My Notes from the Diabetes Summit
An Interview with Dr. Brian Mowll
Founder and Medical Director of Sweet Life Diabetes Health Centers. Certified Diabetes Educator and IFM Certified in Functional Medicine
I want to start today with the different types of diabetes, we are going to talk about seven different types of Diabetes Mellitus. I think this is going to pre-frame the rest of the content for today. Most of you here are likely interested in type 2 and pre-diabetes as that’s 90% of all people with diabetes have one of those two, there is over 70 million people with pre-diabetes and over 25 million with type 2. If you add up those two numbers that’s a quarter of our population so one out of every four people walking around either have diabetes or pre-diabetes, think about that it’s staggering. If you look at the leading causes of death in our country if you take heart disease, preventable forms of cancer, diabetes and stroke alone that’s almost nine out of ten people will die from one of those preventable diseases. I always talk about being the one in ten, you want to look at nine other people around you if your not the different one the one living differently, eating differently, taking better care of yourself, keeping yourself in better physical condition, if your not the one then guess what your one of the nine. That’s not where you want to be because that means your going to die of a preventable disease, heart disease, cancer, stroke or the complications of diabetes. We want to stop that and reverse that so that’s what we want to talk about.
Lets’ get into the different types of diabetes
Type 1, Gestational, LADA (type 1 1/2), MODY (type 1 1/2), Pre-Diabetes, Type 2 and Type 3.
Type 1 diabetes is an insulin deficiency, very simply put it’s a lack of insulin and this comes from an autoimmune attack on the pancreas, the beta cells the insulin producing cells in the pancreas. This is typically due to some sort of trigger and there is many autoimmune triggers, some of them are food based others are infection based but something triggered the immune system typically in childhood to destroy the pancreas. I have patients as young as three months old that have type 1 diabetes and I’ve patients in their twenties diagnosed with type 1 it’s a condition that requires insulin for life.
The second form of diabetes is gestational diabetes or GDM diabetes of pregnancy, this obviously is self limiting but the key with gestational diabetes is many people who have diabetes during pregnancy will go on to be type 2 diabetic, about fifty percent. This is a significant issue to be aware of. There is two other forms of type one and a half diabetes and this is somewhere between type 1 and type 2 there is LADA and MODY. LADA is an autoimmune form of type 1 diabetes as well that happens later in life and MODY is a genetic form of diabetes there’s over ten different genetic forms, genetic causes that could lead to that. It’s rare I only mention it because often times it gets misdiagnosed as type 2 and there is certain things that we want to look for.
Then we have what I call the big two which is pre-diabetes and type 2 diabetes these are associated with insulin resistance, it’s not an insulin deficiency it’s insulin resistance. We are going to describe it in better detail in the rest of this webinar. Finally type 3 diabetes is an animal all unto itself it’s brain diabetes and this is what many people think is one of the root cause of Alzheimer’s Disease and Dementia. What happens is the brain cells become insulin resistant and can no longer take up sugar the way they normally would so their function decreases and they can’t burn glucose for energy as well. The insulin resistance alone can trigger problems which can be associated with these plaques and tangles that we often think of as being related to Alzheimer’s. For those of you that are more interested in this I did an interview with Dr. Peter Osborne (my notes from that interview here), it’s something that people with blood sugar dysregulation should learn more about.
We are going to go back to pre-diabetes and type 2 these are the big ones, the big difference between type 1 and type 2 is type 1 is insulin deficient or insulin insufficient, insulin dependent. Type 2 diabetes is a condition of insulin resistance now most of you have probably heard that term and if you think about the word it means your cells, the cells of your liver and your muscles in particular are resistant to the hormone insulin. Insulin is a fascinating hormone it was actually one of the first hormones ever discovered, from an evolutionary biology perspective it’s one of the oldest hormones we know about, a survival hormone, very important. It’s job is to take any excess energy if you eat more calories than you can use at that given time, if you eat more carbohydrates even more protein that you need at that time insulin’s job is to sock that away, that extra energy because calories are just energy. If we can’t use it or burn it at that time insulin’s job is to sock that extra energy away for later use storage so it’s a storage hormone, it’s a growth hormone, insulin is very high in babies because babies need to store a lot of that extra energy their getting for later use. Bears become highly insulin resistant just before they go into hibernation because they need that extra energy for winter because their insulin resistant they store all that extra energy in the form typically as fat. Here is the key takeaway insulin is essential for health, it’s essential to get nutrients into your cells to burn for fuel. Extra insulin is detrimental it causes weight gain and fat storage it’s inflammatory and causes cardiovascular disease, it can actually lead to cancer and cause cancer growth. The right amount of insulin is essential for life, too much insulin becomes one of the most detrimental things to your health because it’s a growth and storage hormone.
Insulin resistance means that our cells have started to shut off from the effects of insulin, think about that loud noisy room or maybe that person that keeps bugging you and you sort of tune them out your becoming resistant to them that’s insulin resistance. I’m spending a long time on this because this is the key to understanding type 2 diabetes. Insulin resistance means that you don’t respond to the hormone insulin properly so what does your pancreas then do to overcome that resistance. If were having a conversation and you can’t hear me I am going to want to speak louder so you can hear me that’s what the pancreas does it makes more insulin, this is the central issue with type 2 diabetes. You don’t use insulin properly and you make too much insulin and that causes you to become fat, inflamed and it cause this cascade of negative metabolic effects. Hopefully that clears up in your mind really what type 2 diabetes is because it’s not insulin deficiency it’s really not even about high blood sugar, yes your blood sugar goes high but why does it go high, it goes high because you can’t get it into your cells and it can’t get into your cells because your insulin resistant. Insulin is like a key that opens the cell that allows glucose in to be burned as fuel.
If we want to treat type 2 diabetes at it’s root cause does it make sense to treat blood sugar or does it make sense to treat insulin resistance. Hopefully your saying it makes sense to treat insulin resistance because that’s the key to reversing diabetes. If we turn our focus on what conventional care does the ADA American Diabetes Association makes their recommendations every year and your primary doctor, your endocrinologist is only doing what their told to do. They are told very little to focus on healthy eating, weight control and physical exercise that makes up about two percent of the chart they get. They are told to focus a lot on drugs, metformin, when you were first diagnosed with diabetes what did they do did they spend hours on weight control, healthy eating and physical activity, no of course not. They pulled out their prescription pad and they gave you metformin that’s called mono-therapy and then we have combination therapy so we tack on other drugs like Actos, Avandia or others such as the injectable’s or one of the new class of drugs called SGLT2 inhibiting drugs. They act on the kidneys to reduce renal threshold for sugar which means you pee out more sugar, those are new we don’t know much about them other than they can cause urinary tract infections, dehydration and deplete you of vital minerals. I actually have a patient that went into the hospital with heart palpitations and it took them three days to figure out it was actually the SGLT2 inhibitor had depleted his blood levels of calcium and magnesium and was leading to heart issues. You have to be careful with some of these there are side effects to every drug, not that drugs are bad we need them in certain situations but for me I would rather address the root cause and that’s the key. None of these with maybe the exception of these TZD drugs in the purple box address insulin resistance, those drugs it turns out are associated with very serious side effects like bladder cancer and heart attacks because of the way they work. It turns out that the way they improve insulin sensitivity is by causing you to lay down more fat so the new fat cells that you lay down are not insulin resistant. If some of you have doctors that are still holding on to Actos as a miracle drug to help reduce blood sugar can it be effective, yes but it can also be dangerous so you have to be careful with it. That’s true for any of these drugs let me be real clear if your blood sugar is high you need to get it down and if the best way to get it down is to use pharmaceutical therapy then you do it. I’m not telling you to go flush your medications down the toilet, what I’m telling you is while your addressing your high blood sugar you also need to be addressing the root cause of diabetes which is insulin resistance.
Let’s talk about a different model of care and this different model of care is called functional medicine, functional medicine looks at the body completely differently than conventional medicine does. Conventional medicine takes different parts of the body and studies, them this works really well for school so let me go study the heart for while or the kidneys and so forth. That’s the way medicine was designed the problem is in practice it doesn’t work because now you have twenty different doctors going in twenty different directions prescribing twenty different medications and no one is integrating them. The primary care physician has now become virtually powerless specialists have all the power in medicine today and they don’t agree with each other so there is various disagreements in medicine and no one is bringing them together. That’s what functional medicine is all about it’s about integrating all the systems of the body looking at the body as a whole system and not just an accumulation of symptoms, it’s about addressing the root cause of diabetes or any health condition, it’s about treating the patient not the disease. Functional medicine is where it’s at I encourage you to look for a functional medicine doctor not necessarily to replace your primary care physician but to be on your health care team as that ultimate generalist who can really look at your body wholistically and help integrate this. This is what I do with diabetes I practice functional medicine, certified in functional medicine by the IFM, Dr. Mar Hyman is the Chairman of our Board he is the one who made these statements: “Functional Medicine is the Future of Medicine. It seeks to identify and address the root causes of disease and views the body as one integrated system. It treats the whole system not just the symptoms.” This is what we want to look at as an approach to handling diabetes particularly type 2 diabetes.
I want to put the question out there, do you think diabetes is reversible after going through eight days of the diabetes summit. Did that change your mind or open your mind or give you some extra hope, hopefully it did. Type 2 diabetes is absolutely reversible without question without doubt, I have seen it in hundreds and hundreds of clients. Their coming off medications, coming off insulin, getting their blood sugar down to normal or near normal, losing weight, completely transforming their health, so absolutely 100% diabetes is reversible don’t let anyone tell you different they are lying to you. How do I know this because it’s been published in peer reviewed scientific journals it has been published that diabetes is reversible. If someone tells you it’s not they just haven’t read the research, bottom line.
There is two forms of therapy that have been shown to reverse diabetes the first is bariatric surgery, that’s stomach stapling, bypass surgery, clamps and so forth. Don’t worry I’m not recommending it this is not a gastric bypass webinar I’m just using it as an example because without a doubt bariatric surgery can reverse diabetes at least temporarily in about 80% of the people that undergo it. The way bariatric surgery reverses type 2 diabetes it turns out has less to do with the weight loss and more to do with the removal of visceral fat or deep adipose fat. There is a myth that fat, being overweight causes diabetes it’s completely nonsense. How do we know this, because I have had people come in having lost fifty pounds and their still diabetic they didn’t reduce their blood sugar at all. There has been studies done with liposuction that shows sucking out fifty pounds of fat via liposuction does not alter blood sugar. So how does bariatric surgery do it, when they do these surgeries oftentimes they will remove the fat around the viscera, around the liver, around the pancreas. If you listen to my presentation with Roy Taylor he describes this quite a bit, he does MRI studies and did pre and post MRI both from bariatric surgery and from turns out to be the second form of published research showing that it is reversible and that is through intensive dietary change. Let me ask you this if you knew that bariatric surgery and dietary changes could reverse type 2 diabetes which would you choose to do, if you said bariatric surgery your on the wrong webinar if you said dietary changes then your in the right place. That’s what were going to talk about intensive dietary changes have been shown to reverse type 2 diabetes. Most of that research was done by Roy Taylor over in the UK at New Castle University you can look it up and send a link to your doctor if he is still living in the dark ages. Realize that this has been studied, it’s been published, it’s been peer reviewed, it’s been published again and backed up many times through various studies. These are a couple of articles Diabetologia which is the European standard for diabetes care there’s Diabetes Care Journal from the American Diabetes Association I have both published research from Dr. Taylor. Hopefully that gives you hope and your excited and eager to figure out how to do it.
There is ten things that we have to look at in order to reverse diabetes and to get blood sugar under control, we have to change body composition. A few minutes ago I said being overweight does not cause diabetes and that’s absolutely true however it can be a contributing factor especially when you have too much visceral fat or belly fat. When I say belly fat I don’t mean the fat hanging off your belly I mean the fat pushing out your organs, it’s the fat underneath the muscle packed in around the organs. It’s almost like that beer belly that big apple shape we have to change that if were going to reverse diabetes. We have to change your diet we have to get you moving, the body is not meant to be sedentary, getting out for one hour a day or thirty minutes a day or walking for fifteen to twenty minutes after diner. While those are all great strategies it’s just not enough we have to move our body we need to become active we need to find ways to incorporate physical activity in our life all day long every day seven days a week. Don’t exercise three days a week sit on your butt the rest of the week and expect that to reverse diabetes it doesn’t work and I don’t care if you have two knee replacements and you use a walker you can find ways to be active. Do some floor exercises do some stretching there is so many things that you can do, there’s ergometer machines that you could just pedal with your feet or even with your arms and hands there is always ways to get active is the key.
Sleep quality is as it turns out it’s extremely important there has been two studies done on this one showed just one night of less than five hours of sleep can cause insulin resistance immediately. There was another study that showed that three night of less than 4 1/2 hours of sleep led to significant levels of insulin release . The people who had these three nights of lack of sleep made three times the amount of insulin as they did when they had normal sleep. Remember what we said insulin does, it causes fat storage, causes you to gain weight it causes inflammation. People notice sometimes they get swollen when they haven’t slept and one of the reasons is insulin acts on the kidneys and causes you to retain fluid and because of that you get swollen. Fluid retention is one of the key indicators of insulin resistance.
This next one is metabolic function, is your metabolism tuned to burn fat or is it tuned to burn sugar. How do we know that, well our metabolism will burn both it does this through something called the mitochondria. There is a little engine in our cells and if you think about it your engine needs gas and that gas gets converted and makes your car go. We have two fuels that our cells can take in, that our mitochondria can take in and then turn into energy what are called high phosphate energy groups that you could use for cellular energy for fuel. One is glucose and the other is fat so what’s missing there out of the three macronutrients, protein, protein does not get burned for energy. Protein is made up of amino acids it makes up our bricks and mortar it’s used for things like neurotransmitter production, detoxification, we can turn protein into sugar to be burned for fuel but we don’t burn protein. We burn glucose and we burn fat we have to get them into our cells, the mitochondria will burn one or the other preferentially. It will burn both but one or the other and you can change that you can take your body and turn it into a fat burning machine. Fat is much more of an effective fuel, fat gives up over twice the amount of energy as sugar does. If your a sugar burner your going to crave sugar and carbohydrates your going to need that next meal and if you happen to skip a meal your really going to feel it because your craving that sugar, carbohydrate fix. If your a fat burner and you happen to go a little longer than usual without eating you can tap into your fat stores assuming you have ample fat stores. You can tap into that to burn for fuel also you will notice on your lipid panel if your triglycerides level is over one hundred typically your burning sugar not fat. If your a fat burner your going to tend not to be overweight your going to burn that fat especially that visceral fat packed around the organs so your probably not going to be inflamed and insulin resistant.
We want to become fat burners fat burning machines and the way to do that is by tuning our metabolic system the right way. Organ status like liver function, kidney function, thyroid function, adrenal gland function, these all play into blood sugar health. The digestive tract, we have a micrbiome, bacteria that line our digestive tract that break down our food that determine largely how we actually synthesize the food that were eating. They have shown through various studies over the last couple of years that the quality of our microbiome, the bacteria in our digestive track will determine how you regulate and control blood sugar and determine if your insulin resistant or not. Chronic inflammation from various sources can cause insulin resistance and diabetes. Hormone balance testosterone, estrogen, thyroid, cortisol, adrenalin, and all these hormones are important in regulating blood sugar.
Lastly nutrient status, we want to make sure not only that our diet is good but that our nutrient status is good. I am talking about micronutrients, things like minerals, vitamins, bioflavonoids and anti-oxidants these small particles that are important in driving metabolic function. Chromium, biotin, zinc, magnesium, lipoic acid, nutrients like carnitine and CoQ10 which drive fat burning in the mitochondria, B vitamins, vitamin C, vitamin D, these are all important in controlling and regulating blood sugar.
How do we assess all this, part of functional medicine is about viewing the body and each patient as an individual and running specific lab tests to find out what’s truly causing their health problems and in this case causing diabetes. We do some alternative testing something called fasting insulin or C-peptide, if your using insulin as a type 1 or type 2 diabetic we can test insulin but it’s not accurate. We have to do something called a C-peptide test which tells us how much insulin your pancreas is producing. The key with this is if were really reversing diabetes it’s about treating insulin resistance and being insulin resistant makes you over produce insulin. Don’t you think it’s important to test your insulin levels, of course, it’s how many of your doctors have tested your insulin levels. I guarantee if there’s a thousand people listening less than ten people have had their insulin tested. Doctors just don’t do it, it’s not part of the standard of care, that’s not what their taught, many times the insurance will cover this but they just don’t run it because their not taught to do it their not taught the value of it. If your addressing the root cause of diabetes not just managing drugs to lower blood sugar then running a fasting insulin is extremely important. There is other parts of a diabetes assessment panel often times we will do, proinsulin, C-peptide, there’s hormones like adiponectin, leptin, there’s excitatory cytokines and interleukins that we can oftentimes test for. Check for inflammation as well as high sensitivity, C reactive protein that’s a good inflammation test as well, often times we’ll do advanced lipid markers. Last year on my summit I had Dr. Steven Sinatra an integrated cardiologist and he said running a standard lipid panel is like practicing dinosaur medicine it’s virtually useless, the only thing useful about it is the triglyceride levels and possibly the triglyceride HDL ratio we have to run a more advanced lipid panel. Looking for particle size, particle number, it’s important to know what type of cholesterol you have. There is various particles listed here that are associated with both protection and the risk of plaquing in the arteries, the key is if they can be run why not do them. Here’s the various micronutrients that I mentioned biotin, chromium, magnesium, zinc, which is important for insulin production, carnitine, CoQ10, inositol, vitamins E, D, B and C these are all important nutrients. Glutathione which is a cellular antioxidant, cysteine is an important amino acid these can all be tested and that’s the key, don’t you want to know your cell levels of these if you have diabetes.
A lot of people ask me about supplements and they can be very important, I’m not going to recommend you go out and take this entire list of supplements I think they can be used strategically. Mostly I think if you need them they could be very helpful. If your intracellular levels of chromium are low that’s certainly going to effect your ability to regulate blood sugar. Supplementing chromium can be that key maybe that you need, same with biotin and vitamin D, low vitamin D is associated with risk for diabetes. Antioxidants like alpha-lipoic acid, these are important but supplements are meant to be supplemental the key with supplements is you have to take them in the right dose and in the right form. If you look around online there is all sorts of magic pills, glucose lowering pills, some of them may be effective many of them are not because they don’t use the proper forms they don’t use the proper amount. These are all backed up by peer reviewed clinical research studies, specific amounts that you want to do chromium for example, 200mcg has shown to be ineffective 400-1000mcg has been shown to be very effective at regulating blood sugar. Same thing with biotin 500mcg of biotin isn’t going to do much good 3-8ml of biotin depending on the person has shown to especially in combination with chromium, to be good at making you more insulin sensitive and improve your glucose tolerance, your ability to regulate glucose in your blood.
Some examples gymnema is an herb, berberine is an alkaloid compound that has shown to have metformin like effects it acts on the same pathways as metformin does it has been shown to be just as effective in at least one study. Vitamins B6, B9 and B12 are neuro protective and fiber can be important for kidney function it can help with the lipids a bit and it can help slow the glycemic response from the foods that you eat. These are good supplements, if you want professional grade supplements we do have a dispensary found on my web page with more information about the supplements that we recommend.
Where do we go from here, I want to give you some suggestions of what you can do. We look at the different types of care and I don’t want to position these as an either or, standard care is important, going to your doctor, standard quarterly checkups, running basic labs, having your feet checked, your eyes examined, making sure your not developing any wounds that can turn into infections. But really standard care is not designed to reverse diabetes in fact it’s designed to keep you diabetic for life and to keep you taking medications. All the ADA recommended nutritional guidelines are all based around assuming your taking diabetes medications. If you don’t want that and you want to reverse your diabetes and do something different you have to take a different approach and that’s the key to understand. A real food dietetic nutritional approach and lifestyle approach and to me that’s what patient centered care is all about it’s about focusing on the person not the condition, looking at the root cause not the disease. Realizing it’s not one size fits all it has to be customized focusing on natural care using a good healthy real food diet lifestyle modification, safe research backed evidence based natural supplementation these are all very important. It’s non insurance dependent meaning when you go into your primary care doctor their doing what insurance covers. Understand many times you will say why don’t they run this test, why doesn’t my doctor spend and hour talking to me about my diet and nutrition plan, why isn’t my doctor telling me all this information, they do what insurance covers period and unfortunately insurance doesn’t cover that. It doesn’t cover reversing diabetes, it doesn’t cover a detailed customized real food whole food nutrition based therapy and lifestyle intervention. You have got to be willing to make some investment in your health. We are talking about diabetes here not just losing a few pounds were talking about saving your kidney’s, your eyesight, saving your life potentially, helping with sexual function, helping with all the things that we know diabetes can do to us. I had a patient come in that had a foot amputated and his blood sugar was fairy well controlled with drugs. What happened he had an ulcer on his foot he didn’t pay attention to it, it got infected, it caused osteomyelitis an infection in the bone and weeks later he had his foot chopped off. He was managing his diabetes with medications but at that point he really hadn’t made many dietary changes, he hadn’t done much to reverse his diabetes. This is scary stuff be willing to invest in your health because it will be well worth it.
We have a five phase approach, phase one is metabolic jumpstart and that’s where we take the first month to turn your metabolism around, help detoxify your body, help reverse inflammation and to help get this thing off on the right foot. Next is mitochondrial reprogramming helping to change whether you burn fat or sugar, turn you into a fat burning machine and help you loose weight get your triglycerides down and start to produce some energy. Then we go through some dietary changes which is adding some foods back in, checking your carbohydrate tolerance, bringing back in some of those fun foods that maybe you had cut out for a little while, you’ve been in training here and ultimately we work toward lifetime wellness.
This is what Medicare says: Anything you do that seeks to prevent disease, promote health and prolong and enhance the quality of life is not considered medically necessary and therefore not covered. The bad news is all insurance follows the same guideline for the most part. The good news is that care can still be affordable and it’s well worth the investment so don’t depend on your insurance to cover you, to cover your health. Obviously we want insurance for medications and our routine visits , lab testing and hospitalization but realize if your doing anything to prevent disease, promote heath or enhance the quality of your life or prolong your life according to insurance it’s not their responsibility so you have to be willing to make some investment on your own.
Dr. Mowll web page drmowll.com
This is a good page for information on Dr. Roy Taylor’s work.
Disclaimer: The information contained on this site is for educational purposes only and should not be used as a substitute for diagnosis or treatment rendered by a licensed physician. It is essential that you discuss with your doctor any symptoms or medical problems that you may be experiencing.
M.Scherker medical researcher