Reversing Diabetes Naturally: The Science Big Medicine Ignored

Summary

Podcast Summary: Reversing Diabetes Naturally: The Science Big Medicine Ignored

Title: The Dr. Hyman Show
Host: Dr. Mark Hyman
Guests: Gary Taubes, Mimi Grishman, Sarah Hallberg, Sammy Inkonen
Episode Release Date: April 28, 2025

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Introduction

In this enlightening episode of The Dr. Hyman Show, Dr. Mark Hyman delves into the transformative potential of dietary interventions in reversing type 2 diabetes. Joined by renowned author Gary Taubes and experts Mimi Grishman, Sarah Hallberg, and Sammy Inkonen, the discussion challenges conventional medical approaches dominated by pharmaceutical interventions and underscores the significance of personalized nutrition.

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Understanding Diabetes and Carbohydrate Metabolism

Gary Taubes initiates the conversation by highlighting the paradox in carbohydrate metabolism:

Gary Taubes [00:02]: "Patients do well if you don't feed them carbs. How weird is that? It's a disorder of carbohydrate metabolism. If you tell them not to eat it, they do fine."

This statement sets the stage for exploring how reducing carbohydrate intake can effectively manage and even reverse diabetes, positioning it as a metabolic dysfunction rather than a purely chronic disease.

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Traditional Approaches vs. Dietary Interventions

Dr. Hyman critiques the longstanding medical model that relies heavily on medications to manage diabetes:

Gary Taubes [04:31]: "They [medical trials] actually were able to reverse [type 2 diabetes]. Not just slow it down or delay the complications or to manage the disease, but literally to reverse it."

Traditional methods often lead to a progressive need for additional drugs without addressing the root cause—dietary habits. Taubes emphasizes that reducing carbohydrate intake can mitigate the necessity for continual pharmacological interventions.

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Virta Health's Role in Diabetes Reversal

Sammy Inkonen, representing Virta Health, shares insights into their innovative approach:

Sammy Inkonen [10:46]: "We could just convince insurance companies and employers that they could save money as diabetes is an expensive disorder… create this company, Virta Health."

Virta Health leverages a low-carb, high-fat ketogenic diet combined with telemedicine and personalized coaching to reverse diabetes. Their model focuses on supporting patients in making sustainable dietary changes, thereby reducing reliance on medications and improving overall metabolic health.

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Hormones and Appetite Regulation

The discussion transitions to the hormonal mechanisms influenced by diet:

Sarah Hallberg [25:06]: "When folks increase their fat intake… the hormones that drive appetite are naturally suppressed and the hormones that signal satiety go up."

Dr. Hyman elaborates on how a well-formulated ketogenic diet can enhance hormones like GLP1, which regulate hunger and satiety, potentially eliminating the need for appetite-suppressing drugs like Ozempic.

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Comparison to Pharmaceutical Interventions

The conversation juxtaposes dietary interventions with pharmaceutical treatments:

Gary Taubes [18:46]: "Chronic progressive disease, diabetic complications, more and more drugs, complications of drugs. This way, as far as we can tell, and we can't, you know, there are unknown, unknowns here. As far as we can tell, if you eat this way, you'll be fine."

The guests argue that while medications can manage symptoms, they do not address the underlying metabolic dysfunction. In contrast, dietary changes can reverse insulin resistance and improve metabolic health without the side effects associated with long-term drug use.

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Critique of Red Meat and Diabetes Study

A significant portion of the episode is dedicated to dissecting a flawed observational study linking red meat consumption to type 2 diabetes. Mimi Grishman and Gary Taubes highlight several methodological issues:

1. Study Design Flaws:

   • Food Frequency Questionnaires (FFQs): These tools are inherently inaccurate as they rely on participants' memory and honesty about their dietary intake.

   Gary Taubes [25:06]: "They used a food frequency questionnaire. These are highly inaccurate."

2. Confounding Variables:

   • Participants consuming more red meat also exhibited other unhealthy behaviors such as higher BMI, smoking, and lower physical activity, which the study did not adequately adjust for.

   Mimi Grishman [72:24]: "They did not adjust for adiposity… the people who ate more red meat were more overweight."

3. Calibration Issues:

   • The study artificially inflated risk percentages through statistical manipulations known as calibration.

   Gary Taubes [15:19]: "The calibration doubled the effect for total red meat, processed meat and unprocessed red meat… before the calibration was 28%, after it was 47%."

4. Inconsistent Serving Sizes:

   • Variations in serving size definitions across different phases of the study led to inconsistent and unreliable data.

   Gary Taubes [21:31]: "The serving size of bacon is one slice, but before it was two slices."

5. Contradictory Findings:

   • The study reported higher diabetes risks for total red meat intake compared to its processed and unprocessed forms, which defies logical consistency.

   Gary Taubes [22:54]: "Total red meat intake had a higher risk of diabetes than both processed and unprocessed red meat. So that doesn't make sense."

The hosts argue that such studies are often misconstrued by media to promote plant-based diets without considering the complexities and limitations inherent in observational research.

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Functional Medicine Perspective on Type 2 Diabetes

Mimi Grishman introduces the functional medicine approach, focusing on insulin resistance as the root cause of type 2 diabetes. Key strategies include:

• Eliminating Ultra-Processed Foods: Reducing intake of sugar, refined grains, and high-starch foods.

  Mimi Grishman [44:15]: "The root cause is something called insulin resistance. And this comes from eating a diet that's high in sugar, refined flour, grains, ultra-processed food."

• Emphasizing Quality Nutrition: Incorporating good quality proteins, healthy fats, fiber-rich fruits and vegetables, and minimally processed carbs.

• Comprehensive Testing: Utilizing advanced biomarkers to assess metabolic health, including fasting glucose, insulin levels, and inflammatory markers.

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Conclusions and Implications for Health

The episode concludes with a strong advocacy for personalized, nutrition-based interventions over generalized dietary guidelines and pharmaceutical management. The guests collectively emphasize that:

• Dietary Interventions Are Sufficient: Properly managed low-carb diets can reverse insulin resistance and type 2 diabetes without the need for lifelong medication.

• Systemic Change Is Necessary: Addressing the root causes of metabolic dysfunction can alleviate not only diabetes but also reduce risks for various other health complications.

• Critique of Current Research Practices: Emphasizes the need for more rigorous, causative research in nutrition science to inform public health policies accurately.

Sarah Hallberg [35:25]: "If you could prevent… teach people to eat well and keep them healthy, that's better for everyone."

This episode serves as a compelling argument for rethinking diabetes management through the lens of functional medicine and personalized nutrition, challenging the predominant pharmaceutical-centric approach.

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Notable Quotes

• Gary Taubes [00:02]: "Patients do well if you don't feed them carbs. How weird is that? It's a disorder of carbohydrate metabolism. If you tell them not to eat it, they do fine."

• Gary Taubes [15:52]: "We don't know the short, the midterm and long term side effects of exogenous drugs, but we know the side effects of healthy food."

• Sarah Hallberg [27:14]: "Preserving and de-stressing that beta cell is critical."

• Dr. Mark Hyman [20:25]: "She's … just put her off, you know, grains and beans, sugar, processed food, put her on lots of good fats… within three months she was off her medications."

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Final Thoughts

This episode of The Dr. Hyman Show provides a thorough examination of the potential for dietary interventions to reverse type 2 diabetes, backed by expert insights and critical analysis of current research. It advocates for a paradigm shift towards personalized nutrition and functional medicine, challenging established medical practices and encouraging listeners to reconsider their approach to managing metabolic health.

Transcript

[Dr. Mark Hyman]

Coming up on this episode of the Dr. Hyman Show.

[Gary Taubes]

Patients do well if you don't feed them carbs. How weird is that? It's a disorder of carbohydrate metabolism. If you tell them not to eat it, they do fine.

[Dr. Mark Hyman]

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[Mimi Grishman]

Now, before we jump into today's episode, I'd like to note that while I wish I could help everyone by my personal practice, there's simply not enough time.

[Dr. Mark Hyman]

For me to do this at scale.

[Mimi Grishman]

And that's why I've been busy building several passion projects to help you better understand. Well, you it. If you're looking for data about your biology, check out Function Health for real time lab insights. And if you're in need of deepening your knowledge around your health journey, check out my membership community, the Hymen Hive. And if you're looking for curated and trusted supplements and health products for your health journey, visit my [e-mail] for my website store for a summary of my favorite and thoroughly tested products.

[Dr. Mark Hyman]

There are essential fatty acids, there are essential amino acids, there are no essential carbohydrates, so the body actually does not need them biologically to thrive, even though it's our main fuel source. So historically we'd been adapted to a whole range of diets from the Inuits and basically a ketogenic diet to the Pima Indians who were ate 80% carbohydrates, but it was all high fiber plant based carbohydrates that were really nutrient dense. So the body can survive and thrive on many different things and the quality of the calories matter, which is really the thesis of your book, Good calories, bad calories. And I think most people don't understand that they actually can regulate their biology if they figure out what their particular metabolic type is because everybody's different. And for example, I need a little more carbohydrates because I'm kind of thin. And if I don't eat them and I go keto, I'll lose too much weight. But if I take a patient who's overweight and type 2 diabetic, they're going to do really well if I do that.

[Gary Taubes]

And a little bit of carbohydrates might prevent them from doing really well.

[Dr. Mark Hyman]

Yeah, that's.

[Gary Taubes]

That's the. I think one of the points that I've made in my other books is we do think everybody is different. And we definitely evolved to cope with the proteins and fats in our diet. That the idea that the foods that we didn't. The new foods of modern life.

[Dr. Mark Hyman]

Ultra processed food. That's not even food.

[Gary Taubes]

Yeah, I'm not wild about the term ultra processed because it's sort of like miasma theory of all these kind of vague things that we're going to throw. And Michael Pollan called them food like substances. I prefer that it's more to the point, but they don't meet the actual.

[Dr. Mark Hyman]

Criteria of the definition of food. If you look at.

[Gary Taubes]

But we didn't have time to adopt to high levels of sugar in our diet and sugary beverages in our diet. These things didn't exist. We didn't have time. I mean, I'm agnostic about the seed oil issue. I don't find the evidence. I mean, I can easily believe that these things are toxic.

[Dr. Mark Hyman]

But the evidence is confusing for sure.

[Gary Taubes]

There's a certain absence of human clinical trial evidence.

[Dr. Mark Hyman]

Just like sugar, you know, when you think about sugar, we never had exposure to the amount of sugar we're eating now. Historically, as species, we never had 10% of our diet being refined soybean oil before. That's a new phenomena for humanity. And maybe it's okay, maybe it's not. But I think it should be questioned.

[Gary Taubes]

Yeah, it certainly should be questioned. And that's the thing. Those you. So you can propose that those are problems. And with the sugar and refined grains, you could see what happens when you take them out of people's lives. I mean, and we have clinical trials.

[Dr. Mark Hyman]

Can you talk about that? Like you talk about the virta health work and Sarah Hallberg's work and the sort of work on advanced type 2 diabetes, where they actually were able to reverse it. Not just slow it down or delay the complications or to manage the disease, but literally to reverse it.

[Gary Taubes]

Yeah, well, so this is, you know, getting back to the history a bit. We get to the 1970s, 80s, the diabetes community, to their credit, did some really ambitious clinical trials. And what they find out, in effect, is that this disease, by their treatment, is a chronic progressive disorder. It just gets worse. A famous British trial where they just. They show, they start people on diet only, and then they add one drug, and then they go and they see how many of the patients, patients diagnosed with type 2 diabetes can stick with one drug, monotherapy. And the answer is like 10%. So as time goes on, you keep on having to add drugs to keep the blood sugar under control. They do these. We set a cord, and I forget the other names of the other two trials looking at intensive insulin therapy, and they find that they does more harm than good at the very best. And then they do this huge look ahead trial. $200 million to demonstrate if you lose weight, you'll reduce diabetic complications. It's a fundamental pillar of thinking with diabetes. Just get your patients to lose weight, they'll be fine. And they get them to lose weight, and it doesn't make a damn bit of difference. A trial was ended for futility, a $200 million trial. And it's a great quote in the New York Times from a Harvard diabetes specialist named David Nathan, who says, we have to have an adult conversation about this, and they never do. But while this is.

[Mimi Grishman]

But this is an important point, they.

[Dr. Mark Hyman]

Lost weight and they got worse.

[Gary Taubes]

So, no, they lost weight and they didn't get better, so they lost weight. The idea was, you lose weight, you'll have fewer complications. You reduce heart disease, you reduce strokes, you reduce mortality from this disease. It didn't make any sense.

[Dr. Mark Hyman]

Was it because of how they lost weight?

[Gary Taubes]

Well, it could have been because of how they lost weight. In fact, back around 2003, when I first heard about this trial from one of the principal investigators, I was in a conference, invited me to talk in Houston. I remember saying to him, look, are you doing a low carb arm? Okay, just do a low carb arm. Make it not just low calorie, low fat. Fruits, vegetables, whole grains, the usual Mediterranean diet, right? Well, this was pre Mediterranean. I mean, this was. Yeah, it was just classic low fat. But in low fat, they're also saying, you're eating fruits, vegetables, whole grains. You know, cut back on meat, exercise. No, they Never crossed their mind to do a low carb diet because that was still considered quackish. But as the diabetes community keeps learning about how ineffective their treatments are and how their belief system is falling apart on top of them and not having an adult conversation about it, which is maybe we're making some mistakes here. Other physicians coping with this increased obesity in their patients are confronted with patients who don't take their advice and instead like buy Atkins Diet Revolution book and lose £40 on Atkins.

[Mimi Grishman]

Yeah.

[Gary Taubes]

And a few of these doctors are open minded enough. Eric Westman and David Ludwigger, they say, I'm going to look into this. I'm going to actually do a clinical trial. So they start doing clinical trials. There's a big study at the Philadelphia va and there the woman named Linda Stern is frustrated by how much her inability to help her patients. So she literally goes to like a Brentano's bookstore and she sits down in the diet section, starts reading diets.

[Mimi Grishman]

The doctor's going to the bookstore to read self help books. Because it's not in the textbooks, you.

[Gary Taubes]

Know, it's not, not, not, not definitely don't get grades, good grades for this in med school anyways. I think she found protein power and sounds.

[Dr. Mark Hyman]

That's right.

[Gary Taubes]

And she tries it on herself. And this is effortless to lose weight. So they put together a clinical trial. And this is a Veterans Administration's hospital, so there are a lot of vets, they're not just obese and metabolic syndrome and type 2 diabetes. And instead of cutting them out of the trial, as you would, you know, the inclusion criteria in a pharmaceutical trial is going to say we're going to take these patients because they're ill. She says, since this so associates with obesity, let's do it. And not only do these patients lose a lot of weight on the diet, but their type 2 diabetes gets better on this high fat, low carb Atkins small protein power diet. So you start getting this groundswell. This is this movement of doctors who are reading these articles in the literature and saying, look, diet really seems to help. They don't know this deeper history, although Eric Westman at Duke is looking into it. It's just patients do well if you don't feed them carbs. How weird is that? It's a disorder of carbohydrate metabolism.

[Dr. Mark Hyman]

Exactly.

[Gary Taubes]

Tell them not to eat it, they do fine.

[Dr. Mark Hyman]

You don't take the toxin, you don't need the antidote.

[Gary Taubes]

So Steve Finney and Jeff Volek too. Steve is Ph.D. nutritionist and is out at UC Davis and he's been, he had studied ketogenic diets and Jeff Volek as an exercise physiology, PhD then at the University of Connecticut. And they start working together and publishing on this. And they helped start this company, Virta Health. I remember Steve's idea. I think it was we could just convince insurance companies and employers that they could save money as diabetes is an expensive disorder, it's costing them. It's the most expensive, $15,000 a year in medical bills. If they could save 80% of that by getting these people on a diet, wouldn't they want to do that? So they'd become the clients, not the patients. We'll go after the payers of the insurers, the Kaisers and Blue Shields of the world. And they create this company, they get this brilliant CEO, Sammy Inkonen, who was a world class Stanford mba.

[Mimi Grishman]

Yeah.

[Gary Taubes]

Made millions creating the website. I always forget whether it was Trulia or one of the real estate websites. And it's a world class triathlete who was diagnosed with pre diabetes despite having come in first in his age group in the Ironman triathlon. And Sammy goes to Steve and Jeff for advice on how to treat the pre diabetes and also how he wants to. This is Sam Inc. And he wants to row to Hawaii from San Francisco to Hawaii with his wife Meredith. And he thinks they could do it.

[Mimi Grishman]

With it's like a fun ketogenic diet.

[Gary Taubes]

Jeff and Steve can coach him and they start talking about this idea and they start this company, Virta Health. Meanwhile, by the way, Sammy and Meredith do route to Hawaii and they break the record and they don't eat any carbohydrates on the whole trip. I think it was 24 miles.

[Dr. Mark Hyman]

How he got the pre diabetes was he was using all those goos and energy things that athletes use to fuel their body fat.

[Gary Taubes]

Sammy believed that a low fat diet was the healthiest way to eat. He had been told that. And Sammy is, I think he's Norwegian. And as he put it, not that being Norwegian matters, but if he's Finnish, I apologize. He's just got the best, you know, if somebody tells him not to eat fat, he doesn't eat fat. I mean this is an extraordinarily. The man has an extraordinary strength of will. And then he's diagnosed with prediabetes. So there's something wrong. This is a common phenomena that happens to many people in our world, right. You're doing what's supposed to be the right thing and it doesn't work for you. And then you do the Wrong thing, which in this case is low carb, high fat ketogenic animal diet. And you get better and you say, wait a minute, if it's wrong for me, maybe it's wrong for a lot of people, if not everybody. So they start this company, Virta Health. They realize they need a clinical trial to convince the. And they meet Sarah Hallberg, who is a physician in Indiana, amazing woman to whom the book is dedicated, who has been asked to run an obesity clinic at Indiana Health and has to learn everything she can about obesity. And she starts reading all the literature and she goes down the rabbit hole and she experiences this, you know, based on jello revelation. And she realizes that the only people who seem to be having effective, who seem to be effectively getting their patients to lose weight are these people like Westman who are advocating for these Atkins low carb keto diets. And so she goes and spends time with Westman, she goes and starts, you know, advocating for this at her obesity clinic. And she meets Jeff and Steve and they put together a clinical trial where they're going to randomize people for type 2 diabetes. People with type 2 diabetes died of this nutritional ketosis. Keto with smartphones and personal coaching and.

[Dr. Mark Hyman]

Supporting telemedicine, adjusting their medications if they need to.

[Gary Taubes]

Right? Yeah. Because you're going to have to adjust medication. If you stop, stop eating the toxin, you're going to have to lower the dose of the antidote. And it's either that or the American Diabetes association standard of care, which is drug therapy. And they do the trial and after a few years they report one year results. And after three years they report two year results.

[Mimi Grishman]

Yeah.

[Gary Taubes]

And for patients who comply with the diet, they seem to put this progressive chronic disease into remission. So it's not a progressive chronic disease. No, it's only a progressive chronic disease if you're eating the toxin.

[Mimi Grishman]

Yeah.

[Gary Taubes]

If you're not eating the toxin, you don't manifest the symptoms. And it's not the ideal clinical trial. Yeah, there's all kinds of problems with. It wasn't randomized. Actually, I probably said randomized and I should not. It was. They let patients choose whether they wanted the diet or the ADA standard of care.

[Mimi Grishman]

Yeah.

[Gary Taubes]

But even with those constraints, it demonstrated beyond a shadow of a doubt that a disorder which is considered chronic and progressive is not necessarily chronic and progressive. And that the defining factor is a diet. Again, whether you eat the toxin.

[Dr. Mark Hyman]

That's true. I mean, our practice at the Ultra Wellness Center, I've seen that over and over again. People just don't on insulin, get off insulin on meds, get off meds, normalize their weight, normalize their metabolism. Their A1C goes down. They went from 11 to five and a half in a few months. I mean, it's quite remarkable.

[Gary Taubes]

It's quite remarkable. And so by the end of the book, my apple eye. I mean, again, I. This book does not advocate. It's a dense historical.

[Mimi Grishman]

Yeah, it's like a mystery novel and.

[Gary Taubes]

A mystery novel who done it and.

[Mimi Grishman]

Who didn't do it.

[Gary Taubes]

I think it's a very good book.

[Mimi Grishman]

The.

[Gary Taubes]

The question is, imagine a scenario where everybody, every physician, was taught not just the proper drug therapy, but how effective this dietary therapy was. Because there have always been two levers to pull to keep blood sugar under control. There's diet or drugs. Until 1921, we only had diet. And for patients with type 2 diabetes, it was effective. Don't eat these foods. You'll be fine. Once we had drugs, you had two lovers. And the idea was, use the drugs, give the drugs. You know, we're going to say that diet is integral the cornerstone of therapy, but we're going to pay lip service to it because we got the drugs. What if, confronted with a new patient, you give them the diagnosis, you have type 2 diabetes or type 1 diabetes, and you say, look, we can do this. We can treat your symptoms with drugs. You can continue to eat exactly the way you want, or if it's type one, we're gonna. You're gonna eat, you know, at specific intervals, specific amounts to allow us to maximize, you know, craft a diet to maximize efficiency of the drug therapy. And there's all these complications we know are gonna ensue. So you're gonna have an increased risk of heart disease and stroke and dementia and blindness and retinopathies. And for some of you, no matter how well you manage your blood sugar with these drugs, those complications are gonna happen anyway, at which point we're gonna blame you. But.

[Mimi Grishman]

Right. It's the patient's fault.

[Gary Taubes]

Or you can do this diet. Now, what it means is no more bread, potatoes, sweets.

[Mimi Grishman]

Yeah. Which people.

[Gary Taubes]

Sugary beverages.

[Mimi Grishman]

Which people crave. It's hard.

[Dr. Mark Hyman]

Cause they crave those foods when they have insulin resistance.

[Gary Taubes]

Yeah. Which is fascinating. If you eat this way, as far as we can tell, you'll be fine. No drugs. No complications of drugs. No needing more doses or new doses. No waiting for new drugs to come along. No dialysis. As far as we can tell, if you eat this way, you'll be fine.

[Dr. Mark Hyman]

Amazing.

[Mimi Grishman]

I mean, we spend a week and.

[Gary Taubes]

It'Ll probably take two or three months. You might love it immediately. It might take two or three months to get used to it. In which case, like somebody who's quit smoking, you, you won't miss cigarettes after a while, right? You will at first. You won't after a while. It's your choice.

[Mimi Grishman]

Yeah.

[Gary Taubes]

We're happy either way.

[Mimi Grishman]

Yeah.

[Gary Taubes]

Okay. Because we want you to be healthy. But this way, chronic progressive disease, diabetic complications, more and more drugs, complications of drugs. This way, as far as we can tell, and we can't, you know, there are unknown, unknowns here. As far as we can tell, if you eat this way, you'll be fine.

[Mimi Grishman]

Yeah.

[Gary Taubes]

You choose.

[Mimi Grishman]

Yeah.

[Gary Taubes]

And if you do eat this way, let's make sure you do it right.

[Mimi Grishman]

Yeah.

[Gary Taubes]

And if you choose the drugs, we'll make sure you.

[Mimi Grishman]

I mean, it's such a, it's such.

[Dr. Mark Hyman]

A simple notion and yet it's, it's, it's, you know, bucking against the, the establishment paradigm that we should be using drug therapy and high carbohydrate diets and diabetics. I mean, I think the ADA is starting to come along, the American Diabetic association, but it's really tough. And I think, well, they're starting to.

[Gary Taubes]

Come along, but if you see how they do it. So they put out these standard of care documents and every year, every January, and there'll be like eight or ten of these documents. And what they do is they revise based on what research came out in that past year. So they really have no mechanism by which to say, let's just rethink this everything. And then when they're revising it, the discussion of diet is buried, is inside in this document where it's sort of, you can do this or you can do that or you can try this diet. We have this research for this or this research for that. They don't have any mechanism to say, can we just try, let's try a different approach. Okay. Let's divide the world up. Let's say this is what we can be achieved with diet, and this is what can be achieved with drug therapy. And this is the complications that we know of with diets. Not many. And these are the complications we know with drug therapy. Chronic progressive disease. Many people might choose drugs. Maybe they're right.

[Dr. Mark Hyman]

I mean, I don't know.

[Mimi Grishman]

I mean, I think when you look.

[Dr. Mark Hyman]

At the data, to me, it's pretty clear that if you use drug therapy that it is a progressive chronic disease and you can mitigate or slow the complications, but it's not gonna prevent them.

[Gary Taubes]

Well, this is.

[Dr. Mark Hyman]

And then if you use the dietary therapy, it goes away. And. And.

[Mimi Grishman]

And, you know, I think people might.

[Dr. Mark Hyman]

Be listening, going, well, you know, Gary, you're giving these people a ketogenic diet with 75, 80% of their diet is fat. What about their heart and, you know, maybe say, their diabetes. But actually, they looked at over 20 cardiovascular biomarkers as part of the virta study. And. And they were all improved. Actually, they got better.

[Gary Taubes]

Right.

[Dr. Mark Hyman]

You know, and I. I've seen this over and over. I had a patient which was really struggling with. With weight loss, and she had pre diabetes. She had triglycerides of 3 plus 100 or HDL, was very low. And her. Her total cholesterol was over 300.

[Mimi Grishman]

Very high.

[Dr. Mark Hyman]

Insulin levels, rising blood sugar. And I'm like, why don't you try a ketogenic diet? She did it. Not only did she lose 20 pounds, but her cholesterol dropped 100 points. Her triglycerides dropped 200 points. Her H2 went up 30 points. Her blood sugar normalized. Now, that may not work for somebody else who's a thin guy who is an athlete. And I've seen people who use the skidajank diet like that who actually don't do well. And I'm one of those guys, if I eat too much of the wrong fats, my cholesterol goes off the rails.

[Gary Taubes]

But we don't know how harmful that is.

[Dr. Mark Hyman]

We don't. We don't. Unless we look inside your arteries and.

[Mimi Grishman]

Then we can tell.

[Gary Taubes]

Well, you can. Yeah. Then, yeah.

[Mimi Grishman]

So it's just fascinating.

[Dr. Mark Hyman]

I think this is really important moment in history because we have this craze of Ozempic and Wegobi Manjaro. It's the golden child of the moment of pharmacology. And nobody's really talking about the issue that matters, which is what we're eating and why we're eating what we're eating.

[Gary Taubes]

And that's because we have this mindset that the people with obesity, we're not going to blame it on willpower. We're going to acknowledge that it's a disease. Now, this is what Oprah was saying. But we're also going to assume that they won't change their diet. And, you know, it's really complicated. I've read a lot of the literature of mostly women, but not entirely women with obesity. They're so confused. They know it's not a willpower problem.

[Dr. Mark Hyman]

No, it's not a willpower Problem.

[Gary Taubes]

And often these authors will say, I tried every diet, none of them worked. And I want to reach out to them, say, well, you didn't try the right one because they always include Atkins in the list. Did it not work for you, or are you someone? But then they'll say, you know, it's just one of these books I read recently. It's, you know, I don't want to go through my life not eating a donut.

[Dr. Mark Hyman]

Right.

[Gary Taubes]

Well, I understand.

[Mimi Grishman]

I get that.

[Dr. Mark Hyman]

I get that.

[Gary Taubes]

But, you know, I was. I've been biased by my history as a cigarette smoker. There was a period in my life where I couldn't imagine going through my life without a cigarette.

[Mimi Grishman]

Yeah.

[Gary Taubes]

In fact, my next cigarette was what pulled me forward into the future. Maybe it's an inappropriate metaphor. I'm not sure it is or not.

[Dr. Mark Hyman]

Well, no. And we know there's real addiction with these foods, whatever you call them, food like substances or ultra processed food or high starch and sugar foods. They activate the brain centers for pleasure. And we can map that on brain imaging studies. So there's no doubt that these have biological effects on the brain that drive our behavior, our cravings, our appetite. But I think what's really remarkable as a doctor treating these patients is that when you do the right thing, their brain chemistry changes, their hormones change, their metabolism changes, and they don't actually have those cravings. It's not like they have to use willpower to fix it. Use science. If you're struggling with stress, poor sleep, or low energy, you might be magnesium deficient like 75% of people. That's why I recommend Magnesium Breakthrough by bioptimizers. Unlike most magnesium supplements, Magnesium Breakthrough gives you all seven essential forms of magnesium for better absorption and real results. Deeper sleep, less stress, and more energy. I take it every night and I notice the difference. Try it for [e-mail] hymen and use code HYMAN10 for 10% off your order. When you have diabetes, you become carbohydrate intolerant. They're not. Doesn't mean all of us are born that way, but we come that way because we live in a sort of a soup of sugar and starch that's washing over us for decades, and that leads to the development of this metabolic dysfunction. And the solution is to kind of reverse that trend by restricting carbohydrates and increasing fats and tell us sort of how that works and why we kind of got so far away from it. Because it was the treatment, you know, a Hundred years ago. And now we're coming back to it as the treatment and explain the biology behind the science of ketogenic diets as a diabetes reversal treatment.

[Sarah Hallberg]

So, you know, in the trial, our patients were on a well formulated ketogenic diet, which is very low carb, so 30 grams. But practically in our clinical workflows, we do a lot of low carb. And not everybody's in well formulated ketogenic diet. So we really try to sort of meet patients where they need to be. And there's a lot of heterogeneity in type 2 diabetes. Right. We've, in genome wide association studies, we now know there's hundreds of different, like types of type 2 diabetes. But sort of like the end result or the goal is to preserve beta cell functional mass. And the bet beta cells are those cells that make insulin. And so anything we can do to de stress that beta cell and keep its insulin production up is critical. And when we eat high carb diets, we add to cytokine release, inflammation, glucotoxicity, all of these things stress out the beta cell. And so that sort of accelerates the destruction of beta cell function and mass over time. And that's when you start seeing the one way trolley for type 2 diabetes. So if you can that pathway, you can definitely improve insulin secretion and also decrease, while you're losing weight, decrease the insulin resistance at other target organs like in your liver and your muscles. So you, you also spare the beta cell from having to produce more insulin to do the same job. So multiple layers of de stressing the beta cell through the nutritional intervention directly, but also indirectly by affecting other parts of metabolism. I mean, energy homeostasis is so complex. I have so much humility. You know, I started my fellowship training studying adipokines. I was in a lab where I was studying leptin and adiponectin. And like there are so many other cascades and they all interact with the gut, the microbiome, the brain, your satiety centers, your pancreas. So there's so much complexity. So really thinking about it simplistically though, is really preserving and de stressing that beta cell.

[Dr. Mark Hyman]

And the way you do that is by basically restricting carbohydrates and adding a lot of fat. Now it's not the bacon and kind of cheeseburger diet, right? There's a healthy way to do this. It doesn't mean you have to be eating a lot of food that may not be great for you. And so I think people are often thinking oh, fat is bad, fat makes me fat. If we eat fat, you get fat. And there's this whole mythology we had about that. And in fact that was sort of the prevailing theory for so long and now it's shifted. And we understand that actually for these metabolically dysfunctional people, which is most of America, that we're eating way too many refined starches and sugars. I mean, carbohydrates are also vegetables, so there's no harm in eating vegetables. But the starch and sugar and the refined carbohydrates are the ones that are driving this problem. And so the solution is restricting those. And you're saying you don't always have to be fully ketogenic, you can be very low carb. And I've seen this too. I mean, I had a patient at Cleveland Clinic who was type 2 diabetic on insulin for 10 years, you know, had heart failure, had kidneys starting to fail, fatty liver hypertension, had multiple stents put in for cardiac disease and was on, you know, 20,000 of coping medications. Her body mass index was 43, which is huge person, and her A1C blood sugar average was 11.2. And we just didn't put her on a keto diet. But since she just took her off, you know, grains and beans, sugar, processed food, put her on lots of good fats, olive oil, avocado, some nuts and seeds, healthy protein, lots of veggies, fiber, and was about 50% fat, not 75 or 85% fat, which is what most keto diets are. And within three days she was offer insulin. In three months she was off her medications. Her A1C went from 11.2 to 5.5, which is normal. Her ejection fracture went to normal, her kidneys got better, fatty liver got better, her blood pressure got better. A year she lost like 116 pounds. So without Ozempic, without a gastric bypass, simply by getting the group support, which we did, and by using kind of a very, kind of low carbohydrate diet that was a very anti inflammatory diet. So what I'm hearing you say is it doesn't have to be always ketogenic, but it has to sort of be matched to that person's state of metabolic dysfunction. And the more sick you are, the probably the higher dose of drug you need in a sense. Right.

[Sammy Inkonen]

I would also add that we haven't published this. Actually we published some, but we actually have very interesting dose response data. So pharmaceutical companies usually do a what they have to do like a dose response study. So here's the molecule. You add more of that molecule and then see what happens in terms of safety and in terms of outcomes. And obviously you can then tease out the correlation and correlation like, oh, more of this acetaminophen. Unless you have pain and whatnot. We actually have very interesting dose response data to carbohydrate restriction and seeing what happens to weight, glycemic control and getting, getting off the meds. And I guess the punchline is the, the more insulin resistant you are, the more of that dose the better. Is basically without sharing all of our secrets. But it's fascinating because we've, we literally have dose response curves and it kind of tells, tells the story. The other thing I wanted to add, Mark, when I listened to you and I was thinking those patient outcomes and what you had seen, if I wasn't, if, if I did not have the 10 year history of building Verda and seeing exactly the same results now with a hundred thousand plus Americans, I would still be like, oh, I'm sure nutrition can work. But come on, like these are the, like the grandfather who was 100 pounds overweight and then ran a marathon. Like we always hear these stories like, oh, it's a one anomaly, one out of million. But I think really what the world needs to hear this is individuals, business decision makers, policy decision makers, scientists, is that these results are systematically possible. Absolutely systematically possible. And this idea that we have 200 million sick American adults metabolically unhealthy and the best we can do is manage symptoms with medications is ridiculous. It is so ridiculous. And so we really have to get the message across that there is a way, nutritionally, you don't have to be a superman or superwoman, ordinary person. There's a systematic way to achieve those results. Obviously there's a distribution. Some are hugely successful in terms of moderately successful, but that message hasn't broken through yet. And it has to. And that's why I'm grateful to be on this podcast too, because it's ridiculous.

[Dr. Mark Hyman]

Yeah.

[Sammy Inkonen]

There's no other way out of this metabolic health mess GLP wants in. Tap water is not going to solve this mess.

[Mimi Grishman]

No, no.

[Dr. Mark Hyman]

And it's interesting when you're talking about how you, you, you're sort of able to execute on things in the sense that you learned in your research around these hormones and molecules that regulate appetite like adiponectin and leptin and the inflammatory molecules that are produced by your fat cells. And that was sort of where your research was. And what we're learning is that the application of the right nutritional approach in metabolic dysfunction actually automatically regulates those hormones. Rather than having to take Ozempic, which artificially does this, your body can naturally change the levels of the appetite and fullness hormones that are driving this overeating behavior that is driven by the carbohydrates. So when you eat more sugar and starch, you want more sugar and starch when you eat that. I mean, I would say Nobody can eat 12 avocados, but anybody can eat a whole bag of Chips Ahoy cookies. Right? So it's just like no limit on that. And I think the body has this natural ability. When you feed it in a way that it's designed to work, it actually resets. And it's not willpower, it's just science. So can you explain how that works?

[Sarah Hallberg]

Yeah. So when folks increase their fat intake, and certainly when people achieve nutritional ketosis with higher ketone levels, the hormones that drive appetite are naturally suppressed and the hormones that signal satiety go up. So endogenous GLP1 CCK go up and then, you know, things like ghrelin go down. So again, so exactly like harnessing nutrition to appropriately do that positive feed loop, that's towards improving health and decreasing hunger, it drives with just the nutritional changes.

[Dr. Mark Hyman]

So what's interesting is that, is that you said something that I want to sort of highlight and double click on, which is that when you eat in the right way, you naturally increase your GLP1 peptides, which are regulating your appetite, and that you don't have to take Ozempic. And what you also said, Sammy, earlier, was that you're achieving Ozempic like results without taking the drug, without all the side effects and without all the costs. And so can you kind of explain what. And we talked about this when we were hanging out in person in Aspen. You know, the. The data that shows that, you know, out there, the pharmaceutical companies are funding billions of dollars of research on these GLP1 agonists and other related peptides around a whole spectrum of diseases, from depression to autoimmune disease, to neurodegenerative diseases, to longevity, to obviously weight loss and diabetes to cardiovascular disease. And they're trying to get all these studies done to get indications for these other applications of these drugs. But what you're saying, when I heard you say, was that using this nutritional approach, you can actually achieve all the same types of outcomes. And it's not the drug itself, it's actually the change in your metabolic health. Can you explain more about that, Mimi Grishman? How that works.

[Sammy Inkonen]

Yeah, absolutely. And first upfront I want to say that this may sound like, oh, this guy is so anti pharmaceutical. No, I'm a physicist by training, I believe in science, I believe in western medicine. And also these GLP1 drugs, you know, first one was I think in America approved for treating type 2 diabetes 2005. And it's a tool in a toolkit. It is a tool in a toolkit for type 2 diabetes and in some cases for obesity. So I just want to be very clear and obviously virta our providers practice evidence based medicine. So anything I say next isn't going to be like, oh, you know, drugs are bad in all cases. No, that is not the case. But to answer your question specifically, and this is all data that's published in peer review. So if anyone wants to sort of double check, you can go to vertaheld.com and/research and find out published in peer reviewed results. But indeed. So what we've been able to show is that as we run our nutrition program among our patients, the following things either improve or get reversed. Obviously type 2 diabetes, so that's glycemic control. So blood sugar comes down, hypertension, so blood pressure comes down, inflammation comes down. So this is CRP C reactive protein and white blood cell count. And we also have an unpublished paper looking at 16 inflammation protein proteins of which almost all improve, which is unheard of. Better than Humira. That's unpublished. So that's a caveat. Depressive symptoms improve, sleep apnea improves, so gets reversed. Knee pain goes down, cardiovascular disease risk markers and 12 year cardiovascular risk goes down, kidney and liver function improve. So we looked at EGFR and we can't really say that we can. It would be a little bit overreaching to say we reverse kidney disease, but we have shown that we improve kidney function and same with liver function. So when you look at these broad spectrum metabolic health improvements, it's basically the same list that the GLP1 manufacturers are now showing that we either improve or reverse. And we've already published this data. So what can we conclude include again, I'm not the medical doctor here, so maybe charisma can kind of COVID me up here. Yeah, but basically what we we can show is it is possible to achieve the same broad metabolic health improvements as TLP1s may or may not nutritionally, 100% nutritionally. Therefore it is not the exogenous molecule that is achieving these results alone because it's possible to achieve the same results nutritionally. Now we can still debate the mechanism Is it all about the weight loss or are there other things in play? And our hypothesis is there are other things in play, but again, such as information reduce inflammation. But we can achieve the same things nutritionally, which I think again is a very important message to be heard because in the next year and two there's going to be headlines. Oh, GLP 1 is now improved. The eighth new thing. The answer is, guess what? Nutrition improves all those things. And then finally I will say again, there's a place for these drugs. GLP1 is a tool in a toolkit. But I think this statement holds true, which is we don't know the short, the midterm and long term side effects of exogenous drugs, but we know the side effects of healthy food.

[Gary Taubes]

Guess what?

[Sammy Inkonen]

Better longer life.

[Dr. Mark Hyman]

That's right.

[Sammy Inkonen]

Like healthy food. It's tough to say like what's bad about that? Not much.

[Dr. Mark Hyman]

That's right. Yeah. No, I think, I think you're right. I think, and I'd love to hear your perspective as endocrinologist GRISHMA about the GLP1s and you know, their utility, but also the risks. And I sort of whether or not they're really necessary. If we actually got our nutrition right and we got the delivery system right, which is this continuous care model to support people in behavior change, because that's the biggest thing. And this sort of conversation you just were mentioning, Sammy, reminded me of a study I read that looked at gastric bypass and they did a controlled study where they took a group of obese patients. Half of them got bypass and half of them didn't. But the diet that the bypass patients got after their surgery was the same diet that the non bypass patients got. And they both reversed their diabetes within a couple of weeks. It wasn't the diet, it wasn't the surgery, it was the food. And I hear you saying the same thing about this GOP one. So I'd love. Grishman, you sort of share from an endocrinologist perspective, you know, what, what your thinking is about this, you know, you know, where they play a role and actually is this approach of, you know, very aggressive nutritional intervention with the continuous care model of lifestyle support and behavioral change, you know, actually better. And how do we think about that?

[Sarah Hallberg]

Yeah, no, I think that's a great question. And it kind of hits on something we spoke about earlier during this call with insulin and how we sort of, I think we missed an opportunity of marrying some of the nutritional sciences to patients who were able to receive insulin. And when you think of like even type 1 diabetes, of course insulin was life saving. But because we didn't really invest in figuring out the right nutritional, now we have a lot of folks with type 1 diabetes who we say they have double diabetes.

[Dr. Mark Hyman]

Yes.

[Sarah Hallberg]

Which is type one with insulin resistance. Because we've, we've just let people eat whatever they want even if it doesn't work for their body. So I like that, like to think of that as an analogy for GLP1. You just can't what, eat whatever you want just because there's a new medication. Because guess what again, the energy homeostasis is super complex. There's no silver bullet. Like you actually have to eat right for your body. And there's so many, like I said, the genome wide studies have shown that there's a lot of different types of type 2 diabetes. And if we can get to the root cause, we can help a lot of folks and not look at one target molecule that we're using today, which is, you know, the GLP1 therapy and that. So I think really thinking more holistically about our patients that these are not magic bullets. Look, they're great medications for patients with diabetes and other non glycemic indications like reasons outside of blood sugar control such as heart disease, heart failure, kidney disease, there's mortality and there's outcomes data to support their use. But what about the millions of people who have not yet developed those complications who have diabetes and the folks who have pre diabetes and obesity. And this is diabetes is the tip of the iceberg. We have a whole society below that where we need to drive impact because we can't just medicate everybody in the country. So really thinking about the root cause and finding the right nutrition for the individual patient. And this is the, this is part of precision medicine. Right. Personalizing your diet to what works for you. And it's hard work. I mean what our coaches and clinicians do at Virta, it's a daily again like a white glove experience where we're getting that data, we're doing that positive feedback to make those changes, to learn and course correct when things aren't going well, to celebrate when we get those lab reviews. So really it has to be a very patient, centric, holistic approach. But so I think there is a role for these medications. But I think we need a better solution for as a population.

[Dr. Mark Hyman]

But is your belief that if people were able to adhere to a diet that was right for them, that these drugs are redundant?

[Sarah Hallberg]

I think so. I think if you could prevent, I mean I'm of the mindset, prevention is always better, less is more. So if you can teach people to eat well and keep them healthy, that's better for everyone. They feel better. They have all the other non. Forget about just the metabolic risk. Think about neurocognitive risk, cancer risk. There's so many downstream things that just by eating right we can fix. And then I'll just really quickly say, like even sort of transgenerational, like when young adults who are in their prime reproductive years, when they're metabolically unhealthy, we know there's all this epigenetic changes that drives the next couple generations to have metabolic dysfunction. There's real implications for populations when you teach them how to eat correctly. The last thing I'll add is diabetes disproportionately affects minority populations and those with less socioeconomic means. Imagine if we could improve that without costly medications and prevent it and close some of the complication gaps and the death gaps that we have in the United States.

[Dr. Mark Hyman]

Yeah, I know, absolutely. I mean the health disparities are huge and there's a whole food inequity issue and nutrition security issue and there's all.

[Sarah Hallberg]

The ways in which and equity around getting medications, accessing expensive medications and accessing expensive technology like cgm. There's all kinds of equity issues. So what if we went to the root cause and just helped people be healthier from day one?

[Mimi Grishman]

So how do we think about type 2 diabetes from a functional medicine perspective? What's the root cause? Functional medicine is all about root cause. The root cause is something called insulin resistance. And this comes from eating a diet that's high in sugar, refined flour, grains, ultra processed food, there's no doubt about this. Also from lack of exercise and being sedentary, not moving enough, or being under muscled Right. Muscle is your metabolic Spanx, according to my friend JJ Virgin. And how do you address that? Well, you eliminate ultra processed food, processed grains, refined grains and starches, sweets, sugar sweetened beverages especially. And that improves your blood sugar balance and your insulin sensitivity. And what should you be eating then? Good quality protein and it can be meat. Okay, that's my view of the literature, not my opinion, but it's pretty much evidenced by the randomized control trials. Fiber, right. Fruits, vegetables, nuts, seeds, sometimes whole grains if you're not fully blown diabetic, healthy fats, olive oil, avocado oil, macadamia oil, none of these will will affect your blood sugar. And then you want to use testing to test your fasting glucose, your fasting insulin, your A1C triglycerides and other markers to understand if your insulin resistance. Now I co founded a company called called Function Health. You can go to functionhealth.com We've created an initial test of over 110 biomarkers. It's 4.99 a year membership and includes testing twice a year. And you get all the metabolic markers you need. You get insulin which your doctor almost never tests A1C or blood sugar. But you also look at lipid particle size we call lipoprotein fractionation. Not just your regular cholesterol profile but whether or not you have small particles, dense particles, large or small triglycerides or hdl. All these will tell you about your cardio metabolic health. We also measure inflammatory markers like C reactive protein and others so you get a really good understanding of where you're at. So go on check it out, go to functionhealth.com you can use the code young forever if you want to jump the wait list. But it's really a way to get testing to see what's going on with you and what's going on with your diet. So again test don't guess. Now it's no secret that navigating the realm of nutrition has become a challenge for the general public and even for people like me and healthcare professionals who've been studying this for 30 years. One week eggs are good for us, only be vilified for allegedly raising cholesterol levels. The next week, the narrative on dietary fats is no less tumultuous. And I wrote a whole book on this called E fat content. Some experts say that it's a chief culprit behind heart disease. Others say it's critical for overall health and well being. Well, more recently, a study made headlines linking red meat consumption to an increased risk of for type 2 diabetes, leaving the public once again confused and understandably so. And that's why in today's Health Bites episode, we're diving deep into the findings from this paper and unpacking the study's design flaws, its inaccuracies and where the researchers got it straight up wrong. The study was entitled Red Meat Intake and the risk of type 2 diabetes in a Prospective Cohort Study of United States Females and Males published in October of 2023. Now, this was a type of study design. It's important to understand study design because you have to understand science before you can interpret science. And you have to understand the type of studies that are done and which can show cause and effect and which can show correlation, not causation for example, every day I wake up and the sun comes up. It's 100% correlated, but it's 0% causal. You know, if I die tomorrow, the sun's going to keep coming up. If I slept through the middle of the day, the sun's going to keep coming up. So it has nothing to do with each other. And essentially that's what these observational studies, like this particular study did. They looked at correlation, not causation. And that means that we can't prove cause and effect. So when you hear the headline Red meat is linked to causing type 2 diabetes, it's BS, okay? We have to look at what the data show when it doesn't. And these studies are not wrong. They're not bad to do. They're done in order to help us understand what might be a useful avenue for further research. Right? They're not the end of the research. They're useful for generating hypothesis. For example, in the study of smoking and lung cancer, they did observational studies, right? They weren't going to do a randomized controlled trial because they're not talking about half people on cigarettes and half people are not on cigarettes. So basically they found that there was a 20 fold increase, maybe 10 to 20 fold increase in the risk of lung cancer in smokers. Now to put that in perspective, that's a thousand to two thousand percent increase in your risk of having a particular disease. And that ended up being correct because it was such a strong correlation. Whereas in this red meat diabetes study, to cut to the punch, it was about a 20% increase, right? Which essentially is relatively meaningless. And let's just say 200% increase in a correlation study, you pretty much want to ignore the data. And Dr. Ioannides from Stanford has written a lot about this, is an incredible scientist who's dissected the value of different types of studies and what we can learn from them and what we can't. So we have to start out really understanding that the study was not designed by its very nature, which all scientists would agree to prove cause and effect. It's just the nature of science. Okay, so let's get into the study. This is what we call a prospective cohort study. And it's an observational study, a population study, an epidemiological study, all means the same thing. Essentially it studies a group of individuals over time to look at the association between certain exposures, behaviors, diets and risk factors on specific outcomes. So basically, they track thousands of people over many, many years, looked at what they ate and saw if there was a correlation with diabetes and lo and behold, they found one. But let's talk about the problems with why this may not actually be as clear as the study seems to generate. Now, in this type of study, mainly people are identified based on their exposure status and then they're followed over time to observe and record outcomes. In other words, what did people eat over many decades and what, what was that diet? And was it correlated with any bad outcomes later in life? So you follow people for 30 years, you have them track their diet records, which we'll talk about in a minute, and then you see whether or not a particular food or types of food seems to correlate, not cause correlate with some bad outcome like diabetes. And that's what they did. And basically the goal is just to assess relationships between various insults, exposures, toxins, smoking, diet, whatever, and outcomes. So it essentially looks for things that may be worth further studying with a randomized control double blind trial. Okay, this was not done here. Now it can be helpful, but they say, well, we're going to control for variables we call confounding variables, which means things that kind of can throw the study off. In other words, we'll talk about this. But for example, there was a study done many years ago by the NIH and the aarp, the American association of Retired Persons, that looked at meat eating and chronic disease and death and cancer and so forth. They found a big correlation. But that study showed also that the people who ate meat didn't care about their health and smoked more, drank more, ate More calories, about 800 more a day, were more overweight, didn't eat fruits and vegetables, didn't exercise, just drank more alcohol, didn't take their vitamins, of course they had more disease. It wasn't because of the meat. It was, it was just a, we call it a problem that was shown because of these confounding variables. And we'll talk about more about that. Now this study was published in the American Journal of Clinical Nutrition and it was published by folks at Harvard who are great scientists, but they're focused on epidemiology, particularly at the school of Public health, which is where the study was published out of. And, and unfortunately, you know, people have bias and the study authors are very biased toward a plant based diet. And so right off the bat, you kind of look at. All right, well, they already have a bias and that affects the study, the outcome study. So basically the objective of this study was to assess the link between total processed and unprocessed red meat intake and type 2 diabetes. And then to estimate the effect of substituting different protein sources like vegetables, proteins, nuts, seeds, beans, grains for red meat and type 2 diabetes risk. So we're doing but again, just a hypothesis generating study. Now, again, this was a population study. It was based on the nurses health study, which was about 216,000 participants, the first and the second one, and the health professionals follow study, which was including men. Now, the first study started in 1976 female nurses and then another one 89 female nurses and health professional study was started in 86. And they followed people for a long period of time. They calculate the amount of years and people and they come up with a number called 5.4 million person years. So that's pretty good. And what they did was really interesting. They looked at something called a food frequency questionnaire. And this assesses people's diet every two to four years from the baseline. Now, can you remember what you had last Thursday for lunch? Do you remember the amount of this or that you had over the last week? Probably not. Right? And so these are flawed tools and there's a lot of research and science about how flawed these tools are and how imperfect they are and how often they are very misleading. We see that in this study. So the study findings, right, just to be clear, this is association correlation, not causation. They found between the lowest and the highest ready me intake, there was a risk of diabetes that went up by 62%, right? Not 200%, 62%. Processed meat associated with 51%. And unprocessed red meat was about 40% risk. If you substituted one serving of nuts or beans, then your risk was 30% lower. If you substituted for processed red meat, the risk was 41% lower. And unprocessed meat was about 29% lower. So they're basically saying if you had one serving of dairy for total processed or unprocessed red meat, you had a lower risk of type 2 diabetes. Now, this study is really important because it kind of misses a lot the point. What is the mechanism here? Now, they try to explain some of the mechanisms, but it's pretty weak. We know that the sugar that you eat, sugar and refined carbohydrates is the primary cause of type 2 diabetes, not red meat. And ancestrally, we've been eating meat for as long as we've been human. I just came back from the Maasai population in Africa, as I mentioned on different podcasts, and these people ate the blood, the milk and the meat of their cows. That was their main diet. They were healthy, they were super thin, they were very fit and they had no diabetes. I recently visited their community and the Coca Cola truck drives up every day. They get processed cookies from the local town that are made by the industrial food system and now they're gaining weight. And type 2 diabetes is rampant in this Maasai community in Africa. And it's just heartbreaking to see that within minutes this entire Coca Cola truck, a big truck, just was emptied out by the local population not knowing what they were doing themselves. And they didn't even know that it was connected. So you know this. Basically this study fueled a lot of clickbait headlines. For example, WebMD said just two servings of red meat per week raises diabetes risk. Well, that doesn't. It shows that it's correlated, but not causing. Eating red meat, sir, more than once a week is linked to type 2 diabetes risk. That's CBS. This is just bad reporting and bad journalism. And the social media was just all over the place, right? Some people were pro red meat, some people anti red meat. People are super confused and then nobody knows who to believe and everybody's distrusting public health and dietary guidelines and it's just a mess. So I'm going to try to unpack it for you so you really understand how to think about this and also how to actually know what to believe around this whole issue of red meat and diabetes and what we know. So basically the problem with this study, as we mentioned, is an observational study and we just cannot draw conclusions from an observational study. Doesn't prove causality and we have to look at also the limitations of the study. There are a lot of limitations. The study authors, for example, as I mentioned, are very biased toward a plant based diet and veganism. The how they pick the participants of the study, which may not be an issue, industry funding we want to look at that probably was an issue here. But there's this thing called recall bias which is common with food frequency questionnaires. People are more likely to report healthy food than unhealthy food. And desserts, sugar, sweetened beverages, alcohol are underreported. This is published. We're going to put all the references for everything I'm saying in the show notes. So have a look at those. Everything I'm saying is documented, is well researched and you can kind of dive in, but would take me about 10 hours if I covered every study in detail. So basically, you know, I've found this my practice. People overestimate how much extra they exercise and they underestimate how Much they eat, it's pretty difficult by humans are pretty flawed. Now the 2012 study from Red meat consumption and mortality, it looked at a prospective court. Studies from the people who ate a lot of red meat, about the highest 20%, had a 45% higher risk of dying from heart disease compared to those who ate the least red meat, the lowest 20%. However, when they looked more closely at the people in these extreme groups, they noticed that besides eating red meat, they had other habits that made them more likely to have heart disease, like don't exercise, they ate too much, they smoked, their cholesterol was worse. So. Or they maybe had fish consumption which affected their, you know, health and risks. For example, maybe the people in their lowest risk group exercised and didn't eat meat, but they also didn't smoke and they also ate healthier food. So you can't quite tell what's going on. So the study, you know, supports the idea that eating a lot of red meat is linked to high risk of heart disease. People who choose to eat more or less red meat have other lifestyle issues that influence their health. Now there are other factors, these confounding variables I mentioned, you know, when you look at confounding variables, they try to control for these but it's really tough like and they only, only control what research think to control for. And it basically makes it really hard to determine true cause and effect. Like I mentioned with the ARP study, they smoked more, they drank more, they ate less fruits and vegetables, they didn't exercise and all these other issues. That's why they had more disease, not because of the meat. So it's basically other issues with the study could be design flaws and maybe the study population is different from the regular population so it may not be widely generalizable. And also they do all these weird statistical calibrations to normalize the data. And we're going to talk about what that means. And they did this. In that study there was, I think a scientist named Roger Williams who said there's liars, damn liars and statisticians or maybe that was Mark Twain, I don't know. But I think, you know, I think it's true. You can kind of manipulate the data to make it show what you want. And that's clearly been done here. And the other thing this study does is it, it actually supports dietary guidelines to limit red meat consumption. And why does it say that? Well, I mean the study basically said our study supports this current dietary recommendations for limiting the consumption of red meat intake and emphasizes the importance of different alternative sources of protein for type 2 diabetes prevention. But dietary guidelines, just like this study, are heavily based on observational data. The data that can't prove cause and effect, and the systematic reviews and meta analysis of observational data are the weakest types of studies. Right? There's confounders, there's bias, There's a lot of problems with the studies. And often the researchers have ties to industry. The expert panels are not independent. It's kind of a mess. So how do we know what to do in science? Well, randomized controlled trials are the gold standard for drawing causal inferences between exposures and the outcomes. For example, you know, you, you give people placebo or blood pressure drug who have high blood pressure, and you follow them for three months and you can see, okay, well, did the people taking the placebo lower their blood pressure or the people on the pill? That's a randomized control trial. And you randomize people so they're not, you're not stacking the deck in favor of, you know, healthier or sicker population. Now, they're hard to do in nutrition because you need to control everything. And it's really hard to do. It's great in a lab rat, but it's not really easy in humans because they're what we call free living and they do whatever they want. So you say, well, I want you to eat a low fat diet, or I want you to eat a low carb diet, or I want you to, you know, exercise 150 minutes a week, or I want you to not smoke, or I want you to sleep eight hours a night, or whatever you want. You tell them they're not going to probably do it. And it's hard to do. You'd have to basically put people in a locked metabolic ward and put them there for years and give them the food that they eat and track everything they do in order to actually know what's going on, like a lab rat. But we really can't do that. We can't take, you know, 10,000 people and feed them a vegan diet and 10,000 people and feed them a omnivore diet, including red meat and healthy foods, follow them for 30 years and give them all the food and track that. It would be billions and billions of dollars and impossible to do. So it's not practical, it's not ethical, it's expensive, it's hard to recruit volunteers for this. And people just, it's hard to do these nutrition studies. So we have to do the best with the data we have, which are systematic reviews and meta analysis of randomized control trials, mechanistic studies, lab studies. There's many different levels of evidence, so you have to look at the total community benefit of all the evidence. So now let's dive into this problem of study design and what was wrong with this paper and why it does not prove that red meat causes type 2 diabetes. So what they did, as I mentioned before, they gave them a food frequency questionnaire. They're highly inaccurate. Right. Every two to three years, people get asked, what do they eat? And they got a questionnaire. What's their average intake of food and beverage over the last 12 months? Do you know what you ate over the last 12 months? I couldn't have a clue. I mean, how often do you remember eating X and Y food? Right? Do you eat chicken with the skin on or without the skin? You eat hamburgers, hot dogs, processed meats. They give all these questions. They also, you know, kind of weirdly track things like beef, pork and lamb as a sandwich or mixed dish. But no serving sizes were noted. You know, sandwiches in lasagna have also bread and pasta and processed carbs. So is that part of it? We don't know. So they basically kind of looked at, you know, what they were eating. The second issue is, and by the way, I can go way more into these food frequency questionnaires, but just trust me, based on the data, we'll put the links in the show notes, they're really highly inaccurate. They've really been proven to not be a good tool for looking at nutritional intakes over time and don't really correlate with a valid metric for tracking outcomes. So right off the bat, it's a tough study to do. The second issue, and I kind of mentioned it, is that the red meat definition included sandwiches and lasagna, which basically were counted twice and as processed and unprocessed red meat. Now, processed red meat is hot dogs, bacon meat, sandwiches, sausage. Unprocessed red meat is like hamburgers, beef, pork, lamb, a sandwich. So it's kind of weird. They kind of included other foods in the meat. So you have to be clear. The third issue is the serving size has changed over time. And why? Because the food frequency questionnaires were different in the different parts of the study. So One was in 1980, one was in 84 when I had 61 items and 120 items. And they basically changed the definitions of what a serving is even in these food frequency questionnaires. So it's super confusing. So the nurses in the study asked how often they consume two slices of bacon. Now, the serving size of bacon is one slice, but before it was two slices. Right? How they adjust for this? One serving of processed red meat is considered 45 grams. How did they measure it? Did they weigh their lunch meat? Did they take their bologna or salami and put it on scale? I doubt it. You know, what about chicken, beef, pork or lamb? They say six to eight ounces was a serving. Today one serving is three ounces. Did they know this? Did they translate a three ounce serving to a six to eight ounce equivalent? Probably not. And it creates more error in the studies. Issue 4 in the study was that this is really crazy. They use statistics to massage the data to have the outcome they want. It calls this process calibration. We're calibrating the results using a seven day weighted diet record and food frequency questionnaires from two other population studies. In other words, they kind of acknowledge that food frequency questionnaires are not that accurate. So they're going to use other ones to correlate and see if they can kind of create this mishmash of data to show what they want. So what they found was that this is kind of crazy. The calibration doubled the effect for total red meat, processed meat and unprocessed red meat. So before the calibration, for example, one serving, an increment of total red meat was associated with a 28% higher risk of diabetes. After the calibration it was 47%. Before the calibration, one serving increment of processed red meat was associated with a 50 high risk of diabetes. After it was 101%. So it's like, what are you doing here? Right. So guess what number was repeat reported in the headlines. Not the uncalibrated but the calibrated number. Right. Too much red meat is linked to a 50 increase in type 2 diabetes. Well, in NPR they didn't really do a good job of doing a review of the study. They didn't do investigative journalism, which I think is sorely lacking. And basically they. They found that there's 50% increase in red meat. So like I said, before the calibration was 28%. After it was 47%. The next issue was the authors compared the lowest intake of red meat to the highest intake, but have historically reported the risk using servings and for example, which is a more quantitative metric. So just to explain what that means, in the 2011 paper, another one called red meat consumption the risk of type 2 diabetes, three cohorts of US adults and an updated meta analysis, they reported 12% risk of diabetes for one serving and 32% for processed meat and 14% for total red meat. But this paper compared the highest to lowest intakes claiming a 51% increased risk for eating unprocessed and 101% increased risk for processed and 40% for total. But basically this method using qualitative versus quantitative generated a lot more headline worthy statistics. So in other words, the way they reported this, it just makes it more sensational and look better for the agenda of having a study show that red meat causes diabetes. Another thing with the study is the women in this study, right, the nurse self study compared to the men in this study show that the women ate more red meat than the men. Now this is the first study ever to claim this. Now typically every other study has shown the opposite. So what does that mean? Well, I don't know, but it just seems to kind of be a clue that maybe the study is a little wacky and doesn't comport with all the other data we have around meat consumption and being female and male. The next issue was the total red meat intake had a higher risk of diabetes than both processed and unprocessed red meat. So that doesn't make sense. Right. If you, if you, how could this, the total red meat be worse than the individual types of red meat when the total is a sum of both of them, Right? So you don't get like one plus one equals three. It doesn't make sense. So most studies are looking at the risk associated with red meat, show that the processed meat is riskier than unprocessed red meat and total red meat. The sum falls in between, right? So if you have processed red meat being a higher risk and unprocessed lower risk, the average risk is going to be lower, Right? Kind of a combination. But in this study they found the opposite, which doesn't make any sense. If red meat it's processed makes you have a higher risk of diabetes and unpressed rest reciprocity lower, then if you add them together, you shouldn't have a higher risk when you combine them. So it doesn't make sense. The next issue of the study was what we call healthy user bias. And I think this is really, really important. Essentially it's talking about what I mentioned earlier, which is the idea of confounders, this idea of why were the people in the study having more diabetes or not? Was it because of the meat they were eating or a bunch of other habits? Right. The people in this study, when you look at their characteristics, they had much higher body mass index. In other words, they were heavier, they were less physically active, they were more likely to be smokers, and they were less likely to take vitamins. Right. So of course they're going to have more risk. Right. So the healthier people didn't eat red meat. Why? Because they thought that red meat is bad. That's the propaganda that we have in our society, which is red meat causes heart disease, red meat causes cancer. So we should be eating less meat. In fact, we are, which is really another really important point. When you look at the amount of meat we're eating, it's dramatically decreased over the last 30, 40 years. Dramatically. Because the message in the public health domain has been to eat less meat. But at the same time, what's happened, the risk of diabetes has skyrocketed.

[Dr. Mark Hyman]

Right?

[Mimi Grishman]

Just double tripled in different populations. So how could that make sense? Red meat's going down, diabetes going up. Okay, well, that's a problem. How do we explain that with this study? What was so interesting to me in this study was that they didn't adjust for body weight, or we call bmi. That's nuts. Because the group that actually had more diabetes was more overweight. Now, was that attributed to the red meat intake? That's what they say, that red meat causes you to gain weight, but there's just no data to support that. I mean, they basically said because the likelihood that weight gain mediates at least part of the association between red and meat intake and type 2 diabetes, we did not adjust for adiposity in the primary analysis. In other words, they did not actually account for the fact that the people who ate more red meat were more overweight. Now, a lot of other things can cause that, and particularly they do. Particularly ultra processed foods, sugar and refined carbohydrates. That's clear from the data. Not meat. The next issue was grains and sugar were excluded from the characteristics table. That's crazy. How do you actually evaluate the effect of diet if you exclude the very thing that's causing diabetes, namely sugar and refined carbohydrates? They just said, oh, we're not going to include that. Okay, we're not going to look at that. Why? Well, I don't know, but it doesn't make any sense to me. The next problem with the study is that calorie intake was reported extremely low. Now, this doesn't make sense because people we know eat a certain amount of food. They're not starving themselves. And in the study they basically excluded people ate less than 500 calories a day for women, or more than 3,500 calories. They just got rid of them from the house. It's the same thing for men. Men who Consume less than 800 calories a day or more than 4,200 calories a day were excluded. And you can see how do you get these numbers? Because food frequency questionnaires are so problematic. People do all kinds of things that show that they're not actually truly reporting on how much or what they ate because they're getting all these extremes. Oh, men are eating 800 calories a day or 4,200 calories. It doesn't make any sense. But what was really interesting is the average calorie intake for women was 1200 calories and for men it was 1600 calories. That's not a sustainable diet for people. They're not going to eat that much. They're going to be starving all the time. So it just shows you the flaw in these food frequency questionnaires. They don't show you what people are actually eating. You know, very low averages for healthcare practitioners. People, especially nurses, are on their feet all day. So that just kind of makes me want to throw out the study altogether because again, how do you rely on data that's so imperfect, where your calorie count is so off? So how do you know what actually people are eating?

[Dr. Mark Hyman]

I wanted to share something exciting with you. My team and I just launched the Hyman Hive, a powerful new wellness community designed to help you put personalized health into action with the tools, support and accountability to make it last. Inside the hive, you'll get monthly live sessions with me, office hours with our resident functional nutritionist, science backed protocols, exclusive challenges, behind the scenes content, and access to a thriving community of people who are just as committed to their health as you are. We're already seeing incredible conversations, connections and breakthroughs inside. And it's only the beginning. If you want in, now's the time. Founding member pricing ends April 30th. That's just $27 a month for full access to everything the hive has to offer.

[Mimi Grishman]

Offer.

[Dr. Mark Hyman]

After that, the price goes up. So join us today@doctor hyman.com hive. That's Dr. Hyman.com hive H I V E. I'll see you inside. If you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels at Dr. Mark Hyman. Please reach out. I'd love to hear your comments and questions. Don't forget to rate review and subscribe to the Dr. Hyman show wherever you get your podcasts. And don't forget to check out my YouTube channel at Drmark Hyman for video versions of this podcast and more. Thank you so much again for tuning in. We'll see you next time on the Dr. Hyman Show. This podcast is separate from my clinical practice at the Ultra Wellness center, my work at Cleveland Clinic and Function Health where I am Chief Medical Officer. This podcast represents my opinions and my guests opinions. Neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical medical professional. This podcast is provided with the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, please seek out a qualified medical practitioner. And if you're looking for a functional medicine practitioner, visit my clinic, the Ultra Wellness center at ultrawellnesscenter.com and request to become a patient. It's important to have someone in your corner who is a trained, licensed healthcare practitioner and can help you make changes, especially when it comes to your health. This podcast is free as part of my mission to bring practical ways of improving health to the public, so I'd like to express gratitude to sponsors that made today's podcast possible. Thanks so much again for listening.