Vegan Diabetes Summit, Day 6 Part 2

Published 4.5.2017
This is the tenth 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 high carb, low fat diet, consisting of mostly fruit. Most of the discussion in the sessions were about type two diabetes (T2D) though, which is the type that most people have.

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. This is the second half of day six of the summit, which I thought was one of the most interesting.

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 intended to be recaps, merely some notes and commentary I made while listening.

Scott Stoll MD

This was one of the best presentations of the entire summit. It was also one of the few that focused a good bit on T1D, though of course, T2D got mentioned. Dr Stoll was a member of the 1994 US Olympic bobsled team and currently serves as the team physician for the National bobsled team (not sure there is any other).

• Back then athletes didn’t get a lot of nutritional advice, except that protein is king and get enough calories. They did use supplements like creatine.
• Came to PB medicine because he found that drugs couldn’t help people who were “falling apart” due to all the treatments for disease.
• He researched and found that for a lot of them it comes down to what you throw down your gullet.
• Using a whole foods plant based diet (WFPBD) he found that T2D get reversed, and T1D sufferers gained insulin sensitivity and require less insulin. In other words, insulin sensitivity increased.
• Asked about athletes with T1D. Most have very poor diets. Find that T1D don’t even understand the basics of traditional diet. Some find low carb diets.
• Stoll tries to think of athletes not just for the near term, but what will they be like in their 40s and 50s. A young body can tolerate a wide range of abuse, but in the end, it catches up with the person.
• Low carb high fat (LCHF) diet in training room: Yes, it have lower blood glucose (BG) levels, but insulin dosing doesn’t change. Claimed that they have problems with concentration— "brain fog?" LCHF athletes also have slower recovery because you need glucose for recovery. This is particularly important for aerobic exercises.
• LCHF athletes also have higher markets for inflammation. Higher fat means free radicals which slows healing.
• HPHF (high protein high fat) alters the microbiome to even an even more inflammatory state.
• HF diets mean the blood has high free fatty acid (FFA) content effects insulin requirements, increases the insulin needed. Makes it more difficult to control dosing.
• Because of hypoglycemia fears, athletes run their BG high. Then the only way to mitigate that is to avoid carb. T1D get the LC message and athletes get the HP message, which means LC (Meat equals high fat).
• Stoll points out that a small thing at the wrong time can destroy your Olympic dream, be it an infection or injury. So eating fruits and vegetables helps the body get the phytonutrients and the anti-oxidants that it needs to repair and recover.
• Looking at biomarkers (BG and insulin dosing) then you think LC works, but the rest of it (recovery etc) shows that it doesn’t. You want to feed your biome with plants.
• LCHF diets tend to be low in phytonutrients. Anecdotally this seems true. The LC blogosphere is replete with bloggers denouncing the need for vegetables, or stating that they are “carnivores.” No human is a carnivore, and animal products don’t have phytonutrients.
• BG and insulin dosing can be controlled with a PBD, plus the phytonutrients and anti-oxidants that you get.
• Aerobic activities are easier to manage BG because muscles are a “vacuum” for the glucose. Anaerobic activities are harder. Puts more physical stress on the body. Stress affects BG. Length and time of exertion are important for dosing insulin.
• So how should athletes control BG during sports? Do not skip insulin doses. Some do because it effects weight (this is part of why Taubes argues insulin makes you fat). It’s the food that makes the most difference. If you’re going to do an activity, take insulin an hour before. Also matter where you inject, should not inject in a muscle that will be rapidly contracting.
• Need to be consistent in training too. With that stability, insulin management is easier. Don’t drink alcohol, get enough sleep.
• Why inject in muscle rather than fat? Muscle gives a more steady state release into the bloodstream (provided it’s not contracting) than fat.
• Of course, WFPBD and unrefined carbs have a different effect than refined carbs do. Also touts aerobic exercise. But diet is the most important part. Exercise is next important.
• So T1D can reduce insulin needs by 50% quickly after adopting the WFPBD. And long term complications then go away too.

Rosa Oliveira Ph.D.

Oliveira founded an integrative medicine department, and came close to being bypassed on general principal. I’ve written previously of my firm belief that there is only medicine— either the treatments you espouse are science based and accepted as valid, or they are not. Homeopathy is the worst of the examples of what I mean, but there are others. However, the presentation began with genetic science, and so I listened. Note: I did not take down the specific names of the genes discussed.

• She studies insulin resistance more than T2D.
• Talking about genetics, gene expression and diabetes. Seems to suggest that the way someone reacts to a diet is based in genetics— or at least gene expression.
• Starts with caffeine as an example. How you metabolize caffeine is genetic, and she has whatever marker makes caffeine a bad idea.
• But then she says stop blaming genes. Diabetes and obesity is not related to your genes. She has an identical twin, and she does have the genes to be obese. But she is not obese. In other words, genes load the gun, but lifestyle pulls the trigger.
• Carbs and fat play a role in developing T2D. In other words, Eating. Too. Much.
• Everybody (9 out of 10) has genetic markers that mean that if we eat more than 30% of calories from fat, we will get fat. That’s total fat. Any kind of fat. That's different than anyone else has said in this summit.
• 30% isn’t the consensus number, in the plant based low fat <20% is low fat, but the ideal in <10%. So if in a trial low fat is defined as 30%, that’s not low fat, it’s the max level above which obesity occurs.
• 10% of calories from fat, is that enough to get the needed essential fats? Of course she says yes. Points out that there is fat in most everything, just as there’s protein in most everything. Thus you don’t have to add fats (oil or animal products) in order to get fat in the diet.
• LC vs LF, she understands why LC is compelling. Based on markers BG, insulin and weight, LC works. That’s different than what others have said too. However, overall health is not better on LC.
• I really liked her clogged sink analogy for BG control and low carb. Low carb diets are like a plumber who tells you to just not use the sink, whereas a low fat diet is the plumber who says let’s unclog the drain. This analogy fits my observations of the low fat (mostly vegan) and low carb internets. That’s obviously a subjective measure, but it is striking that low carb adherents talk of controlling T2D, while low fat proponents talk about reversal. You can’t reverse T2D unless you increase insulin sensitivity. LCHF does not do that— or a random oral glucose tolerance test wouldn’t be a problem.
• AH HA!! at the end she goes into why they don’t say vegan— it’s because there are a lot of vegans that eat like crap. Veganism doesn’t mean whole foods, it just means no animal products so it can mean a lot of crap. Colin Campbell is the one who started that (at least he’s the one who told her not to say it).
• She is not a fan of doing everything all at once. Do what you can for 30 days to improve your diet. See if you can do it for that long and keep it up, then add something else. Don’t say it’s for the rest of the your life, unless you find that you can live like that.

Read the rest of the series:

• Mastering Diabetes Summit, Day 1
• Mastering Diabetes Summit, Day 2
• Mastering Diabetes Summit Day 3 (Part 1)
• Mastering Diabetes Summit Day 3 (Part 2)
• Mastering Diabetes Summit Day 4 (Part 1)
• Mastering Diabetes Summit Day 4 (Part 2)
• Mastering Diabetes Summit Day 5 (Part 1)
• Mastering Diabetes Summit Day 5 (Part 2)
• Mastering Diabetes Summit Day 6 (Part 1)

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