes between periodic prolonged fasting, and so-called intermittent fasting, of which there are also many types. So far, Dr. Greger has only addressed alternate day fasting. I would like to see him tackle the literature pertaining to longer fasts and the lasting benefits that they may offer.

        4. Plant

          It’s not at all clear if the results from this study were in fact due to

          1. fasting per se …………… or to …………….
          2. calorie restriction
          3. weight loss
          4. lower fat intake
          5. lower carbohydrate intake

        5. Plant T.T., I agree. It is not an either / or, but a “why-not-both.” WFPB combined with time-window-fasting (or eat-towards-the-early-part-of-the-day, when circadian rhythm works to your advantage—makes good sense.

      3. I agree. All the fiber in WFPB restricts calories and has people saying they are eating all they can, not exercising and still loosing weight. Where’s the peanut butter!

        1. Fiber is great, but to me that is a separate issue. There may be some people who are ‘eating all they can, not exercising, and still losing weight’ but I have never met one. There are a lot more people who like myself have to be mindful of what and how much they eat, and how much exercise they get in a week. Nut butters stay on the store shelves.

          1. Barb, Dr. Esselstyn has a video (I cannot find it for you–sorry) where he points out that the blue zone Okinawans do not exercise that much but still have good health. It should also be mentioned that some of these ideal blue zones have been corrupted by SAD eating culture.

            1. I don’t know what you are on about Dan. You’re off on a tangent. I was not commenting about blue zones, the Okinawans, Dr Esselstyn, or about the american standard diet.
              I simply responded to you ‘eat all they can, not exercising, and still losing weight’ comment.

              1. * Dan, My apologies, I think I may have confused you rather than explain my comment.

                Yes, you are right in that we sometimes hear in success stories written by wfpb people on these sites that
                they can now eat as much as they want and still lose weight, maintain weight, or whatever.

                I have been at this wfpb a long time (since the 80’s basically) but vegan for the past decade. I have not had the experience of eating all I want and losing weight. The first months of being vegan and struggling to figure out what to eat probably is the time when most people will lose weight. True in my case anyway.

                Today, if people ask me about what I eat, I never claim to eat all I want, or that they could either. I don’t claim specific health benefits either. I leave it to them to discover for themselves how it will go should they try it. Why? Because for one, I personally have to be very conscious of what and how much I eat to prevent weight gain. Same with the folks I hang out with. The other point is that even if people are willing to give it a try, their interpretation of wfpb, and ‘as much as I want’ may be very different.

                At any rate, you might be interested to see how other cultures have handled the potential problem of middle age spread. The idea of leaving the table while still hungry was something practised by the Okinawans, and other cultures as we see here:
                https://en.m.wikipedia.org/wiki/Hara_hachi_bun_me

                1. Barb,

                  Maybe it matters how much of what foods people eat?

                  I recall reading Dr. Greger saying that he tries to eat a pound of greens a day! OK, Wow! To me, that seems like a lot; I’ve realized that I don’t even get the 2 servings of greens recommended in the Daily Dozen every day (it’s more like a few times a week). As for vegetables, I tend to eat the starchier ones, though I’m making an effort to eat more of the non-starchy ones more often. But I wonder if greens and non-starchy vegetables made up a large portion of food intake, perhaps it would be possible to eat as much as you wanted?

                  And we do limit how much we eat of some foods, for example bread (even though it’s home made whole grain sourdough), nuts, seeds, and oh, true confessions, the indulgence in sweets. Though these days, I find that just a little indulgence goes a long way toward satisfying my desire for it.

                  As for age, my husband lost weight after 65, and I lost weight at about 48 (separately) as vegetarians, practicing portion control and making healthier choices; we both lost more after switching to WPF eating a few years ago (age 73 and 65), and my brother lost weight at 66 switching to WPF eating after about 10 years as a vegetarian. My husband and I didn’t change our activity levels, though my brother did. But I’ve never claimed to eat all I want, though I don’t feel hungry or deprived in any way, and sometimes I do eat too much at one meal, and then I regret it.

                  It would be interesting to see individual data from the studies that show weight loss from eating WPF (though some do present ranges); I’m going to guess that even though the average loss is significant, there is considerable variation among the study subjects. The reason(s) why some folks don’t lose as much as others would be worth looking into. We are all different. Dr. Kim Williams (past president of American College of Cardiology), recommends that all his heart patients become vegan, because he says that their cholesterol levels will drop — but he can’t predict by how much.

                  1. Dr J, thanks as always for your comments. I think it would be so interesting (maybe not that scientific!) for us at least if Dr Greger did a questionaire for those who eat wfpb.
                    I focus on the daily dozen, and tend to avoid starchy veg , or at least limit them. I have been eating consciously since I was a kid, but it was how we were raised. 1 small boiled or baked potato, 2 veg, a salad and meat or fish… no gravy or sauces ever. I eat 2 servings of greens daily, but a pound would last me a long time. Veg and greens are very expensive here. I eat oatmeal daily, a bit of rice twice a week, maybe 1 piece of bread daily. Lots of veg. Lots of fruit. Today it’s borsht and a salad. I have been approx the same weight for decades but not without determined effort.

                    Dr Kim Williams is one of my favs. I listen to him frequently. On one of his videos he says how much he enjoys the food. He eats, then eats again in an hour because he is starving. He garnered quite a laugh on that one.

                    There is a phenomenal study Jenkins did with his people eating just veg and fruit and they got terrific results. Since this is diabetes weekend, I will find a couple of amazing videos that I recall Dr Greger did on the topic, with diet description.

                    1. This study Dr Greger has mentioned a couple of times, but here he discusses fruit intake and diabetes.

                      https://nutritionfacts.org/video/if-fructose-is-bad-what-about-fruit/

                      There are 2 videos in the Ma-Pi 2 study series about the macrobiotic study. Why didn’t we sign up for that one Dr J? The people were housed and fed an extraordinary diet of fresh, organic foods. In Italy!

                      https://nutritionfacts.org/video/benefits-of-a-macrobiotic-diet-for-diabetes/

                    2. Barb, I am like Dr. Kim Williams. I will eat my morning oatmeal, but within an hour I am eating a potato and peanut butter between two toasted breads. Diet restriction (other than not eating the wrong foods) is not my thing. Dr. Kim Williams just looks skinny. Dr. Greger looks skinny. Dr. Esselstyn (& whole family) look bone skinny. Have you seen the food amount they put on their table? Dr. Colin Campbell (skinny), Dr. Klapper (skinny), Dr. Ornish (skinny), Dr. Popper (skinny), Dr. McDougald (skinny), Dr. Pritikin (skinny), Dr. Barnard (skinny), Dr. Burdick (skinny). These vegans look so skinny you would think they’ve been in a work camp with maybe a cup of soup a day. But they are eating mountains of food. Many of them have published cook books and sponsor eating programs teaching how to eat. Are there people that can’t seem to get their weight where they want it. Yes. Dr. Greger has fairly recently touched on this subject, in a video, when he said obese kids and teenagers can be likely (high percentage) to stay that way throughout life. Dr. Greger has also talked about culture (knowing someone who knows someone obese), health of relatives (even distant) and maternal health (stress) to name just some. My two brain cells say, if metabolism is not working for you, do what you can to eat what you think is healthy, get some exercise and good sleep, try to have healthy relationships and know you’ve covered the bases fairly well.

                2. I have heard of the Okinawans eating that way. National Geographic did the program, that I saw, with Dan Buetner (sp?). Maybe I remember that they put food on their plates (from the kitchen?), ate the food on their plate and did not refill.

        1. I think that’s a fried, shredded potato patty like they might serve at Denny’s similar restaurant. I guess a lot of typical SAD eaters eat those at home too.

    1. Dr. Cobalt,

      I was thinking the same thing.

      This is one of my top video list from this site. This alone would be enough for understanding Diabetes. This, plus the Keto and Diabetes video to help understand that Keto lowers blood sugar, but it doesn’t really help, on top of still killing the Beta cells and increasing insulin resistance.

      I am wondering if diets like Atkins and Keto explain the whole Type 1.5 phenomenon.

    1. YR,

      I looked at it and I don’t think Dr. Greger’s video disagrees with WebMD. To me, this video is explaining the mechanism that causes the cause.

      WebMD buries the mechanism down under the category of risk factors.

      I do see that they put “genetic factors” at the top of the list, but so many people are able to reverse it that it seems to me that they aren’t including this science in their logic.

          1. Wait, I just thought about something.

            We have to include the night eating because eating low glycemic index becomes high glycemic index at night and eating anything with higher glycemic index brings people into Diabetic blood sugar levels, so that I have to put next to this video as what could be causing high blood sugar levels.

    2. YR, your conclusion is a non sequitur. The article doesn’t contradict this video. The video discusses the mechanisms that your article does not. So your comment is a random leap.

      1. JNN, “my” conclusion or the conclusion of WebMed? My sentence was in reference to Dr. G.’s “currently” word.

        We all know how medical science is: one week a food is good for us, the next is lethal. Same with what causes diseases. Now we have the answer! Oops, no, we don’t.

        1. YR,

          Actually, the evidence for the health benefits from eating whole plant foods has been around for a long time; it’s just getting better, and we’re getting more of it.

          What’s important is the preponderance of the evidence: what conclusion does most of the data support? There are some great videos on this site, describing how studies and data can be manipulated, to support desired conclusions. And some contrary results will occur simply by chance, others as a result of poor experimental design and/or analysis. (That’s one reason why scientists publish their results; so others can criticize them. And then to build upon them.) But what conclusions does the vast weight of the evidence support? It all points to whole plant food eating as one of the healthiest ways to eat, if not the healthiest.

          But new evidence may emerge in the future, to tweak or even change this way of eating. But again, it would require a lot of very good evidence, to change the scientific paradigm.

        2. YR

          Your post would be correct if you deleted ‘medical science’ and replaced it by ‘sensational media reporting’. Medical science as expressed in dietary guidelines and reports by panels of experts convened by major health authorities and professional associations, does not change day by day in accordance with the latest industry/Atkins/Virta Health etc etc funded study.

          The attitude expressed in your post is common among many people I know. They use it to justify eating the way they have always eaten. It is also used by people selling unhealthy diets because, well, testimonials and stories are so much more convincing than all that science-y stuff that changes from one day to the next at least according to the media aren’t they?.

          How many years have you been coming here now?

              1. Did I not already give my perspective simply by including “I’m thinking” in my comment? Don’t you know how to dissect a simple sentence?

                1. You seem to be churning out the non sequiturs at a positively Stakhanovite rate lately.

                  Or perhaps you just don’t realise that these days, ‘yours’ is used to mean ‘one’s’?

                    1. You mean credible evidence from reputable sources?

                      It was interesting to see that the Russian Academy of Science has a Pseudoscience Commission. Score one for the Russkie.

                      In the US on the other hand, the Cleveland Clinic appointed uberquack Mark Hyman as its head, It obviously believes that pseudoscience is more profitable than actual medical science. They are probably correct.

    3. The webmd link was pretty good I thought. They did explain the mechanism of insulin resistance in 1 or 2 paragraphs, and they did list other risk factors which might nudge people into getting tested if they recognize factors in themselves.
      They opened with obesity and sedentary lifestyle as being the cause of over 90 to 95% of diabetes in usa.
      They also mentioned that the risk increases as we get older. (I kind of wondered what impact aging has on how we metabolize fats and sugars… with shrove tuesday
      coming up, I think about it often lol)
      They also say on another page that doabetes can not be cured. “reversal” may be possible in some recently diagnosed folks, which means that blood sugars are stabilized and medications are no longer needed. Is it because beta cells are destroyed that diabetes can not be cured?

      1. Barb,

        Yes, if too many Beta Cells are destroyed, it would be a condition that couldn’t be managed with just diet.

        That is why Cyrus and Robby have people take the C-Peptide test to see whether their body is producing enough insulin.

      1. Yes. agreed. I think that talking about ‘risk factors’ is probably better than talking about ’causes’ though.

        After all, smoking doesn’t cause lung cancer or cardiovascular disease in everybody but it is a significant risk factor. In the popular mind, the ’cause’ terminology can be exploited by charlatans and cranks. For example, they can use the ‘one black swan’ argument (and I have seen this done) – the belief that all swans were white was disproved by the finding of the first black swan in Australia. Some people eat a lot of saturated fat but don’t get T2D. Therefore, they say, this disproves the claim that eating saturated fat causes diabetes. The other way of exploiting the popular conception of a cause is the widespread attitude that things can only have one cause. So if you can show that sugary soft drinks ’cause’ T2D then this must prove that fats don’t cause T2D, mustn’t it?. I have seen that argued too.

      2. Marilyn,

        Yes, but I think that is where the WFPB doctors do the calories in fat versus sugar.

        They do a version of the fat you eat is the fat you wear and say things like when they biopsied fat in obese people they could see which fats were in their diets.

        I am not disagreeing with you because sugary junk food will also cause weight gain, but I have heard the WFPB doctors talk about it that the junk food also generally has fat in it. Butter, lard, oil.

    4. YR (YeahRight) wrote: “Until it [the cause of diabetes] no longer is.”

      I (a retired research physiologist) would never consider WebMD as a source for current scientific information. It is fine for getting a brief general overview on many medical subjects, but as a expert source for biomedical mechanisms, no.

  3. Wow, great explanation!! Thankyou. So do we have any healing herbs etc. for the pancreas? or is exclusion of SFA the only answer? Mthx, Sharon

    1. Sharon,

      There aren’t human studies.

      Lemon is one I am self-experimenting with right now. (Honestly, it is more about how I am getting myself to drink more water, but there was a sentence calling lemons “anti-genetic mutants” and it specifically was protective of the Pancreas in mice.)

      I do have a paragraph that I am looking into to see whether things like garlic or turmeric or cinnamon or blueberries or broccoli sprouts or one of the usual heroes might help, but, so far, this mainly shows me that there might be a pathway.

      Although the number of acinar cell-derived β-cells was too low to establish euglycemia, this study provided the first strong evidence of an endogenous pathway for acinar-to-β-cell conversion (5). Even more remarkable is a very recent study demonstrating that infusion of diabetic mice with EGF and CNTF induces widespread acinar-to-β-cell transdifferentiation, sufficient to restore normal blood sugar control in the majority of animals (110). CNTF acts through the JAK-STAT pathway, and its ability to promote β-cell neogenesis requires acinar cell Stat3 expression. EGFR signaling and JAK-STAT signaling therefore appear to be central modulators of acinar cell plasticity, promoting ductal metaplasia in the context of pancreatitis but β-cell differentiation in the context of diabetes.

    2. In many people, weight loss can restore pancreatic function and reverse type 2 diabetes. So can fasting apparently.

      This why we see reports of T2D reversal following strict weight loss diets, fasting and bariatric surgery

      https://www.ncl.ac.uk/magres/research/diabetes/reversal/#publicinformation
      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6194375/
      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6747427/

      ubmed.ncbi.nlm.nih.gov/30852132-durability-of-a-primary-care-led-weight-management-intervention-for-remission-of-type-2-diabetes-2-year-results-of-the-direct-open-label-cluster-randomised-trial/
      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4771522/

      Note though that this only applies to type 2 diabetes and some animal studies have shown increased risk of diabetes with fasting regimes. these approaches should only be emploted under medical supervision.

  4. This has got to be one of the best ever videos and topic. It’s a keeper and so worth listening/reading again and again. Even reading the references too. Thanks very much Be well and hugs.

    1. Ruthie,

      I felt the same way. Definitely one of the best ever videos on one of the most important health topics. This is one that I HAVE TO watch over and over and over again to really get the science.

      1. As Deb said, she must “watch over (this video) and over again”, and she is correct– there is a lot of material to cover, with rapidly flipping pages and the very briefest commentary by Dr. Greger.

        For many NF viewers/readers, going to the source articles is possible in many instances. But when they are not available, it sometimes is enough to halt the video on the right frame, and read its principal, relevant paragraphs.

  5. If you think about it, high cholesterol and fats can cause insulin resistance, and estrogen and DHEA are competitive inhibitors of cholesterol, sharing the same steroid backbone. Thus, lower hormone levels result in increased active cholesterol.

    1. Demetra Mills, yes , it’s known that postmenopausal women can see a rise in their LDL cholesterol when estrogen levels fall. High triglycerides can be a risk factor in diabetes as mentioned in the webmd article YR linked, above. However, as a postmenopausal woman with high LDL, I have not had high triglycerides, or high blood sugars. Maintaining a low bmi and active lifestyle helps keep risk of diabetes low too.

      1. I need one of those charts with the marks on either side to explain the soy data.

        The Japanese data on strokes in the Webinar helped me so much. I had looked at that information, but it is the bigger picture of the statistics that I am not quite getting.

        Can you take on soy for postmenopausal women who are trying to not have Diabetes?

        Among overweight but not lean Japanese women, soy intake was associated with a reduced risk of T2D 71.

        In a group of middle-aged Chinese women with no history of diabetes, cancer or cardiovascular disease, intake of legumes, including soy, was associated with reduced T2D risk 72.

        In post-menopausal Chinese women with pre-diabetes or early stage untreated diabetes, 3 or 6 month treatment with soy protein (15 g), either alone, or supplemented with isoflavones (100 mg), did not affect measures of glycemic control and insulin resistance 73.

        Other intervention trials show that isoflavone consumption after the onset of T2D was associated with positive health outcomes. In post-menopausal women being treated for T2D, daily isoflavone intake (100 mg of aglycones) for one year led to an improvement in insulin sensitivity and blood lipid parameters, reducing the risk for cardiovascular disease 74. Similar results were observed in a more short-term study with post-menopausal women being treated for T2D, where 12-week supplementation of soy (30 g isolated soy protein containing 132 mg of glucoside conjugated isoflavones) lowered fasting insulin, insulin resistance, glycated hemoglobin (A1C) , and total and LDL cholesterol 66. In contrast, a later study showed that daily consumption of isoflavones (132 mg) for 3 months had no effect on body mass index, plasma A1C, glucose, insulin or lipids in postmenopausal women with T2D, suggesting that other components of the soy could be responsible for the health benefits observed in the previous study 75. Six weeks of consuming a soy product that provided at least 165 mg of isoflavones per day led to improved blood lipid profiles but not glucose homeostasis in a group of T2D patients 76. Clearly, there are conflicting results on the effects of isoflavone consumption on cholesterol levels and measures of glucose control, with most of the studies using a soy-based product containing a mixture of different components. A recent meta-analysis of 24 human studies revealed that although soy consumption did not affect measures of glycemic control (e.g., fasting insulin, glucose and A1C), studies with intact soy protein rather than purified isoflavones or protein extract were associated with reductions in fasting blood glucose 77. This suggests components of soy other than isoflavones or interactions of isoflavones with other soy components were attributable to the anti-diabetic effects of soy in human studies.

  6. Fencepost,

    That is something to think about, but, more than one thing in soy is protective of the Pancreas and Beta Cells and I haven’t found any warnings about it where it made Diabetes or Pancreas function or Beta Cells worse.

    Vglycin, a soy peptide promoted the restoration of β-cells in rats (and, yes, that doesn’t mean all that much for humans, but it is better than nothing)

    https://www.ncbi.nlm.nih.gov/pubmed/26510947

    In postmenopausal women, Genistein, from soy, decreased fasting glucose levels and increased glucose tolerance and insulin sensitivity.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678366/

    Daidzein is another thing from soy that helps with the free fatty acid concentrations and there is an article on that, but this is just one on daidzein.

    https://www.ncbi.nlm.nih.gov/pubmed/17932873

    But soy and daidzein are what help turn people into s-equol producers (See Dr. Greger’s video) Only a third of people can become s-equol producers, but 60% of vegans are equol producers, so I don’t know if going vegan and eating soy increase the odds or not. But being one increases your odds of preserving your Beta cells.

    https://www.ncbi.nlm.nih.gov/pubmed/25297619

    Gut microbiome might be involved.

    They said that the gut bacterial communities may be involved in the mechanism of islet destruction and that they have done studies manipulating the gut microbiomes in animal models and it protected them from islet destruction. They said that the mechanism was by down-regulating both the adaptive and innate immune systems and that immediately flies over my head.

    This might take a while.

  7. For anybody interested in more pictures, I just stumbled across Mic The Vegan’s version of the concept.

    Mic is a good add-on to this video. His helped me visualize the ceramides and diacylglycerol and how saturated fats versus unsaturated fats can BOTH be involved in insulin resistance, but saturated fats are way more involved because they contribute to BOTH the ceramide and diacylglycerol pathways.

    https://www.youtube.com/watch?v=tKGK2saMd7s

  8. I was trying to learn the NEFA’s part but got confused by this sentence at the journal of insulin resistance.

    https://insulinresistance.org/index.php/jir/article/view/22/49#6

    Plasma leptin concentration, but not plasma non-esterified fatty acid level, was better correlated with insulin resistance, the median variance explained being 33.29%. Morphometric measures alone had a median variance explained of 16%. Ethnicity explained part of the variance across studies with the correlation being significantly poorer in Asians.

    The most I can almost guess at putting together is that they used to think the NEFA’s were in the fat and now they think they are in the muscle. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3178283/

    So maybe plasma is a different category still.

  9. Does the saturated fat contained in whole coconuts have the same type 2 diabetes causing properties as the saturated fat from animal sources?

    1. Shawn,

      Mic The Vegans video goes into that.

      Palm oil is the worst. Animal products are very, very bad.

      Coconut oil was definitely better than those comparatively and he definitely has the specific information on that.

      The unsaturated fats are much better.

      He mentioned olive, and I am assuming that he was talking olive oil, but I am not 100% positive.

      Vegan processed food is packed with palm oil and he specifically said that people could accidentally go vegan and get worse.

      1. Populations that eat coconut oil have very high rates of cardiovascular disease. Populations that eat whole-food coconut meat do not. ALL oils cause reduced flow mediated dilation which is closely associated with cardiovascular events like heart attacks. There is no “healthy” oil.

        1. I keep a jar of coconut oil in my bathroom. It makes an excellent skin moisturizer after a shower.

          So IMO it does have some redeeming virtues.

  10. This is the “smoking gun” explanation of type2 diabetes we have been waiting to see– and “waiting” is absolutely correct. The dates on many of the studies quoted, ranging from 1996 through 1999 and even later, make it clear researchers have known for more than two decades about the damage our bacon-and-egg lifestyle does to metabolic health, with a horrendous death toll in not only diabetes but heart disease and stroke incidence. Why has so little been published by health media, many of which– even today– resolutely refuse to advocate a whole-food, plant-based diet?

    1. Alphaa

      You nailed it.

      Why hasn’t the media jumped on it?

      Why do doctors and dieticians who work with diabetes still not seem to know it?

      Why aren’t young people being taught this?

      What The Health is going on?

      1. And it does make me angry with doctors like Dr Fung.

        I am going to tell you that I came here 2 1:4 years ago with zero science background, zero nutrition background, zero medical background and serious Alzheimer’s symptoms but I have kept plodding slowly forward.

        I have given the Keto doctors a pass because they might not know the other perspective but Geez Louise, I at least read the studies that are out there on the various topics and at least try to understand things from both sides.

        They can’t be as confused as I have been and the fact they are in all of these debates, they aren’t lacking exposure to the topics like I have been either.

        I guess technically it is possible, but come on, have the diabetes doctors really never had a patient ask about it? Highly unlikely.

        That means they are more likely deceptive in some way.

        1. RE: Alzheimer’s Symptoms

          Deb, as one of Dr. Greger’s recent videos revealed, the current thinking about Alzheimer’s is now moving toward AD as a cardiovascular disease of chronic neuron starvation, all due to “dat ol’ debil” of saturated animal fat and accumulated plaque. Cure the cardiovascular dysfunction, and prepare to be relieved of at least a few worrisome symptoms.

          Although Nathan Pritikin’s own heart attack was considered “normal”, at the time, his recovery was dismissed as an aberration. Yet, Pritikin was clearly on to something– at his autopsy, examiners remarked Pritikin had the arteries of a teenager.

          Continue on your path– you may succeed in reversing most, even all the malfunctions you believe now burden you.

            1. Thanks for that– McDougall has some good work in his own legacy.

              The McDougall issue of some controversy is salt, which McDougall claims is the wrong villain, and blamed out-of-context. Although the evidence seems solid on the salt-restriction side, I am prepared to read further.

              With my own diet, adding a salted (160mg /tablespoon, maybe three measures, total) vinaigrette salad dressing– no other dietary changes– boosted my systolic 20 points, into hypertensive. It normally is 105/67. After about 10 days, it has come back down considerably, with no other diet changes (except eating my salad with only vinegar, or no dressing at all).

  11. The thing is, when I am trying to learn, I have to learn every single vocabulary word and I had to learn the mechanisms starting at the children’s videos version of things.

    By next year, NERF’s and Quicki’s and ceramides will be old hat for me and I am almost able to understand sentences in the studies.

    They have zero excuse.

    The 25 hours of nutrition training is enough for highly educated people to understand something.

    Pritikin already learned more by being curious than people who have dedicated their whole lives to specialties.

    1. Perhaps they do understand but there is just too big (and lucrative) a market for this sort of thing? Telling people what they want to hear can pay big bucks after all.

      1. Mr Fumblefingers,

        A friend tells me that her MD acquaintances have told her that they don’t bother telling patients “what to eat” because patients won’t listen, or won’t change anyway. Well, there is certainly limited time during medical visits. But perhaps the emphasis should be on the evidence: in that, there is evidence that eating more WPF results in all kinds of healthy benefits in most people. But I’m not sure even that would work. Because as I’ve related, I’ve had a few people tell me that they will continue to eat what they want to eat, because they can just take a pill for whatever ails them. We have been him hacked by the food industry.

        Cartoon; Professor at a blackboard, on the first day of medical school: A PATIENT CURED IS A CUSTOMER LOST.

        1. Thanks Dr J but I wasn’t referring to the majority of doctors. I was trying to respond to Deb’s earlier comment about the keto doctors but my response was cut adrift. This below was what Deb wrote and what prompted my post. Sorry if I caused any confusion.

          ‘I have given the Keto doctors a pass because they might not know the other perspective but Geez Louise, I at least read the studies that are out there on the various topics and at least try to understand things from both sides.
          They can’t be as confused as I have been and the fact they are in all of these debates, they aren’t lacking exposure to the topics like I have been either.
          I guess technically it is possible, but come on, have the diabetes doctors really never had a patient ask about it? Highly unlikely.
          That means they are more likely deceptive in some way.’

          Of course, the human capacity for self-deception is enormous and probably most of them are sincere.but even so …………..

  12. Hi,
    Great video, however I would like more specific info if it is available. Since you mention that ‘saturated’ fat causes diabetes, I wonder if you have looked at the intake of coconut oil, a plant based form to see if it also has this devastating effect on insulin resistance, the liver and the CV system?

    Thanks,
    James

    1. Just what I also wanted to ask.
      I personally am now, since I know Dr. Gregers work, cutting down on ANY added fat, but my family still uses lots of it, including Ghee, but also Coconut Oil. Then there is also the other plant-sources for saturated fat, Cocoabutter and Palm Fat, which is added to many industrial products (which should be avoided anyway, I know). But reading it black on white might convince my family to reduce those also.

    2. Hard clinical endpoint fact: populations that consume coconut oil and other saturated fat plant oils have high rates of cardiovascular events.

  13. Sorry for processing that here.

    To Dr Greger.

    As many pictures as possible and as many mechanisms as possible helps.

    I know that my brain has been spinning trying to understand things.

    But I assure you that things get crossed off the list and I will get quieter.

  14. In addition to this video being one of the most sharp and incisive in its content, the voice of Dr. Greger supported with the rich and continuous display of the actual research pages delivers the information in a way the audience can stop and read it and reinforces the credibility of the information. This one is one of the best. I hope NutritionFacts goes back to this style of presentation.

    1. Okay, Tom, maybe you can help me understand.

      I think Dr. Fung’s view is that if you want to hold onto Keto, fasting is a way of emptying out the liver and once the fatty liver is gone, the insulin resistance is gone.

      But I think I need to understand the mechanism that the Beta Cells get killed in the first place. Dr. Fung is ignoring the dying Beta cells and he is saying Fructose, not fats or glucose causes fatty liver.

      I think the WFPB doctors point out that fat turns to fat easier than carbs turn to fat.

      I guess I am to What causes Fatty Liver and What causes the Beta Cells to die.

      I think Dr. Fung is ignoring what causes the Beta Cells to die and he is giving an alternate way to get the fat out of the liver so that there won’t be as many NEFA’s swimming all around.

      1. Dr. Fung uses the word “Keto” interchangeably between the diet and the concept of fasting itself is what it feels like.

        That makes it more confusing to me.

        He is why people do the high-fat diet and combine it with as much fasting as possible as an alternate answer to Whole Food Plant-Based very low oil.

        It seems like, as long as people fast enough, maybe he might be able to say they reverse insulin resistance that way.

        But the Beta Cells dying in the first place seems to be ignored.

        Plus, his view is that fructose is the cause of fatty liver disease, so that is what I am stumbling over.

        1. TBH, I haven’t spent much time looking at his claims. However, there are I think a number of problems with Dr Fung’s approach.

          One is that he presents the ’cause’ as an ‘either/or’ choice. It is either dietary fat or dietary sugar/glucose. The situation appears to be that type 2 diabetes can be caused in a number of ways. As Dr Greger has pointed out, there are known mechanisms by which dietary saturated fat can induce T2D. Excess dietary sugar may be converted to fat in the liver and promote localised insulin resistance, so it too can be considered a risk factor, Excess body weight itself can also increase risk for T2D and clearly both excess dietary fat and sugar can cause excess adiposity. The human body can also synthesise saturated fats from dietary carbohydrates which further complicates the situation..

          The other major problem to my mind is that he consistently attributes the benefits of weight loss and fasting to low carb eating..

          As far I know, he has only published one article in the professional literature on this topic and that never even mentioned low carb diets (except when briefly referring to a study by other researchers). It was a case study of just three patients with T2D which attributed the observed benefits of the intervention to fasting – although the weight loss the patients experienced may have been the real ’cause’ of their improvements..
          https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6194375/

          As far as I know, populations eating traditional low fat WFPB diets experience little or no T2D. Masaai and Eskimoes also reputedly had low T2D rates also However, the lipid profile of the animal foods they consumed was probably much lower in saturated fatty acids and higher in eg PUFAs than the animal foods eaten in Western societies. They also engaged in much vigorous physical activity and have a number of genetic adaptations to their diet.

          A WFPB diet that is low in fat, refined carbs and sodium, and high in fibre, seems much the safest and most effective counter to T2D risk based on human history. Losing weight in prediabetic perons and newly diagnosed T2 diabetics may also be a very effective strategy. It is probably how ketu gurus like Fung get the results they claim to deliver.

          He makes big claims supported by assertions and testimonials. That sounds more like marketing than science to me.

              1. PS: Dr Greger, I know that your audience loves Diabetes videos and we could use all of the videos on the studies like the one on the fats versus simple sugar harming the liver as we can get.

                People such as Dr. Fung are doing “It isn’t intramyocellular lipids, it is overflowing fatty acids coming from fatty liver caused by fructose.”

                Fatty liver videos, what preserves Beta cells videos fats versus sugar videos all would be welcome.

              1. Some people are pretty scathing about Lustig

                camreportdivision.wordpress.com/2015/03/22/robert-lustig-is-now-obese-after-avoiding-sugar-and-eating-meat-the-bitter-truth-video-claims-are-debunked/

    1. PubMed has a sentence though which I found intriguing.

      The effects of the FMD (Fasting MImicking Diet to produce new Beta Cells) are reversed by IGF-1 treatment and recapitulated by PKA and mTOR inhibition.

    2. Deb, Dr Fung says the same thing about the effects of fasting. At your link for example, take note around minute 15, where he talks about the beta cells burnout. And later at minute 17 where beta cells function again after surgery, or fasting.. I haven’t watched the whole thing but essentially , the fasting eventually pulls the fat out of the liver and from around the other organs. So can intermittant fasting, fasting mimicking diets

        1. The Counterpoint study demonstrated that beta cells could resume functioning after severe dietary restriction. However, this was in a small group of just 11 people and none of them had had T2D for longer than 4 years. Whether the same thing will be seen in larger groups and/or people who have long-standing T2D remains to be seen

        2. Barb,

          Watching him again, what I end up objecting to is that he describes the theory Dr Greger put up as, “They used to believe….”

          He is discounting the reality that going off the Keto diet and going low fat and lowering the fatty acids works.

          He acts like it is this old ridiculous notion and like it is smarter to not try to bring down the NEFA’s through diet.

          What I am understanding now is that rather than putting water fasting as an alternate way of accomplishing it, he tries to act like the theory was wrong.

          Plus, he uses the concept of keto both for water fasting when most people think of it as eating a keto diet and most people don’t go into ketosis and most don’t lose weight and if they don’t lose weight, the extra fatty acids will hurt them.

          It has taken me 2 years to figure out how to understand this from the Keto (water fasting ketosis) side and the Keto (diet which generally is a lot of oil and no ketosis and has the acetone problem) versus going off oils and improving more that way.

          He wasn’t helpful to my understanding until Dr Greger filled in with enough separate water fasting, intermittent fasting, Keto diet videos.

  15. Okay, what I realized is that the fact that I wasn’t available for Mastering Diabetes seminar when it happened and the fact I haven’t bought Cyrus and Robby’s book yet are probably why I am still sitting here trying to figure the “rest of it” out.

    1. Laughing.

      That is a good one.

      My Alzheimer’s joke would be, what kind of lettuce did they say, I can’t recall, oh, Romaine.

      Oh no, what if I am genetically iceberg lettuce, whatever will I do?

      Now, if they will actually triple wash it and come into my kitchen and chop it up at the very last second so I can get the phytonutrients, we are in business.

  16. Hi,
    I am pregnant for the second time and I h@ve gestational diabetes again. I’m from Hong Kong and I was eating Mostly a vegan diet for over a year before calling pregnant. My A1c was 5.2 when I was 8 weeks pregnant. I thought I might not get it again this time but no matter what I did to try to prevent getting GDM, I ended up getting it. None of my family has diabetes. I guess I just have the genes unfortunately.

    My question is in my circumstances, if I do everything I can to prevent myself from getting type 2 diabetes by eating a vegan diet, exercising (cardio and strength training etc), managing stress levels, no alcohol and smoking and sleeping enough, will I still have type 2 diabetes when I’m older? Because I’ve heard enough times and been anxious for too long about my risks of developing it in the future like it’s inevitable. I’m sick of hearing it and thinking about it. I want to know the truth. Thanks.

    1. Many so-called vegan diets are unhealthy and don’t protect people from chronic diseases. It appears important to eat a whole food plant based diet that is high in fibre. This diet can be ‘vegan’ if desired or include small amounts of animal food but most calories should come from high fibre whole plant foods.

      ”One large study looked at diets of women before they got pregnant. Each daily increase in fiber by 10 grams reduced their risk of gestational diabetes by 26%.’
      https://www.webmd.com/diabetes/gestational-diabetes-guide/gestational-diabetes-can-i-lower-my-risk#1

      Fibre intake also appears to be important in lowering type 2 diabetes risk generally, especially high consumption of cereal fibre. A similar risk reduction (about 25% for every 10 grammes of cereal fibre) to that for gestational diabetes has also been observed in some studies of type 2 diabetes risk
      https://link.springer.com/article/10.1007/s00125-015-3585-9

      1. Cereal fibre.

        Probably not Lucky Charms. They might be magically delicious but there isn’t all that much fiber in it.

        I am saying it because mentally I am not sure what cereals are good cereals.

        I haven’t eaten any cereal in years. I think Ezekiel cereal was the last one I had.

        Except steel cut oatmeal. Is oatmeal under the category cereal?

        1. Yes.

          Cereal is basically edible grass and its seeds – whet, oats, barley, rice etc. …. so grains are cereal.s The difference is that the term ‘cereals’ can include the entire plant whereas ‘grains’ refers just to the seeds.

      2. I feel that my diet before pregnancy was pretty healthy. I ate so many servings of vegetables and fruits and I only mainly eat low GI and high fibre carbs. I was told it’s nothing to do with what I ate before or my weight, I’m just destined to get gestational diabetes which is something I find super annoying.

        I wonder for people like me who already have a very low BMI, low cholesterol levels and blood pressure, is type two diabetes still a destiny in the future? This has been on my mind since my first pregnancy and I got depression and anxiety because of it. However, I just have to worry less about the future and control what I can.

        Thanks for your reply.

        1. Thank you. I wish you all the best for the future.

          It’s important to ensure even on a WFPB diet that that you get all the required nutrients eg B12, iodine, selenium, zinc etc which can sometimes be difficult to obtain on such diets.
          https://www.todaysdietitian.com/newarchives/030413p38.shtml

          The US dietary guidelines also address this broad point
          https://health.gov/our-work/food-nutrition/2015-2020-dietary-guidelines/guidelines/appendix-5/

          Some of these resources below may also be helpful

          https://vegetariannutrition.net/wp-content/uploads/2017/08/Vegetarian-Position-Paper.pdf
          https://veganhealth.org/daily-needs/
          https://nutritionfacts.org/2011/09/12/dr-gregers-2011-optimum-nutrition-recommendations/

          Usually, ‘vegans’ have a much lower risk of type 2 diabetes than non-vegans
          https://veganhealth.org/type-2-diabetes-in-vegans/

          https://www.diabetes.org.uk/guide-to-diabetes/enjoy-food/eating-with-diabetes/veganism-and-diabetes

    2. Angel,

      Make sure that you aren’t eating late at night.

      Watch the video on that one.

      And make sure your oil and refined carb intake is low, particularly look to see if you are eating processed foods with Palm oil.

      Mic The Vegan showed that palm oil is worse than animal products at producing things like ceramides and it is in vegan junk food and processed food.

      Robby and Cyrus from the Mastering Diabetes site just wrote a book on the topic.

      They have people take the C Peptide test to see how well their body is producing insulin and the number on that test tells people whether their Beta cells are capable of producing enough insulin for their body.

      Time restricted eating can help generate new Beta cells. But eating at night can bring you into the Diabetic range even if you aren’t Diabetic.

      1. The fact that 80 or 90% of people who are diagnosed Diabetes can reverse it just by losing weight within the first 4 years after diagnosis, I would say that you aren’t doomed.

        Just watch out for the oils, refined carbs and watch what time you eat.

      2. Hi Deb,

        Thanks for the tips. I really am very careful with my food choices. I certainly hope by doing everything I can, I can prevent myself from getting type two diabetes in the future because I’m pretty sick of checking blood sugars and injecting insulin already and I don’t want a future like this.

        Thanks.
        Angel

  17. Hello. So does this tell us anything about the use of extra virgin olive oil (monosaturated) or cold pressed sesame/sunflower oil (polyunsaturated)? I don’t used the hexane extracted oils anymore, but I do use EVOO and cold pressed sesame/sunflower on occasion.

    1. Dani,

      Olive oil is better than the rest of the ones you listed.

      Mic The Vegan has a small chart on his video on the subject.

      Most of the plant based doctors say that using no oil is even better.

      There are a lot of YouTube videos about cooking without oil.

      But if you want to use oil olive oil is better than most oils.

    2. Dani, olive oil is just as unhealthy as any of the other oils in our diets. None of the plant based doctors recommend olive oil, even for occasional use. I have some links here of the doctors who speak on wfpb eating who address your question about olive oil.
      Dr Klaper:
      https://m.youtube.com/watch?v=OGGQxJLuVjg
      Dr Greger:
      https://nutritionfacts.org/2017/10/17/what-about-extra-virgin-olive-oil/
      Dr Esselstyn:
      https://m.youtube.com/watch?v=b_o4YBQPKtQ

  18. Wow, new imaging technology looking into actual human beings and think WHY TAKE THE RISK? Five and ten years ago, desperate to believe meat dairy chicken fish were not necessarily all that bad, I would’ve looked at Healthline’s (evidence based nutrition) study cholesterol good or bad? citing a 14% RISK reduction in heart disease plus the idea of “good” cholesterol and baby, I was home free. Think I know better now. Maybe Dr G and staff could “vet” Healthline. It’s got impressive funding and associations. Claims to be evidence based.

    1. Healthline bought a popular low carb website some years ago. It was an English-language site but was founded and operated by Scandinavian low carbers pushing the usual ‘saturated fat and cholesterol are health foods’ nonsense

      Unfortunately, Healthline took on many of these low carbers and they still write for Healthline.

      1. Tom,

        That is interesting.

        Their articles are among the first ones Google offers.

        I am juggling so much information right now that I am not quite up to understanding things like that but I feel like I just broke through on some subjects.

        This video, plus the keto and diabetes, plus, night time eating and blood sugar, plus Mic the Vegan, plus Cyrus and Robby, plus Dr Fung and PubMed talking about Beta cells and I feel like I am a few more laps around the information until I can say that I understand enough to feel like I get it.

        If I catch the next Mastering Diabetes seminar, I think I will have broken through.

        Next year, it will be so different for me.

        1. Yes, if I recall correctly it was the grandiosely-named ‘authoritynutrition.com’ website founded by a Swedish personal trainer (who obviously had an inflated sense of his own knowledge of nutrition). It was immensely popular with low carb kooks, which is presumably why Healthline bought it.

      2. Thankyou Mr F. Healthline out of San Francisco got $95 million from Summit Partners to compete with Web MD Summit Partners assets worth $1/2 billion. I googled “who funds healthline”.

    2. Bob,

      Evidence based is all about what evidence you choose to use and your interpretation. On the surface it sounds so scientific but breaks down quickly when you recognize the need for a more personalized approach with many aspects of medicine and most importantly independence vs the inherant bias of many of the claims. For some thoughts on the subject see: https://onlinelibrary.wiley.com/doi/full/10.1111/jep.12147 and of course Dr. G’s take at: https://nutritionfacts.org/video/flashback-friday-evidence-based-medicine-or-evidence-biased/

      And the rest of the Heathline story, from wikipedia: Healthline Media was founded in 1999 as YourDoctor.com, by endocrine specialist James Norman.[5] In 2006, the company was re-launched as Healthline Networks.[6]

      By 2013, it had over $21 million in revenue and 105 employees.[6] Deloitte ranked Healthline Media as one of the top 500 fastest growing technology companies in North America in 2010, 2011, 2012, and 2013.[7]

      In January 2016, Healthline raised $95 million in growth equity financing through Summit Partners.[8] Under the terms of the agreement, Healthline’s media business was established as a standalone entity with David Kopp as CEO. The firm acquired health news website Medical News Today and reference website MediLexicon in May 2016.[9]

      Healthline.com
      Healthline Media’s website publishes health and wellness information, and is a competitor to WebMD.[5][10] In 2009, Kim Komando, a technology columnist with USA Today, listed Healthline.com as a top health information website.[11]

      The company also provides health-related content and tools to more than 40 other sites.[12] In 2010, Healthline Media signed an agreement to provide medical and health-related content to Yahoo! Health.[12] Other partners include AARP.com and DoctorOz.com.[5] Healthline Networks software also powers Aetna’s patient portal.[13]

      Interesting how this group provides many other “partners” with questionable information. Check out the latest issues of the AARP newsletter and wonder what the…… as the reports are so clearly biased and directive toward less than optimal health options.

      Dr. Alan Kadish moderator for Dr. Greger http://www.Centerofhealth.com

      1. Follow the money. Is the bottom line your health or your $. I also noted healthline manages 21 health sites with I think 100’s of 1000ands of “health influencers”. Could that be a lure for advertising fake nutrition products? Correction: Above said Summit Partners worth $50 billion – is only $20Bil

    1. Then that would be just an “opinion,” right Eliot? I for one think a few drops of EVOO on my morning Ezekiel toast are just fine.

      Different strokes, once again.

    2. No. Because it ain’t – some fat is essential. Certain fatty acids aren’t synthesised by the human body and have to be obtained from the diet.

      Also, it’s unavoidable. Even lettuce contains fat. The details are important.

  19. YR,

    I know that Dr. Greger is not coming against your toast.

    Eliot,

    Pretty sure that Jesus knows that all the science jibber-jabber gobledygook is confusing to us mortals.

    The thing is, you can’t just outright say that one of the macros is bad for us and fat is still a macro.

    That is what the low-carbers do with carbs.

    So we need a little bit of the gobbly-gook and a little bit of fat to survive.

  20. But from one of the passionate weekend gobbly-gooking trolls to the visitors who get overwhelmed by the discussion, I understand that it has to look like there was a Diet War food fight in here especially over the weekend.

    I want to say to people like Barb and Tom and YR and Lonie and all of the other passionate people who sometimes change the topic, I genuinely learn more from just interacting in these comments than anywhere else and I appreciate all of it.

  21. And if my brain is processing poorly, I am sorry. I feel confident that I will learn this and not need to do these processes like this forever.

    But today, I filled out forms and put the date as the year 2000 and looked to check what year it was and rewrote it, but clearly I still have moderate to severe Alzheimer’s or something like that. It really sucks. But I am still functioning pretty well. Time is so abstract to me.

    Picasso would be pleased.

      1. YR,

        Yes, I feel so blessed all of the time and the fact that I feel pretty happy and so blessed makes me feel even more blessed. But I can be annoying and the fact that I find that funny annoys some people even more.

        Anyway, this video on how insulin resistance / insulin blocks the brain from seeing leptin and that causes obesity. It is fascinating.

        https://www.youtube.com/watch?v=ceFyF9px20Y

      1. YR,

        Yes, that is why I am here.

        Dementia versus Alzheimer’s? My left nostril not being able to smell peanut butter makes me think Alzheimer’s, but either way, I walked through both with relatives recently and doctors were not able to help either one at all and trying the medicines to see if they worked cost a fortune and that was with my relatives having fairly good secondary insurance from their ex-employers. (My grandmother was a nurse and the hospital paid her secondary insurance for the rest of her life. My other relative worked at management for a very big medically-related company.) Nope. Doctors couldn’t help and it cost a fortune to find that out. There probably was some noseebo effect because the doctors pretty much said, “You can pay a fortune to try all of these meds and they aren’t going to work.” and the insurance companies said, “You can pay for it yourself, because they aren’t going to work.”

        I was watching that man’s video from the “fructose” being the problem side and the thing is, he is still going to ignore that going Whole Food Plant-Based is going to work, even if people like Dr. Kempner gave people table sugar.

        His talk is going to cause me to look more at the whole fructose thing and he gave so many pictures that I am going to have to watch that one over and over and over again, but there will be a definite gain in understanding of the biology, but once he got to the statistics, what I know is that it becomes like the Paleo view of evolution versus the WFPB view of evolution and I don’t find the same chart shown with the logic of too much fat and too much sugar and the same people are eating both becomes obvious.

        Either way, lowering the free floating fatty acids is what has to happen.

        Dr. Greger,

        Does lowering the NEFA’s happen even when people are eating fructose?

        Does lowering the NEFA’s through lowering saturated fats improve the brain seeing leptin issue?

        That second one is the question of the two that is more important because we already know that the theory you posted is a way to improve the situation no matter what.

        He is saying that the increase in insulin blocks the brain from seeing leptin.

        That happening from lowering saturated fat would be such a good video topic.

        Pretty sure I read a study on it, but this man would say that it was because the people lowered fructose, rather than saturated fats.

        Nope, the study I read was that high carb diets prevent the whole ghrelin appetite spike later.

  22. That man’s topic of obesity and sloth being caused by the brain not seeing leptin because of insulin resistance is a good webinar concept.

    The fructose part interests me.

    For instance Kempner gave sugar and yet people still reversed diabetes.

    Did they reverse fatty liver?

    I like the topics of fat versus sugar and what happens when they are combined.

    1. His pointing to places where they drink soda and not alcohol gives him a point.

      He didn’t do the same process with animal products or oil so his answer is not complete.

  23. Where it matters is that, for instance, people like me who have lost most of the Diabetes symptoms, but still might have more fat in my liver, for instance.

    I might have worse of a metabolic reaction say if I made 5 bean casserole and put brown sugar in or drank fruit juice.

    Anyway, it feels like Tesla versus Edison.

    1. Even if they solve leptin and obesity they still have the acetate, but It seems like they had fructose down in the acetate section?

      Maybe?

      Either way, it looks like vegans with obesity insulin resistance might not lose h if they eat fructose.

  24. So I am a vegan on a very low fat diet ever since I started edging towards diabetes. I warn anyone willing to listen not to eat anything with palm oil in it (loaded with palmitic acid, one of the 3 deadly 3 lipids), rarely have an avocado (yummm), and just do a couple of tablespoons of ground flax each day. I do use tahini in salad dressings. So I thought I was doing good. What I was slow to realize is that over-eating carbs (which I must be doing even on a 1200 calorie a day diet since I am gaining weight eating veggies, berries, beans, and groats) sends unused glucose to the liver to be processed into palmitic acid. So there is indeed a way to shoot yourself in your very own vegan foot. The good news is that after a lifetime of trying to control low blood sugar by eating very very few carbs other than greens and fueling entirely on fats, the low fat diet has fixed my problem. I can actually go for hours without food without encountering the blood sugar drops that were really quite dangerous (try driving when your eyesight is narrowing to the size of a quarter). It has been years now since I was “hangry” and mean as a snake because of it. I no longer have to carry spare fat (nuts, mostly) to keep my blood sugar up and avoid the insulin shakes/sweats if I did get desperate enough to eat that petrified sprinkled donut left in the lunchroom that no one else would eat.

  25. Great info. I hve insulin resistance. I hve tried several control get aways in which the environment is setup to succeed. However, after the 5-7 days there…my blood sugars spike after eating potatoes, yams, sweet potatoes etc in the first hour to 230…2nd hour 160s 3rd hour 110. My con cern here is my understanding is blood sugar cannot exceed140 on the 2nd hour without damaging the organs long term. Advise pls. Thk you! Im here on the Holistic Holiday cruise to figure it out!

    1. Hope you’re enjoying the Holistic Holiday at sea and received an answer about your eating potatoes and having insulin spikes.I would ask you to make sure you are not eating something else when you have those potatoes that could be contributing to the spikes (oil? sour cream, even vegan, etc? Also are you eating the skins of the potatoe which would give you more fiber and perhaps you might then settle for less of the sweeter inside of the potato? Timing may also play a role. Do you have spikes if you have potatoes earlier in the day? Once you can answer those questions no and still consistently have spikes, then you may need to pay attention to your individual body’s response and eat your potatoes with smaller servings if you not discovered any other strategies while on the cruise.
      Best of health and continued enjoyment eating potatoes, even if it might be smaller servings than what you’d like. .

  26. Hello! 43 year old male here and I’ve been mostly plant based (and sometimes the less healthy vegan lifestyle) since 2013. I’m an endurance athlete (cycling and running) and I’m having trouble figuring out a solid meal plan during my more intense training. I either eat too much (I get physical symptoms) or not enough (I end up in the kitchen at 2am over indulging). Is there any way you can make video or offer advice on how to eat while training. Also, when should my last meal be? Please help and thank you for your time!

  27. Dr. Greger have you done a video or the dawn phenomenon/dawn effect? The abnormal early-morning increase in blood sugar in some individuals with diabetes that usually takes place between 2 a.m. and 8 a.m.?

  28. Hi Judy,
    Thanks for your question. I refer you to this link from Dr Greger

    U.S. National Library of Medicine, StatPearls. Dawn Phenomenon. November 10, 2019.

    https://nutritionfacts.org/topics/blood-sugar/ and these references for further reading. I hope it is useful to you.

    National Sleep Foundation. Excessive Sleepiness: Sleep Longer to Lower Blood Glucose Levels.

    DiabeteStrong. How to Avoid High Morning Blood Sugar. Published July 7, 2018.

    Rybicka M, Krysiak R, Okopień B. The dawn phenomenon and the Somogyi effect – two phenomena of morning hyperglycaemia. Endokrynol Pol. 2011;62(3):276–284.

    Cleveland Clinic. Blood sugar: Hidden Causes of High Blood Sugar Levels in the Morning. Reviewed May 25, 2018.

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