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Mastering Diabetes Summit Day 5, Part 1- AKA Forks over Knives Day

Published 2.23.2017
This is the seventh 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, however long that process takes.

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.

Matt Lederman MD

This is the first I've ever heard of this particular doctor. He's written a of book, Keep It Simple, Keep It Whole.
  • Says that he tries not to say what to do, but provided the risks and benefits. He gives it as an absolutes rather than relative risks and benefits which is what drug companies do.
  • Talks about relative vs absolute risk: Folic acid is the example. The relative risk is 50% but the absolute risk is 2 in a 1000. With supplementation, the risk is 1 in 1000— so a 50% reduction, but really a small benefit. This is precisely how people argue against statins.
  • Drug companies incentivize doctors to give medication. They support research, they sponsor talks of “thought leaders”. That doesn’t mean that doctors are corrupt, but it does create the appearance of impropriety. And influence can be unconscious.
  • Hence some people think that drug companies should not give money at all. But where will the money come from? In the time of Trump expecting the government to fund it all is naive. And he admits that somebody has to pay for the work. But sponsors do get to see results and might influence how they are presented.
  • Zero mention of diabetes so far, 10 minutes in.
  • Using medication to correct biomarkers isn’t the best way to do it. Medications haven’t been shown that reducing blood pressure to 110 from 140, and using drugs hasn’t been shown to improve the outcome. Natural reduction with lifestyle is best. The Atlantic had a long article recently making these same points.
  • Twelve minutes in Barbaro brings up diabetes, but he means type two diabetes (T2D). Drugs improve markers, but don’t necessarily improve neuropathy and other side effects. Just like lowering cholesterol reduction by drugs doesn’t really lower heart attack incidence.
  • That said, he doesn’t just take people off drugs. Because people lie. It’s one thing to say you’re going to do a radical change, it’s another to actually do it.
  • And then calorie density gets explained again. Essentially he says that people eat the same amount weight of food, (say a pound) so makes the point a pond of vegetables is less caloric than animal products or fried foods (chips). Eating 500 cal/pound is about what humans are designed for.
  • Calories still count! Chips and guacamole still have to be portioned control. Fruits and vegetables can be eaten without counting. I disagree with that blanket statement on the fruit. There are some that can be overeaten— or maybe I've just watch too many crazy vegans on Youtube…
  • Portion control is not useless in a whole food plant based diet (WFPBD). To say so as he is BS. IF you eat a lot of nonstarchy vegetables, then that’s the case (no portions). If you eat nonstarchy fruits, that’s the case. But you can overeat even on a WFPBD. To assert otherwise is as bad as low carb high fat shills who also try to claim calories are meaningless.
  • Says the number one reason fail on the WFPBD is they don’t eat enough calories. Which can be the case on a nutritarian, but I’m sorry the Raw till 4 nut cases overeat whole plant foods and they get fat.
  • Supplementation: Can be harmful BUT vegans MUST supplement B12!! He is definitive on this point. But otherwise, he says supplements should be unnecessary. Doesn’t think the preformed DHA is necessary, the data isn’t clear Not that it helps or hurts. Get your nutrients from food. If you have a deficit, then use a supplement. But B12 IS a MUST. All of that assumes a healthy vegan diet, not full of junk.
  • A discussion of oil ensues, he's on Team Esselstyn, saying oil promotes vascular disease. I don't know if that's true.
  • Saya that after a fatty meal the fat coats the red blood cells. Then they clump and can’t get to smaller blood vessels. Blood vessels can’t dilate as much they need to and plaque builds up.
  • Claims oil increases blood glucose levels (cites an old study) The idea that the fat gums up the cell receptors for insulin. Insulin stores fat, so more insulin so you get fat storage.
  • Only omega 3 and 6 fats are essential, and they are polyunsaturated fats which can be gotten from plants. Olive oil is a monosaturated fat, and coconut oil is saturated fat.
  • Gets asked how to calculate how much protein each person needs? Doesn't answer instead he says don’t make your food intake a science experiment. It’s individual how much protein each person needs. Just eat plants.
  • Calcium (Ca) is discussed. Plenty of Ca in plants, there is no reason to eat dairy for calcium. It’s the balance of Ca that matters. Ca from cauliflower is absorbed twice as well as dairy he claims. And then minimizing salt means that Ca isn’t excreted.
  • Green leafy vegetables and beans are good sources of Ca. The benefit of resistance training and stretching (meaning yoga?) is mentioned. NO to Ca supplements, says they harm blood vessels, and doesn’t stop bone breakage.

Thomas Campbell MD

Thomas Campbell is the son of T. Colin Campbell (though mostly in this summit he was referred to as Colin Campbell without the T), famous (or maybe infamous is the better word) for book The China Study. The son, unlike the father, has an MD and is a practicing physician. This talk surprised me in a positive way. Although I've never read The China Study, I have read articles by Colin Campbell and heard him speak. I expected his son to mirror his father's inflexible attitudes, but he did not— at least in my view. That is, perhaps, the difference in teaching to people and actually treating them.

  • Addressing high fat diets: Diabetes is due to fat build up in the cells, so eating a high fat diet makes no sense. Allows that it might not be as simple as due to fat, but it’s definitely due to fat build up in the cells.
  • Dietary protein and diabetes risk and insulin resistance (IR): Low carbers have higher risk. Have higher risk of death and higher risk of diabetes for high protein and low carb. It’s not just the protein, if you’re not going to eat carbs, you have to eat a lot of fat.
  • What about soy? Yes, it can be part of a WFPBD, though he says whole soy products. Soy beans and edamame Tempeh, plain tofu as a condiment. Stay away from soy powders and oil.
  • Phytoestrogens in soy caused concerns. But they don’t always act like estrogen. Generally, soy is found to be protective against breast cancer.
  • Fish to get essential fatty acids: Obviously says no it’s not necessary. Must acknowledge that studies show that people who eat more fish have better outcomes in heart disease and strokes. But claims that the fish results are better agains the SAD, not against the vegan (such as those by Ornish and Esselstyn). However, you can’t say that eating fish is dangerous. Most people want some sort of meat on the plate, and fish is better than red meat or chicken.
  • Fish oil myths? Looked at the Inuit who ate more fat, but seemed to have less heart disease. That’s where the idea where the type of fat rather than fat itself. Mediterranean diet includes unsaturated fats.
  • Omega 3s were found to be anti-inflammatory 15-20 years ago fish oil supplements had better outcomes in heart disease. But further research on fish oil supplements has shown that in fact they have now benefit (this is true).
  • Still have a body of evidence that shows that omega 3 is protective, but get it from food. Including plants— walnuts, flax seeds, etc
  • People think fish oil when they hear omega 3. Salmon FTW, but not farmed salmon. Ever. In fact, I don’t eat salmon at restaurants any more because it’s almost always farmed.
  • Gluten and wheat. Gluten is not necessary, but only celiac’s really need to avoid it. My comment: Gluten is not an essential nutrient. Tons of WFPBD diet foods have no gluten.
  • Doesn’t seem like he believes in nonceliac gluten sensitivity, though he does allow that there is some evidence it’s real— but not at the levels of the gluten free fad would suggest.
  • THERE ARE PLENTY OF WHOLE GRAINS THAT ARE GLUTEN FREE. I do not accept that it adds a huge difficulty to the diet. Oats, rice, quinoa, amaranth, millet, etc
  • Organic? Less important than if it’s whole food vs processed. Considers organic to be a distraction used to rationalize otherwise bad decisions.
  • Breast milk isn’t plant based, but it’s still the best for infants. I seriously have never thought about whether breast milk in this way…
  • GMO (genetically modified organism) health and environmental effects (potential) the environment is not his area. The evidence is not clear that they are harmful. There’s little evidence, period. Have been eating GMOs since 1990s (Corn ingredients, but not sweet corn that we eat) animal feed is GMO I think, so if you eat meat you’re probably getting GMOs. He says avoid them anyway.
  • He stresses less over labels, because that’s the wrong question. Is it a whole food or processed, and is it a plant or animal? That’s all you need to know.
  • Fascinating. He has not been WFPBD for his entire life. He made gradual improvements over 20 years.
  • Not a fan of fake vegan cheeses= congealed oil. He will make cashew cheese at home. I've done that, it can be tasty, but it ain't cheese.
  • Vitamin A and K, both are fat soluble. Plant food have betacaroteine, which the body has to make into vit A. Some with vit K1 to K2. He’s never come across a vitamin A deficiency with a plant based cultures. There are no vegan cultures. Says this is one way people create distractions by going down esoteric, reductionist rabbit holes and then making broad general pronouncements (paleo peeps in a nutshell). Not aware of an issue in vitamin K deficiency. Says that people talking about it are trying to confuse people. If they can sow doubt, then they win. Theirs is the default diet, so if you don’t change they win.
  • His plate starts with beans! First one to do that. Then whole grains (he does NOT list wheat, instead it was oats and quinoa), then starchy veg. Then other veg and last is fruit.

Caldwell B Esselstyn Jr, MD

Is his father still alive? Usually sons drop the Jr once dad is buried… I've written about Esselstyn before. I listened because I wanted to hear if he'd say anything new about diabetes. Nope. His presentation is basically the same, what's good for the heart is good for the pancreas… and at least in T2D, that's hard to argue against.

  • Says he started out by looking into cancer and nutrition, but didn’t find the answer by looking at other cultures.
  • Noticed that people in cultures eating WFPBD (but not vegan because there aren’t any) didn’t have CVD.
  • Discusses his study in 1985, I’ve heard all this before. There were 24 patients, six went back to regular care they became the “control” group. So 18 remained.
  • Moderation kills Heart disease is a toothless tiger, because it’s food borne and doesn’t exist in half the planet? Um…
  • Quotes: "Patients with cancer aren’t afraid to suffer. Patients with cancer aren’t afraid to die. Patients with cancer are afraid of being abandoned." Says CVD patients the same.
  • He never says why he didn’t adopt the low fat (LF) diet of the cultures that he studied that ate meat but not much. That’s not a small point. Pritikin cured heart disease just like Esselstyn did, but not with veganism.
  • Nitric oxide is the key. This is why moderation kills. Everybody has triple vessel disease? Um…
  • STOP THE BUS. The Okinawans are NOT vegan. The rural Chinese are NOT vegan. They. Are. Not. Do they eat low fat? Hell to the yes. Do they eat very little meat? Hell to the yes. Are they vegan? Hell to the NO.
  • Esselstyn (and for that matter Coin Campbell) extrapolates without evidence that ZERO animal foods are better than 10% or less of calories.
  • I can’t even listen to this man at this point BECAUSE he is distorting the evidence. There is no vegan society.
  • I get the extreme thing, that’s what Fuhrman does. It’s extreme, take it or leave it. That I can respect.
  • I also agree that it’s not a matter of bad genes, but no traditional culture eats a vegan diet.
  • Low carb diet to minimize insulin use, smart or not? He uses a high carb diet so basically he can’t speak to it. There it is folks, the one and only diabetes mention.
  • All the “carbs” he lists are green leafy veg, which are NOT high in carbs. But he does mention legumes.
  • Asks about biomarkers. Those don’t cause heart diseases, it’s the diminished NO . High cholesterol isn’t the cause, it’s all about NO in the blood. I haven’t heard him say that before.
  • Can cholesterol be too low? He already said that biomarkers don’t matter.
  • What about LDL particle size? He doesn’t care. It’s all about eating correctly. Eat a WFPBD and stop injuring endothelial, then you’re done.
  • How about the coronary calcium score? Sure, it shows you have the disease, So then he explains how an increasing Ca scores on the WFPBD is somehow evidence of less inflammation. Robby doesn’t understand this, and so moves on. Basically he says the calcified plaques are less likely to erupt.
  • Wants his patients to chew green leafy veg the size of their fist after boiling 5-6 minutes + a bit of balsamic vinegar. 6 times a day. Yikes. That is a butt ton of greens. What would that be, at ½ pound of greens each?
  • If there’s nothing to eat where you happen to be, he’d have you skip a meal. Better that than eating meat. AGAIN… forget it, it's too repetitive…
  • He gets good compliance because his patients self-select (and he bounces them from the program is they aren't compliant— that little tidbit brought to you by the movie Forks over Knives, which I will be reviewing on Friday.
  • Essential fatty acids on a very low fat diet? He says it’s not really low fat at 10-10.5% fat. Seriously? So he sees no issues of fat deficiencies. To get omega 3 flax seed and chia seeds.
  • Then goes into why he says no nuts— because people can’t eat just one. The restriction is just for CVD patients.

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