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Mastering Diabetes Summit Day 4, Part 2

Published 2.12.2017
This is the sixth in a series in which I am commenting on the Mastering Diabetes Online Summit, otherwise known as the Vegan Diabetes Summit. The two hosts, Cyrus Khambatta and Robby Barbaro, manage their type one diabetes (T1D) with a raw, high carb low fat diet, consisting of mostly fruit. Links to the videos and audio recordings of the event expired Thursday, February 9th at 9:00 PM Pacific time. However, I have notes for most of the talks though day seven (Day 8 was all about testimonials) and I will continue to present them until I've gone through them all.

Please remember: I am not a nutritionist or medical professional. I am stating what these presenters claimed, mostly without any fact checking. When I know a statement is false, I say so. However, no endorsement is implied for statements presented without additional commentary or fact checking. These are not recaps, merely some notes and commentary I made while listening.

Joel Fuhrman MD

Curing young T1Ds, or extending the honeymoon? That's not the title of Fuhrman's talk, but it is the most critical topic and claim that he made during his hour.

In Marc Hellerstein's Summit presentation, he explained the phenomenon of "the honeymoon" seen in the treatment of newly diagnosed T1Ds. Sometimes newly diagnosed T1Ds, who are typically have very low insulin levels plus IR because of the very low insulin levels for a long time prior to diagnosis, which Hellerstein said was a endocrine system characteristic. After being treated with doses of insulin, new T1Ds can become insulin sensitive and seemingly no longer need to be dosed with insulin. This period where biomarkers suggest that the pancreas is "cured" is called the honeymoon period, and it doesn't last. These patients aren't actually cured, and ultimately need to go back on insulin. Hellerstein left open the potential that in this honeymoon period, there might be a way to cure T1Ds, but that none of the research had yielded any positive result.

Fuhrman is claiming (as will be seen in the notes below) that he is treating very young T1Ds, and preserving and even restoring their pancreatic function with his diet alone. That is an extraordinary claim— even as he definitively qualifies it as only being possible for young, NEWLY diagnosed T1D patients. If you are an adult T1D, his diet will not cure you. The best it can do is increase your insulin sensitivity so that you require less insulin.

Still, the claim that he can restore pancreatic beta cell function in young T1Ds is extraordinary, and extraordinary claims require extraordinary proof, which is not provided in the talk.

With that lengthy intro, my notes and commentary follows:
  • Insulin-like growth factor-1 (IGF-1) is where they start the presentation. Both insulin and IGF-1 are growth promoting hormones. IGF-1 is called insulin-like because its structure is similar to insulin.
  • Many years nutritional authorities thought that more protein is better, but now we know it ages us faster and and causes disease. Protein makes us grow bigger, but also speeds up cell aging.
  • Says if you want longevity, then keep animal protein to low levels on the diet. Because too much raises IGF-1.
  • Claims it's not only the IGF-1 in animal products that increases diabetes risk and that for very 10g increase in animal protein consumption, the risk of diabetes (type two diabetes — T2D) goes up by 6%.
  • His hypothesis is that not just IGF-1, also higher leucine also inc mTOR activity that promotes cancer; increased heme iron that is an oxidant, increased saturated fat, less fiber.
  • Does too much plant protein have the same effect? No. "Paleos" look at short studies with soft endpoints (biomarkers and weight loss) to prove their diet is healthy. Hard end points are the long term effect (death heart disease).
  • Fuhrman does seem to know the data and the studies.
  • IGF-1 promotes angiogenesis, which is the growth of new blood vessels, which is how tumors feed themselves. It’s a BAD thing. Excess insulin does this too for fat cells. Dairy products and eggs especially raise IGF-1. Claims this carries through generations. Says that excess protein intake slows down reproduction.
  • His Nutritarian Diet is designed to promote longevity.
  • It includes low glycemic, (not focused on starch) emphasizes green vegetables and other low glycemic. (Is that a slap at McDougall?) and includes superfoods (flax, chia, kale, etc) to maximize phytonutrients and micronutrients.
  • Says 90% of his T2D patients become non-diabetics. Without exercise. Asserts that it’s the high nutrient content of his diet that reverses the beta cell damage.
  • And here is where he claims that he has been able to restore type ONE diabetics to normal function. BUT only for T1D that were young and come to him when first diagnosed. He’s currently working with a 4 year old and 11 year old who are on his diet.
  • Claims that the islet antibodies levels in these patients have declined over time. At first they stop losing beta cells, but then they restore some beta cell function. In other words their glucose response is as a healthy person's— but not when they are sick. They can’t handle the stress of illness, but if they go on long enough as Nutritarians, then they can withstand the stress of being sick.
  • No one else is claiming this, but he’s working with kids who are compliant because they want to stay off insulin. The real question is, is this a cure, or is this just extending the honeymoon period? To my knowledge, he's never published any of these results for peer review.
  • T1Ds fear using insulin— and they tend to gravitate to ketogenic diets because it reduces insulin need (Bernstein is the progenitor of this). Ketogenic diets can lower insulin needs about 30%, Furhman says.
  • Even if you can’t be cured as a T1D, you can reduce the amount of insulin you need. He canNOT cure older, long term T1Ds, but they can reduce their total insulin by 60-70%. Claims his diet also stabilizes the insulin levels needed through the day.
  • Asserts that T1Ds do NOT have to have higher rates of CVD, blindness etc, because it’s not the diabetes making them sick, its the combo of the disease and the ketogenic or standard American diet that most eat. It’s not the disease that shortens lifespan, it’s the therapy. That’s quite a claim. Claims that T1Ds can have a normal lifespan BUT they have to eat much healthier than other people eat.
  • But that’s not what diabetologists say. No, they say, “Be a kid, be a normal adult. Cover it with extra insulin.” If you can keep the insulin required to lower amounts, the damage will be less. Excess insulin is lifespan shortening. Some amount of insulin is required for life.
  • Defines G-BOMBS: greens beans, onions, mushrooms, berries, seeds. He wanted people to remember foods that protect against cancer, rather than nutrient density. Nutrient density is only one element, but it’s certainly one that he pushes most.
  • Then they get into defining what his Nutritarian Diet is. I’ve written about Fuhrman and his diet a number of times, I’m not going to reiterate it here. I read Eat to Live and transcribed my notes. More recently I presented my commentary of an interview between Fuhrman and Penn Jillette, who lost weight mostly by following a Nutritarian Diet.
  • I will note again that a Nutritarian Diet is not vegan. In fact, on the page for Fuhrman’s presentation there was a link to download his program to treat diabetes for free— and I did so. Although there isn’t a lot of meat allowed on the diet, meat is allowed. 5-10% of animal products are permitted. He says that explicitly in the presentation as well. He’d prefer the number be 5%, but up to 10% is fine. And that is what the evidence actually shows.
  • Back to the presentation: Beans and greens said to build up a bacterial build up with regular consumption of beans. Which slows the consumption of carbohydrates other than beans. Hmm. That’s interesting. Regular bean consumer changes the digestive tract. So GBOMBS also cultivate the correct bacteria millieu to lower the glycemic index of other carbs that you eat.
  • GBOMBS all or just beans? All of them, but the most powerful to slow the glycemic effect of food is BEANS! Beans FTW!
  • So naturally Paleo comes up at this point, because they eliminate legumes (all).
  • Says it’s okay to have theories— actually rather hypotheses— but then you have to test. Says the Paleo hypotheses have been disproven. There are people who have food sensitivities— but that doesn’t mean that everyone should avoid those foods.
  • Cooking eliminates the issues that Paleos claims BUT the “anti-nutrients” also have positive effects, removing heavy metals and improving bone health. But no matter how much evidence against it, they won’t change their stance.
  • And THEN he says vegans do the same thing with fat. Brings up walnuts and seeds, which are higher fat, but many vegans still say don’t eat them and warn against them. Ornish only recently unbent about fat. This is interesting, because all the presentations have been resolutely low fat for diabetics— though to be sure, most would probably allow a few nuts and seeds. Just no animal fat.

Joel Kahn, MD

Joel Kahn is a vegan cardiologist who sticks with the science. He has noted that Dr Greger tends to cherry pick data when it come to the health effects of eating meat. The data do not support the idea that a small amount of meat is harmful. Kahn is an ethical vegan.

  • Begins with the paleo movement. Am I missing something? I thought Paleo was fading.
  • The “fat is back” thing is real though.
  • In 2008 the dairy association met in Mexico realized that dairy was losing favor in academia, and decided to try and change this. Soon afterward, Ronald Krauss gave the keynote (pointed to as a sign that the dairy people got their way.
  • Points to the Siri-Tarino meta analysis that concluded that maybe sat fat isn’t associated with heart disease. Notes that a response was included in the Journal, which he claims is highly unusual. Then the Chowdery review concluded the same sort of thing. Again people said the study was flawed, but the headlines were established. In his view these two studies caused the dismissal of years of data. And it’s caused a split in the food and medical world.
  • Lower the fat in your diet (at least the added fats) and improve insulin sensitivity. That’s little tidbit about added fats, not all fats, they passed right over.
  • He admits that there are short term studies that show that paleo can work. His point that any diet will work in the short term is true.
  • Notes that Loren Cordain's original book spoke against saturated fat, against dairy and against processed food. But the movement has gone away from Cordain— something Cordain himself has noted.
  • Also notes that biomarkers are not the be all and end all. It’s all about the blood vessels the endothelial lining. There is a test for that: a blood test that measures nitric oxide in the blood and there’s also a cuff that can be used.
  • Boyd Eaton gets mentioned as the true paleo originator. I have that article. Eaton was a radiologist. Boyd Eaten has said his original concept is no longer value because of damage to the environment. This is new to me. Apparently some of it is on Youtube.
  • Animal welfare comes up. So apparently he engages with Teicholz on Twitter. Bringing up issues of environment and animal suffering. Says if they had the evidence that paleo cures heart disease and diabetes then maybe the animal suffering would be worth it.
  • How much saturated fat is okay? It’s a spectrum— goal is as little as possible. (Ditch the dairy and you’re a long way to that goal…) 7% or less is the AHA’s recommendation.
  • I’ll give Kahn this, he sticks to the science— and admits when he doesn’t know or when vegans don’t know either.
  • Basically, it comes down to the vegans have the data. Paleos have to get the data (or try to get the data) to shut vegans up. Yes, you lose weight on Paleo and low carb high fat diets, but there are associated health risks.
  • Not a lot of diabetes talk. Mentions the movie, Widowmaker, which touts a test that measures calcification of arteries. So he touts the calcium score.
  • Erectile dysfunction (ED) was actually what the talk was supposed to be about. ED is related to diabetes because men with diabetes have ED, and women have poor sex drive.
  • How to eat for incredible for sex: ILYDD (I like your Dick Diet) The plumbing gets clogged up because the arteries down there are smaller. Canary in the coal mine analogy invoked. Eat greens and beets and almonds, pine nuts… not legumes? No added oil.
  • Skin is better with a better diet and exercise habits That’s how he gets women onboard.
  • Mentions deep ear lobe crease (DELC) that can predict severely blocked arteries. Not 100% accurate, but nothing is. DELC might also be Vitamin C related. Vitamin C is important for blood vessel health.
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