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type two diabetes if you have it or know someone who does this video is going to help you more than maybe any video you've ever watched in your life uh there's a new paradigm for the treatment of type 2 diabetes and a new organization that is championing this new paradigm I have with me today a just a excellent guest Dr Mariel glant who is an endocrinologist welcome Dr thank you great where are you where are you at in the world right now uh well I happen to be in Madrid at the moment in Madrid know

you're you're all over the globe uh sometimes in Tel Aviv sometimes in Spain sometimes in New York uh give everybody a a 30 60 second CV of of who you are and why it's so important that this message gets out there um well I am an endocrinologist I've been treating diabetes and obesity for 20 something years um you know I studied uh reputable places I you know I went to I did my residency at Harvard I went to uh fellowship at Colombia I thought I was pretty well trained um for the first 15 years or

so practice um but about 10 years ago I understood that you know we could be doing this a whole lot better and at that point I was lucky because I had my own clinic at that point I was in Tel Aviv and I was kind of a mushroom there I didn't I was really an outsider which worked out really well because I didn't have anybody telling me what I could or could not do so when I discovered this I was like okay let's try it let's start implementing this on our patients and uh and that's

exactly what I did um so I started when I say this you know I mean a low carb approach uh that that really got to the root cause of treating diabetes and and so I went from being a doctor that prescribed a ton of insulin I really uh I actually loved to give a lot of high-intensity insulin at the beginning of treatment to normalize the blood sugars get rid of the glucotoxicity um but then I realized over time that there are much better ways of doing this and so this is how I started and we've

treated some 4,000 patients by now um and from there was born um Ona Health which is an organ it's it's a it's basically a program that helps people especially underserved communities uh reverse their diabetes uh with an emphasis on a ketogenic diet a low carb diet and I'm a family physician I've been practicing over 22 years and I can remember very early in my practice if I had somebody come in and I diagnosed them with type two diabetes and their A1C was seven or eight maybe nine I would say well okay we got to you

got to get on the American Diabetes Association diet I'd give them the handout and we're going to start you on one or two uh prescription medic pills right but if somebody came in with an A1C of 11 or 12 early in my practice I'm like oh my God we've got to get you on insulin right now and I from day one that would be one of the first medications that they were on and then you know the the Paradigm kind of shifted because I followed the research very closely and then they're like oh wait we

don't want to we don't want to lower A1C too aggressively right because that actually there's this big study out showing that if you lower people's A1C too much it's actually dangerous and so right and that became the Paradigm and indeed this is many many doctors currently today in 2024 are still practicing to that and that's that's where the entire you don't want to get people's A1C under much under seven or much under 6.5 because that can actually be dangerous and so that's why a lot of doctors have a big problem with a low carb or

a keto or a carnivore diet is because it's going to lower your A1C more lower than 6.5 and for many doctors that's a red flag oh that's dangerous tell us why as an endocrinologist I see you shaking your head and you're like no that's completely false why is that paradigm wrong and why do why do many doctors still believe that that that's dangerous to have an A1C that's too low and talk about the research and everything that led so many mainstream doctors today to believe that right so what happened was in 2008 a series of

different articles came out published like in the New England Journal for example that showed that uh if we try too aggressively quote unquote to to to lower A1C it was actually worse outcome and there was increased death actually but let's look at what this was doing so that one of the big trials this there were three trials the Accord the Advan and the vadt trials so the Accord trial was 10,000 patients approximately uh this was a publicly funded program uh study so there was this is a legit study um and what they did is that

they they really wanted to see what happens if we go below the A1 C of seven because by that point due to our findings in the Pro in the the trials that were done for type 1 diabetes we knew that we wanted to get to an A1C of less than seven at least seven but the question was okay if if seven is better than nine well maybe six or 6.5 is better than seven so this trial aimed to look at that so one side and and they told the doctors to just give whatever medication they

had to give so they the doctor has freed Reign to give give medications well it turned out that the the the group that gave that was aiming for the A1C less than seven for an A1C of 6.5 had more deaths than the group that was leading to A1C of s so this was like huge okay this you can imagine what are we talking about here right this is like what is going on suddenly everything that we had believed in like the lower the better is not working out so well so then it turned out that

the group that was aiming for the the the patients to have a lower A1C were giving a lot of insulin they were using everything they could because all they had to do it didn't it didn't matter how they were getting the sugar down they just had to get it down but nobody really understood that it matters how you lower your sugar right so in all three trials they were using medications that increased insulin either indirectly through for example suam Ura or by giving insulin and when you increase insulin you get worse outcomes that's the truth

and this is what what we missed in this entire conversation which happened you know around that time there were tons of editorials that were coming out and saying hey you know uh we should really we don't understand what happened was it the medication were people dying of hypoglycemia then nobody really understood that the real problem was the insulin itself that causes the inflammation that causes more insulin resistance and that causes us to get sicker and sicker since this is such a predictor of of chronic disease so what these doctors were doing is they were inducing

a pharmaceutical hyperinsulinemia correct into these patients right exactly so what ends up happening is that in the end once you understand it we're not surprised really right that you get worse outcomes but when we use newer medications such such as Sgt 2s or gp1s you know they have no problem going really low because they actually improve mortality so this just proves the point never mind the diet that's a separate issue but if we just look at you know both gp1s you know that are now making news on a daily basis but gp1s and S gt2s

which lower insulin levels even though I have to say everybody thinks that GP wants increased insulin but they don't they decrease insulin levels overall when you decrease the insulin levels you get improved mortality albe it it's a small benefit but it is a benefit and it proves the point and actually nobody contested that and the endocrinologists were not upset about lowering the A1C in those trials so why do you why do you think back in 2008 that the majority of endocrinologists became very concerned about lowering a1c's less than seven or less than 6.5 but yet

when the GOP 1s came out OIC wovi mongero why were they suddenly not concerned at all about lowering uh how did that concern kind of go away with the GOP ons um well there probably a lot of answers to that I I think look those were very specific tests right this was a specific test for one specific drug so in a way it was in a way cleaner the the they were more comfortable treating this uh there were also newer drugs and they also had a lot of other benefits like weight loss and they had

a uh they decreased blood pressure they decreased triglyceride they increase LDL I won't we can get into that in a minute that you know when you lower insulin in these patients you actually increase the LDL in the S2s but but in general it was a piure that and and and what these drug companies did is that they also brought the whole concept of metabolic disease to the Forefront by talking about metabolic disease for the first time in before that we didn't we were completely glucocentric we only talked about glucose but when the sglt tws came

out they started speaking about you know you know weight loss and and cardiovascular risk and and they started putting the emphasis on cardiovascular risk without however mentioning the word insulin yeah and that's that's odd that they wouldn't mention that but even though it's kind of the the primary driver now I kind of I kind of got us off track here let's go back to those studies in 2008 and that because what a lot of patients don't realize is that their physician is still practicing under the model if I can get your A1c to seven or

6.5 that is the victory we are done that we just need to keep it there and so what you're saying is is that these doctors glean from those studies back then that if you go below that that that could actually be dangerous and increase your risk of dying increase your risk of hypoglycemia and indeed I've had thousands of people say well my doctor told me that I that I it's not the goal to have an A1C under 5.7 that that could actually be dangerous right how how is how is lowering your A1C under 6.5 with

diet in lifestyle how is that different than lowering it with insulin injections or insulinogenic Pharmaceuticals and why is that not dangerous right because really when we look at Health we look at um a balance between storage and and and growth and then catabolic reactions right we want to we want to we want to store and build build and we want to break down and be able to consume what we stored and when we are in in a low insulin State we are able to do that we are able to have that flexibility we are able

to to use fat or sugar as a fuel we are able to to eat and store but then use what we stored when we are taking insulin okay which is our storage hormone insulin is elevated constantly and this makes it on this makes it a situation where you're actually not able to use all of that stored fat you're only storing so this is a situation that's very very unhealthy so this the the reality is that it really matters how we get that A1C down so if I stop eating sugar then my insulin goes down and

so then I have good sugar and good insulin if I keep my sugar low because I'm taking a ton of insulin well I I didn't actually achieve what I wanted to get which is health so this is where the big differentiator is you know how did you get there um and and uh the studies show that over and over again I remember when I was a resident no a fellow sorry and I had and I first heard that sglt2 not that that that um that the sanoras increased cardiovascular disease and I was like what you

know what you talking about you know this is this is supposed to be good for you and and I always had this internal contradiction until I figured it out later in life but I didn't understand how we were giving suono Aras to people knowing that it actually increased cardiovascular disease so it's a so I think the message that the the patient with pre-diabetes or type two diabetes needs to get firmly is that and and tell me if you disagree is your doctor if they say something like oh you don't want to get your A1C down

under much under seven or 6.5 because it can be dangerous all the studies that showed that were studies on pharmaceutically lowering the glucose and thus the A1C none of these guys were using a low carb or a ketogenic diet to lower the A1C under 6.5 so if your doctor says something like oh I know you're doing keto and but your A1C you know as a type two diabetic you don't want to get it down much under 6.5 that can be dangerous is there any truth to that at all if the patient's doing that with a

low carb or a ketogenic diet I I really really believe that there is no danger whatsoever I mean we know that the lower the A1C the better that is you know we want the lower A1C so you know we want to normalize our the sugars you know I'm like would you like to have an A1C of seven no that's not normal you want to have an A1C of five you know five really if we right it's hard to get there but yeah yeah and so that's that's why many people's doctors will say that sort of

thing is because they remember that research from 2008 2009 and all the editorials that oh don't lower a1c's too much but that only applied to lowering the A1C pharmaceutically correct because those things lowered the A1C by spiking or increasing your insulin levels which also has its own own level of risk and that's why the sanal uras lowered d1c yeah but they also increased your risk of cardiac events and you're and but that's because they effectively make you hyperinsulinemic which is just as unhealthy some would argue more unhealthy as than hypoglycemia and so that that's where

that came from and so how did you wrestle with this when you were I think you said 2015 when you were like think maybe there's a better way here how did that how did that argument in your mind happen well it was slow you know I I didn't just jump in I I really uh I I spent hours and hours just reading and pouring over videos and reading I was like you know I I felt like I was going through a revolution I I drove my husband crazy because I was like you've got to watch

this with me you got to you know I I made him read all these books starting from Gary TOS Nina Etc you know I was like you've got to come with me on this journey because I'm going crazy like imagine you know you you you've learned to give insulin your whole life and every you know it's it's uh such such a revolution for me so it was it was slow uh and then I decided you know I tried it on myself and family members and then I said okay and and then you know I tried

it on my first patient I was really lucky that my first patient came you know listened and had amazing results and that was a wonderful way into this journey because you know he he he was a he had an A1C of 10.8 and and he was at 5.4 three months later he be he without knowing it went carnivore 10 years ago you know I said eating meat he was Argentine he didn't so it was really wonderful and and so for me it was an instant feedback that was like okay this is amazing let's keep going

so that how it's that's how it started what what in your opinion as an endocrinologist what's more dangerous high blood sugar or high levels of serum insulin or is it a is it a tie or you just avoid both and don't question it uh the easy answer is the last avoid both and and and don't bother trying to figure that out look I don't have data from tyto to answer that question I have data from the I have data from type ones so if we look at the type ones and we look at something called

the Golden uh medal trial or report from the Joslin the Joslin is actually where I I I spent some time doing research there it's it's a seven story building at Harvard that studies diabetes and it's a fascinating place it's a wonderful place that has been studying um from from a clinical to you know from bench to Clinic very very wonderful research now what did they show they showed that patients who did the best who lived 50 years with Diabetes Type 1 diabetes free of complications or with very minimal complications with great quality of life after

50 years what did they have in common they were insulin sensitive what was their average A1C eight or 7.8 I don't remember exactly but it was they were not perfect and this taught me a lot because I was like okay you know we're pushing and pushing our type ones to be low and I still do believe that they'll benefit from that so don't get the wrong message here I do want low a1c's but the fact that it would that really what predicted the longevity was the insulin sensitivity was high HDL you know cenarius High HDL

right you want that high HDL that tracks so closely with insulin sensitivity so so I think you know I don't really know in type twos what's worse I would pedge it's hard to say because one thing leads to another right it's really exactly now currently the the GOP ones uh OIC wovi mongero and the others have completely engulf the conversation of type two diabetes uh it looks to me like and and I I mean they're obviously having a measurable therapeutic benefit for their patients uh and I think that the majority of their benefit is because

that they're they're they're basically mimicking the effects of a low carb diet that's that's what the gop1 sort to do are do you have any concern about the gop1 drugs uh longterm do you prescribe them what's your current kind of Paradigm around those drugs look they they are they are beneficial okay today um actually there's an article in the New York Times saying that uh we want to make them available for Medicaid and I'm working with Medicaid population and I want I think this is great we should have it um for the benefit because everybody

should have access to the same medications but it is a Band-Aid and and um one of the problems that I have with it is that it sort of starves you and doesn't let you pick the right choices so so one when patients start getting on on doses that are too high they they don't want to eat meat anymore so I have a problem with that um they they are happy just having some kind of bland carb even if it's a they basically are it's in more of a starvation mode which is why you have the

decrease in muscle mass and apparently even bone mass I just uh heard from a friend but I haven't seen the data um so what one of one of the the concerns I have is that you know you're you're going to decrease the calories I think it might help you choose better because you're more able to control those Cravings but in the end you're not getting the benefit of a ketogenic diet when you have a well formulated diet you can eat well your appetite is okay when you eat you can get the right amount of protein

and fat in and then you're not hungry but then you can eat again what the problem with the oics ETC is that they lower your capacity to eat well and and this is I think problematic in the long term but I have to say I do use them in about 20% of my patients uh in in the Medicaid population and about 30 to 40% in in uh in higher socioeconomic status situations and I and I think that they are they can be a useful Gateway into the ketogenic diet a good bridge where uh you you

learn how to how how to control your cravings and how to how to start eating properly sometimes people are so insulin resistant that it's just overwhelming the idea of starting just is overwhelming but we do get very good results when you combine it with a ketogenic diet and you can and that also allows you to use a lower dose so but there's no doubt that they're useful I mean there's definitely a place for them I'm I'm not going to deny that and I use them but I I also think that we have to forget not

forget that this is really just uh be used as a bridge or a or a crutch for a short time yep and I I use them in my practice as well I'm a little concerned about the new higher Doses and the lack of long-term safety data of long-term doses at that higher level but I think it's I think it for some patients it's perfectly acceptable to use the the old lower type two diabetes dosages while teaching them about a lower carb diet a ketogenic diet maybe even a carnivore diet if you're from Argentina right uh

but I think I think it serves as a useful crutch a temporary bandage to say okay your previous diet was horrible okay and and you maybe you're addicted to Sugar well I want to ask you about that later we won't get into that now but I think it's for for three months six months I think they're they're a wonderful tool to use shortterm term at lower doses to knock the edge off that appetite perhaps off that craving so that they can use more of their their frontal cortex and less of their the back part of

their brain to make food choices and then once they've fixed their diet once they've cleaned out their Pantry cleaned out their fridge cleaned out their freezer once they've adopted these and they understand the principles of a low caror a ketogenic diet then you could wean those drugs off is that kind of is that your current Paradigm or do you think there's a place for long-term GOP ones for people to take basically for the rest of their life yeah well I I am a little afraid of that myself too I mean I we don't know what

the long-term data is we do see all sorts of side effects patients don't want to stay on it for life you know patients they don't they don't really want it they're happy when they it comes off it's uh you know I've seen I have to say I've seen patients uh get depressed I know it can be also used for depression sometimes you by by there are there's a case for that and I have seen patients get depressed on gp1s then they come off the gp1 they feel better then they want to try it again and

then they get depressed I think there is something there we don't it's not clear yet I've definitely seen pancreatitis you know there there's a long list of side effects yep but and we don't really know and that's part of the problem is everybody wants to focus on the gop1 re receptors in the gut and some people don't mind talking about the gop1 receptors in the brain because that's where it probably has its prominant effect is those two regions but there are gop1 receptors in the kidney in the pancreas in the bone in in probably in

the heart like there are gop1 receptors everywhere and I don't think the conversation includes these other receptors what are the long-term potential risks of activating those receptors long term with these with these artificially high doses I don't think that gets talked about enough do you know of any research going on about these other gop1 receptors in other parts of the body that may be being negatively affected and we just don't know about that yet yeah I I I know some research in bone and I know some research in muscle but I don't know much more

than that I will say that um you know one of the things like there there sorry about that we have we have the monjaro for example is a combination it's not just the gl1 right right so it's it's a it's a combination of uh two anic hormones so the gp1 we know really well but the newer one we don't the GP ones we don't we don't have enough experience with this so this makes me particularly worried and there are tons of new drugs in development now that are the combination of these two things so we're

still in early days we don't really know much about this uh you know we've been using GOP WS for years I've been using it since 2005 so it's kind of funny to me now that everybody's talking about this now well we've known about this for years you know a lot of it has to do with marketing but um yeah but um but the gp1s we have much less long-term data about the the second part of Monaro and SE and several others and like you said I I read Fierce Pharma that's kind of a pharmaceutical journal

and everybody has has got a a GP one in Phase One or phase two trying to get that to Market as quickly as they can and that may turn out to be great that may be turn out to be a a wonderful combination or it may turn out that that causes long-term harm I think the jury's still out on that um what about berberine Dr glant it kind of the the over-the-counter version of glucophage metformin what are your thoughts on that are are you a fan do you think people should avoid that no I I

like it I use it I think it's uh it's very useful especially in patients that have side effects to metformin and can't use or can't don't have access to the extended release form of Metformin I think it's a great a great choice and it and and might even have other effects so I I like it if you had a new patient come to you today Dr glant with and they're like you know I'm I'm urinating constantly I'm I'm losing weight really fast which is kind of good but I'm not trying to lose weight and you

did your lab evaluation it turns out they have an A1C of 14 severe and you check a a fasting insulin they're still making plenty of insulin it's actually quite High uh you know their maybe their fasting insulin comes back at 35 and their A1C is 14 how what's your what's your initial consultation advice to this patient okay what's the diagnosis and here's how you need to start on the journey back to having a normal A1C let's we're we're now inside of Dr gland's exam room with her patient she is going to walk this patient through

how to get back to Good Health ah this is a fun question okay well first of all um you know this patient uh you know comes with a story right so you want to you want to kind of get to know the patient first and see what what led them to to get so sick um and you you want to First create a relationship with them um and then you I take out my little piece of paper and I start drawing I have a famous drawing that I just repeat over and over again and we

eat three types of foods protein fat and carbs and protein and and fat can get into the cells without a problem but sugar cannot sugar depends on insulin that regulates exactly how much sugar should be in in the bloodstream at any time and it's the hormone that LEDs the sugar into the cell um but it's also a hormone that does many many other things it's also the hormone responsible for turning that excess sugar into fat and storing it first in the liver and then whatever is left over gets stored into fat we cannot store fat

without insulin okay so that's a really important statement because then you're like oh okay so it's actually the bread that's causing the fat gain right the weight gain so then uh I I talk about how in order to you know insulin stores and stores and if we're always eating all the time we're constantly storing at some point the cells are like we've stored enough we we have no more storage room there's no more space here for in inside the atpa to store fat and and um and then we talk about how that fat can't get

out because now the insulin levels are high so high insulin levels are trapping all that energy that's stored in there that can't be used um so how are we going to get it down we're going to get it down by lowering insulin levels and the way to do that is just to cut out the carbs and so anyway we can talk about fatty liver depends on the patient situation we can talk about how insulin leads to high blood pressure we can talk about how we store fat you know they might be very thin and and

and you know first we store fat subcutaneously and then all visceral fat I mean the the conversation can go in many directions depending on the patient but basically I want them to understand that what controls weight gain is insulin you want to lose weight lower the insulin it's as simple as that yep now this patient has an A1C of 14 correct which means they're they're running you know blood sugars of 250 or higher all day long every day effectively and we've also confirmed they're type two not type one and that's a diagnosis that sometimes missed

by primary care doctors because they just check in A1C and this person let's say they're 45 years old and so the primary care doctor is like well this is obviously type two but without checking an insulin level or a c peptide level you're actually blind to that information you don't this may be a Lada you don't know that until you've checked a c peptide or fasting insulin what if this patient with an A1C of 14 said Dr glant I'd really rather fix this without medication if that's possible with an A1C this high if if they

were a minable to adopting a low carb keto or carnivore diet would you give them a three-month trial with an A1C of1 14 or is that too dangerous no I've done it I've done it and I've done it and have had a lot of success with it so it it it just it matters in a way how long they've had diabetes that also matters so you know that's this one of the reasons you want to treat ASAP because the chances for reversal are much higher when you have uh shorter duration of disease but the the

truth is that um you know I I might push for maybe a little metformin or something like that just so I can sleep better at night but right um I I I I don't think too you know that that's too worrisome but I would say you know meformin has its side effects also so it depends sometimes I prefer to just start with a diet and then see them two weeks later and see where they are and then add them at forant I think many doctors in that situation would feel compelled to start some form of

medication if for no no other reason just to treat the chart or to treat the attorneys right because if that person walked out of your office and then had a big fat heart attack the day after and then they their stepdaughter went consulted an attorney they would be like you mean they didn't start any medication whatsoever a lot of docs feel trapped in that situation and I totally understand that uh and so that I think in that case metform and glucophage is great because it's it's relatively low side effects it's not going to increase their

insulin level anymore and you've effectively treated the chart and treated the attorneys so that you're covered as a physician so that if in case something you know you roll the dice every day in case something bad happens you did do something pharmaceutically uh what if this what if this patient said you know I've been hearing this carnivore diet I know it may sound crazy but my e1c is 14 my blood sugar you checked in the office is is above 350 what if I just eat meat and eggs and seafood are you okay with that Dr

gland yep I really am I really am to me I mean you know when when you have a patient that's motivated like that that's the number you have to see who you're talking to if this patient is telling me this 100% right I'm going to go with it because ultimately that patient's going to do great um I I you know if if the patient is more hesitant then I might add a go1 with a um with the metformin and then see how that goes and then peel off the gp1 um and and it just depends

on the motivation of the person Y how often do you go because I hear this a lot from more mainstream Physicians is that they they truly believe their patients are not educated they're not motivated they really don't want to change their diet did how often do you see that in your clinic with a newly diagnosed type two or somebody that transfers to you with type two diabetes how often do you see a patient that's just wholly uninterested in changing their diet or changing their lifestyle is that a common thing or are these doctors way over

prescribing the non-compliant non-interested patient in your opinion you know you know what I find that if you actually have the time to explain to the patient what the benefits are and how much how much they have to gain and how much they can control their Destiny nobody wants to be sick and also when you explain what the diet entails it's not that they're going to be eating you know a little bit of lettuce they're going to be eating really good food so that also changes uh the dynamic so so I I think when when you

I I almost I don't even ever I think maybe twice in my life I've heard a patient say I'm zero interested you know it's very very rare that a patient will have that response I agree but many doctors don't even have the diet discussion because they're truly convinced that their patients really don't want to talk about diet they're not interested in dietary changes where do you think that belief that seems to be very common for doctors both primary care and Endocrinology they they truly believe their patients are not interested in dietary discussions they're not going

to change where does that belief come from in doctors well first of all as you know we've gotten zero lessons in nutrition not no courses zero classes on nutrition so first of all we know nothing about nutrition second of all I think that because the advice we've been giving does not work there's a sense of despondency you know people just feel like it doesn't work and it's true that the the advice we give doesn't work so if you tell people to eat less and move more they're frustrated feel like a failure it doesn't work so

the doctor also believes it doesn't work so I think it's it just feeds on itself yeah I totally agree and I think it I I've I've started calling this the the the false choice so if that patient with an A1C of 14 came to the average doctor or endocrinologist and the doctor said well what's your current diet and they're like well Pepsi Cola Cheetos Donuts that's basically I know that's terrible but that's what I've been eating so with the average doctor the the false choice in my opinion that they're going to offer that is okay

you got to stop the duts stop the the the Doritos and stop the Pepsi instead I want you eating lots of whole grain bread I want you making fruit juice smoothies I want you eating fat-free tortillas fat-free everything I want no more bacon no more animal saturated fat whatsoever look at the plant-based diet uh that in my opinion that's a false choice because you've just replaced one set of carbohydrates with another set of carbohydrates and many patients I in my opinion I think you agree they're very motivated if if they're given the proper dietary choice

but if you're given this false choice and you're like okay fine I they throw away their Pepsi throw away the you know their Cheetos and ding-dong And donuts and they feel fill up the house with whole grain bread and they they're drinking a gallon of fruit juice smoothies a day and and they're you know doing all these things they're actually expending effort and they're expending money and and they're trying and then they come back they come back in three months and get their A1C rechecked and what happens yeah it goes down like by0 three right

right and so and so many people so many patients are frustrated and I think doctors don't recognize that that they have tried these diets these diets for many people just don't work and so I I think that's a a big deal um let's talk about the average endocrinologist because I'll tell you Dr Glenn I get a lot of negative feedback from people who have seen their endocrinologist right when they bring up a low carb diet when they bring up a ketogenic diet why are all doctors but specifically endocrinologists why do they seem almost anti when

it comes to a patient who brings up a low carb keto or carnivore diet ketovore any of the lower carb options why are Specialists so anti even discussing that what's going on with that well it's a true phenomenon first of all it definitely happens I have the most Anti from my colleagues from my Endocrinology colleagues so I I do really feel that uh that you're right about that I I'm I find that family practice doctors are much more open to this um so there's there's something here that's really threatening um are there is a there's

a sense of threat there's there's something threatening here and it's not clear to me what it is okay first of all the idea that any Joe can treat their diabetes and doesn't need us kind of sucks right really like you don't need me anymore like you're going to do this on your own um so maybe that has something to do with it I don't know but the the there's something uh there there are a few things here one is that the word keto in for endocrinologists sounds like keto acidosis and as silly as this is

I think this is a factor keto acidosis is an emergency yes it's a situation where the patient ends up in the hospital you as a doctor don't sleep at night it's a horrible situation you feel terrible for the patient you feel tell for it for you know for this almost like it's a life-threatening situation absolutely this is keto acidosis the fact that ketosis sounds so much like it is one of our problems we should just use a different word if this is I understand I understand patients going wait keto ketosis keto aceta they sound very

similar that makes me nervous but you wouldn't expect that level of of irrational thought from an a board certified inter chologist yet you suspect that may be part of the problem I I do because you know we haven't thought about ketones for 20 years and and it hasn't been part of our of our life so when you hear the word ketosis you don't understand nutritional ketosis versus keto acidosis so I think this is like a gut response right and you know keto acidosis just for whoever is listening is a situation where there's really no insulin

where where fat is being burned in a way that's unchecked uncontrolled and that leads to the buildup of ketones which are acidic and that makes the blood pH much lower and makes the organs fail so it's a very scary situation absolutely kosis of course is a maximum is you know it's where we all want to be uh this is an optimal state right of functioning um so this is I can remember early in my residency when I was doing my Pediatrics rotations the the most sleep nights I ever had was when I had a new

on set type one it was three four five six seven years old they came in with a blood sugar of plus 700 obvious ketones dehydrated potassium High straight to the ICU and basically you checked on your patient every hour if you didn't stay in the IU all night long that you literally you were afraid to sleep but that because literally that's a life-threatening thing that could kill that patient and super scary and I know every endocrinologist has been in that situation many more times than I have as a family medicine doctor very scary and I

totally understand that initial scare that you might like whoa ketosis what no what are you talking about but you would expect that an endocrinologist after they'd seen two people bring up keto three people I want to be in ketosis I want to eat a ketogenic diet you'd think at some point they would become curious I know one of the very first videos I made on my YouTube channel was keto acidosis versus ketosis what's the difference you know as a family doctor and then obviously I have many many followers and patients who use therapeutic diet induced

ketosis every day of their lives right how why why is it okay for board certified IND chronologist to be irrationally afraid of therapeutic ketosis you know I I just think it's ignorance they you know they they they they have never been exposed to this to be honest it took a long time for me to get into this you know a lot a lot of reading because it's it's it's really turning everything upside down and I don't think patient I don't think doctors have that kind of time to really you know I'm happy that we're now

bringing CME courses on this subject and now the new Sarah Holberg Memorial CME that just came out I'm I'm happy that because this is more available but to learn this you have to really go out on your own and and there's there's no way of learning this nothing like this in any conference that I I had ever been to uh not the Ada not the European Association not you know there it's just not there it's not you don't ever learn about it so it what it means is that you have to go out on your

own and learn it just like everybody else that's doing it it's like almost like going back to square one you're not a doctor you're starting from zero in a way yep so and I want to put a link in the show notes to the Sarah Hallberg CME uh because I I for sure and I would I think Dr glant would agree we're making this video today as much for doctors as much for endocrinologists as we're making it for for the patients and just regular folks because I I think you're totally right and I promise I'm

not trying to throw the endocrinologist under the bus but I just think I'm trying to approach this from the perspective of a patient because patients look up to doctors and patients really look up to endocrinologist but and I remember when I was in residency the Endocrinology residents they were the nerds nerd right they were the smartest they were the cream of the crop they were the highest IQ they were the bookworms they were the Nerds and I say that as a complement not as a derogatory term but and so but I think it's great for

just regular people to understand that even the board certified endocrinologist who's the head of the department blah blah blah blah blah they are just just dudes and chicks and when there's an absence of continuing medical education talking about therapeutic ketosis and talking about using low carb diets there there was for decades no CME and that's the way doctors approach a new subject if they're curious about it they're like well I'll take this I'll take this CME because I get continuing medical education credit so I'm not wasting my time and Dr glant just spoke about it's

a huge time commitment to basically restructure your entire Paradigm of human physiology and human nutrition it takes hours and it's it's a little unnerving at first so if I if you can offer your doctor hey here's a CME you can actually take about this that'd be a great kind of strategy for a patient to offer their endocrinologist you can actually get some CME here's a link uh or if if a doctor's reaching out to a colleague an endocrinologist say I has Family Medicine I referred somebody to Endocrinology for brittle typ Ty two diabetes and they

they poo pooed my entire keto strategy then that patient could I or I as a colleague could reach out and say Hey doctor why don't you take this CME I think I think you'll be very happy that you did and now that brings me to the American Diabetes Society both Dr Glenn and I are board members of the American Diabetes Society we all uh as a group of MDS and phds went in together and formed the American Diabetes Society to encourage doctors to restructure your Paradigm stop thinking that the only thing you can do for

type two diabetes is a pharmaceutical intervention there's actually better interventions than that um when I first approached you about the American Diabetes Society you had you had a little bit of hesitation and and I actually respect you more because you had that little bit of hesitation tell people about uh your initial thoughts about the American Diabetes society and and then why you eventually decided to become a member of the board be honest it's fine be honest no I don't actually remember what I said what did I say I remember having hesitations and I'll tell you

I tell you now okay and first of all my my hesitation is you know I I'll say this I want to come from a positive place first of all okay I do not want to be anti I want us I want us I think we should be the diabetes Society because I really believe that we have a lot of data behind us and um and and and and I think over time we will see that the truth will be that this is the uh the the correct way of treating diabetes uh but I guess my

hesitation is you know we don't want to be we don't want to be Fringe we want to be very respectful we we really want doctors uh to know that we understand where they're coming from and that we're not attacking them that we all went through this process ourselves we were trained as regular doctors and and had this time of of understanding that about the LDL and all this stuff that we had to turn upside down you know eating salt all every there's so many myths here that need to be turned upside down um I think

another thing that that that worried me is that I want this to stay a very uh transparent Society extremely transparent where we don't take money from industry and uh industry has the capability of coloring everything and we are victims of that all the time so we have to try to be as clean as possible and you said absolutely and that's when I said okay it's actually in our Articles of Incorporation in the the foundational document of the American Diabetes society that we will not accept a penny from any big Pharmaceutical uh manufacturer uh we will

not accept a penny from any big food manufacturer that literally if if a board member accepted that and put it in the ads checking account they would be kicked out of the ads and blacklisted like we will never take a penny from any of the insulin manufacturers from any of the the gop1 or the gp1 manufacturers we will never take a penny from them it's not that we're anti- gop1 or gp1 it's that we're we're going to be objective and we're going to be transparent we're not going to be that that society that accepts a

million doll check from some pharmaceutical company and then tries to pretend to be objective about our recommendations both two doctors and two patients that's that it's impossible because at the end of the day we're just dudes and chicks and if you write me a big enough check and I put that check in my bank account that is going to color the words that come out of my mouth in the future that's just human nature nobody nobody is above that literally nobody is above that and I think we've seen that multiple different times here in the

last few years and I I welcome you as a board member I I think that we're a better Society because you're a board member and I think going forward uh what what are some of your goals for the American Diabetes Society what would you like to see us doing in the near future and in the The Not So near future I think we really need to reach doctors I think that's the key here you know I I love the Grassroots movement that is happening and there's a lot of interesting good things happening at the moment

but I think that it doesn't matter in a way you know it doesn't matter how much people knock on their door I know that I did my transformation really when I said you know when when I heard Sarah Hallberg and Jason fun those were like you know I heard it from a doctor you two you know you hear it from a doctor you're like you know what and and I'm I I think of myself a little bit I'm sorry that it took me that to to real like but I understand that if you don't hear

from a doctor you have less confidence you don't want to feel like a you know that's just the way we're trained so I think knowing how difficult it was for me to to open up to this because you know I accepted it made sense get the carbs out you know I I I understood that it didn't make sense to eat carbs but to really understand the low car movement there's a lot more to that it's a a lot a lot of depth to it and so you know you want to know that this is legit

any a way and so and so unfortunately I had to hear it from a doctor and that's why I think this should be our strategy I think I I think most doctors are like me and they need to hear from another doctor so I always thank Sarah Hallberg and Jason fun for for for saying this and and you know once I heard that I went down the rabbit hole and learned from a lot of people that are not doctors that's not the point then then I understood that then I started I prefer to listen to

non-d doctors but but first I had to you know understand um that that this was legit and and and and this is why I think we should do this um you know do the CME courses open up a lot of Education to doctors because until that happens every time one of our successful patients goes to a doctor but their LDL is slightly high they're they're thrown right back into confusion you know they're all happy and then they're like oh no but my doctor thinks that you know that I'm making a and I think you're exactly

right I I agree 100% I think the average doctor especially the average endocrinologist they need to hear it from a colleague they need to hear it from a peer or somebody who's board certified who's a fellow in The Academy of whatever and I don't blame doctors for that I think that that that is a useful Paradigm that serves doctors well you don't go looking for advice you're going to give your patients off the you know the dark web somewhere you want to get that from reputable sources and I 100% agree with you that the American

Diabetes Society needs to quickly become that Source uh and we are working together as you know we've got another board meeting coming up in the very near future and we're going to be offering guidelines for the treatment of type 1 diabetics and guidelines for the treatment of type two diabetics uh and you use the word when you were talking about your own story transformation and for most doctors that's a that's a word that's not even in their vocabulary because I think most doctors think that the way treatment progresses is oh we have a randomized control

trial maybe it was sponsored by by the drug company but it was still you know effectively randomized it that that our treatment guidelines should progress one little bit at a time but when you start using the words transformation and start definitely using the word Rabbit Hole most many doctors that makes them very nervous like what are you talking about but unfortunately that's kind of what it feels like even as a doctor you it's like yeah it was kind of a transformative like it literally took my old Paradigm and it flipped it if not upside down

then at least on its side and that makes a lot of doctors nervous it let's just say there's a there's a endocrinologist watching this right now they they've heard something about the ads they've heard a little bit about low carb keto where would you tell a young Doctor Who's who's primary care or Endocrinology where should they start to look for more information about low carb keto even carnivore you know I like to start with the Big Fat Surprise by Nina Tai scholz it's a very easy read it's a it's a it's a book that's not

intimidating whatsoever even my 14-year-old daughter read it uh the the the you need to understand the context you need to understand the historical context and why we got to where we got to so I think this is what the first step and then I would go maybe to Steve finny and Jeff bck um as a you know the Art and Science of low car living and and and then you start going in slowly slowly but the reason I love Nina's book so much is because you understand the whole story and it things make sense and

you're like oh wow you know because there just so many there's so many issues here and unless you have a historical context you're not going to understand why things are as messed up as they are yep and you mentioned the Sarah Hallberg Memorial CME where can doctors find that and I'm going to put a link in the show notes for any doctor watching this if you want to get some CME and also start to become aware of what's going on here we'll find it I I don't know where it is but it's it's it's out

all right so we'll have a link under in the show notes of this video on uh Facebook and on X and on YouTube and uh any other are there any books written by doctors that a doctor could say okay I'm I'm C curious tell me a book recommendation tell me a a a you know I don't want to say a YouTube channel but where's some research that I could read about low carb as an option for type two diabetes Well you know there there are some good papers out there so for example one one paper

out there for doctors is is uh it's written by uh Paul Mason I think Ben bigman and David Diamond I like I use that paper a lot how that the that you don't need to use statins uh in the case of a person who's insulin sensitive on a ketogenic diet um and that is is you know it's a solid published paper that it kind of calms down the doctor and and and helps so it does help to publish you know I I I published uh the audit from my clinic um you have a book as

well that but that's I think it's more patient Focus correct it is it is yeah don't read book is your first book you'll get to that later yeah um you know Eric Westman has some studies um that and and I just reviewed um the I I reviewed all of the the randomized control trials recently and honestly they're not this is the problem we don't have the money to have the this type of study that pharmaceutical would do right this is A2 billion dollar study that you know that sglt2 Etc that that's really we're talking billions

of dollars and who's going to fund that right um so the studies are shorter and the studies it's really difficult to randomize but even you know when you take the randomized control trials um there are a lot of mistakes also done in the trials for I'm gonna just for example um they they get a ketogenic diet versus a lowfat diet so they give the low carb diet the ketogenic diet only for two months and after two months they start adding five gram per week and then they they look at what happens after six months well

that's not a fair comparison because it's not really comparing two different things in the end the results end up being the same so there are a lot of also issues with the studies so you have to understand what those issues are so it is complicated and you have to that's why you got to get in there deep and also I'll add that a lot of times or not a lot of times but sometimes they use the wrong fats so you have to use you have to use normal nature fats right such as saturated fats when

you when you try to make it a lowfat low carb diet that doesn't work either that's not a fair comparison so there are a lot of caveats here in interpreting the data yeah I totally agree I totally agree Dr Glenn thank you so much for doing this uh where where can people find you if if you really resonated with them and they would like to follow you for more information well um for first of all you can go to on. health um this is uh this is what we're working on right now um uh gland.

is um a website uh that's also in English so you can find that information in English and and um yeah just follow us on Ona onas is the future yeah and if you're not already follow the American Diabetes Society on all our different social media channels because we're going to be putting out many more videos like this in the in the near future we have guidelines coming we've got a couple of of big donors who are interested in funding some longer term low carb ketogenic research we actually have some um academic level investigators who are

ready to do a low carb ketogenic study but they've got to have the money so one of the main missions of the American Diabetes Society is to connect the money people with the academic researcher people and say heyy let's do this definitive study that once once and for all patients can use that so that they're not scared to eat a low carb diet doctors can use that to protect themselves legally from a liability standpoint saying no there's research for this and then more and more researchers I think will become quickly interested in this uh because

at the end of this there's not a pharmaceutical patent that's going to get you a billion dollars but there is millions and millions of happy and healthy patients which kind of should be the goal of every doctor right doctor agree completely H thank you so much guys thanks for sharing this video we'll see you next time thanks