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It is Stay Off My Operating Table with Dr. Philip Ovadia.
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Today we're going to be discussing type 1 diabetes.
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But wait, don't run away.
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Dr. Ian Lake, who is our guest has got information that is going to appeal to literally everyone.
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It just so happens that type 1 diabetics focus the light on a problem that affects all of us.
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I've probably already said too much, Phil.
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I'll shut up.
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Awesome.
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Yeah, I'm really excited to be having another conversation with Dr. Ian Lake.
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And I'm gonna let him get into his background, but yes, he is doing some groundbreaking work around Groundbreaking work both as a practitioner but also as a self experimenter, a citizen scientist as we often talk about on the show around type 1 diabetes.
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And like you were alluding to, it can teach us a lot that goes beyond type 1 diabetes.
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And really excited for his new book that just came out, Shifting Gears.
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And so we're gonna be talking about that as well.
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Dr. Lake why don't you give a little bit of your background to our audience, and then we'll start talking about all of the great work that you've been doing.
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Thank you very much for inviting me on.
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Yes, don't go away everyone because I inject the hormone that you naturally produce.
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It's not quite an analogy, but what I do is what your body does.
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So I think it's important for us to understand how insulin works, and type 1s are a good model for how insulin works in people without type 1 diabetes really.
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So I'm getting on a bit now.
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I was diagnosed with type 1 diabetes in my 30s, and I've had it for over 30 years now.
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I'm a general practitioner primary care physician in the UK, and I have been now for nearly 40 years, so I've done my time, as it were.
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When I was diagnosed, I really stuck to the system that I knew 'cause I couldn't think that there's any other option but to c- count my carb- The thing about type 1 diabetes, it's a lack of insulin.
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Our bodies cannot produce insulin, and i- if type 1, it's di- it's defined as an autoimmune reaction really.
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But other people have to inject insulin for other reasons.
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But when you inject insulin it obviously lowers the blood sugar.
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That's what it, one of its roles is.
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It is a master metabolic regulator as well, which I hope to get into a bit later on.
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But I was taught to count my carbohydrates, which are the prime macronutrient, the prime nutrient that raises blood sugar.
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And because blood sugar goes up, insulin is the only hormone we have in our body that brings it down.
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There's plenty of hormones that bring it up, but insulin's the only one that brings it down.
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So my model of care was really counting carbohydrates and injecting insulin.
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And the whole idea is to choreograph this so that you estimate how much insulin you need per meal, estimate how long it's gonna take for that meal to get absorbed into your bloodstream to raise the blood sugar.
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Then you time your insulin and the estimated dose to choris- to c- to choreograph, if you like, with a raised blood sugar.
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So the, as the blood sugar's going up, the insulin will bring it down.
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And it sounds such a no-brainer and such an easy thing to do.
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It is actually virtually impossible to get it right every time.
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But that's the model I grew up with, and that's the model I believed was the right way to go.
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Because the funny thing about having type 1 is that, I'm in a privileged position, as a doctor, that I know a lot of people with type 1 diabetes.
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It's part of what I see every day or m- couple or three times a week i- in my job.
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So I, I understand type 1 and the people who live with it quite well.
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But a lot of people I speak to have never met anyone with the condition.
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They're literally on their own.
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And it's a funny thing really,'cause when I was diagnosed, I thought, "Yeah I know what to do." But then I was shocked that I actually couldn't do it.
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And every Monday was a reset.
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Every Monday, I thought, i'm gonna start today.
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I'm gonna really try really hard.
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I'm gonna count my carbohydrates.
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I'm gonna weigh my porridge, have my porridge for breakfast, inject the right amount of insulin.
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Then I cycle to work, get some exercise." Half, halfway through my morning, I was crashing, and then I was having to correct with sugar.
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That's quite hard when your doctor's hypo.
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You gotta try to avoid that at all costs.
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So I believed a lot in that model and realized really it's almost impossible to do.
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But I spent 20 years doing that.
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And as I said, people with type 1 don't know anyone else, and I didn't really know anyone well.
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To talk to about how they manage their condition.
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In fact, I was so embarrassed that I couldn't manage it that I ha- kept it to myself a lot.
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And I think a lot of people identify with that.
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You just don't want other people to know, especially if you're not doing very well.
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And that's the thing about about being isolated.
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You- what you've got and how you manage it is as good as it gets.
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You think everyone knows it's a difficult condition so it must be as bad as it is because I'm not doing very well." A- and that's my type of type 1 diabetes.
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So I grew up with that.
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20 years later I discovered the brilliant Richard Bernstein's book on how to lower carbohydrates to ma- to manage your diabetes better.
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And I put it down for a year.
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I thought, "Now my training tells me that fat's gonna be really bad for me, so I'm not gonna do that. I'm just stick with what I know." Then I had a ne- not a near fatal, but a very serious hypo when I was o- I was on my own and which shook me quite a lot.
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It's the first big one I'd ever had where I was out of control.
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A serious what?
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Hypo- hypoglycemia, low blood sugar.
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Oh, Okay.
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And I didn't have any any glucose tablets to correct it.
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I was away camping on my own, and I was in dire straits, but I re- I recovered from it and soon after that I got my first letters from the retinal screening department to say that I've got a few little sign, a few signs of early diabetic retinopathy.
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Not serious, but it's there So when you can see it in your eyes, it's, you know it's happening in your brain, around your heart, in your joints, in your liver, in your kidneys.
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You know that process is starting to take hold.
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So I quickly got Richard Bernstein's book out again and thought I've nothing to lose now, I'll try it." And for the last 13 years I've been doing something that is not r- routinely recommended for diabetes management.
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I'm on a high fat, h- moderate to high protein diet, and the very first meal I had was a revelation to me.
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It was such an emotional meal.
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I still remember it.
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Because after three, a three-egg omelet, my blood sugar didn't budge, and that was the first time in 20 years I'd actually got away with a breakfast that didn't alter my blood glucose.
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And the next meal, and the next meal, and the next meal, et cetera, et cetera.
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And ever since, I've been adopting a very low carbohydrate diet because it makes so much sense, and I've I've researched it quite a lot ever since, done some studies of my own, done some experiments of my own.
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Because, as a doctor, when you're swimming against the tide you really question yourself every day.
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"Is this the right thing to be doing?" Am I … is everybody else driving the wrong way down the road or is it me?
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And i- in most cases it's probably ourselves.
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So every single day I question myself, "Is this the right thing to do?" But more and more the evidence is in favor of, the science of m- metabolism is becoming mature now.
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We're starting to find that, yes, it is the logical thing to do for type one diabetes.
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So that's me really.
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So I, I now promote not just car- low carbohydrate diets, but what I call insulin optimization, how to understand insulin as well as we understand glucose.
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Because, if w- with the automated insulin devices now the artificial pancreas, not, but that's what it's promoted as with those you can get a pretty reasonable glucose trace.
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But I put it to people, say, what if you're using, what if your pump is whirring away so f- so hot that it's burning your skin because it's using a huge amount of insulin?
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Is that healthy to have a normal blood glucose but use a lot of insulin?
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'Cause I think insulin, from lots and lots of studies in different areas, metabolic sorry, mental health lots of neurological conditions et cetera.
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W- with c- cancer is promoted by insulin, but probably not caused by it, but insulin doesn't help.
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So there are many conditions, polycystic kidney disease, all respond well to low-carb diets and all don't respond well to high insulin.
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So I'm looking really that we should be m- not just worrying about glucose, which seems to be the gold standard, but equally about insulin as well.
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So that's where I'm coming from.
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Can we talk a little bit about your original diagnosis, right?
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Because being diagnosed with type 1 diabetes in your 30s is fairly atypical and as a physician going through that, I would love to hear how that came about, what your thinking was around this It's about, about a third of people are in the adult age range when they develop type 1.
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There's a peak in the sort of five to seven-year-olds, then again 12 to 14, puberty a- age, and then when we get older, we tend to get… we can get it as adults.
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So about a third of people get… their insulin in their body stops working, and it's thought to be an autoimmune disease where the pancreas is destroyed by the body's immune system.
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Yeah, so I, my first inkling was about a month before because it doesn't always appear all of a sudden.
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I think there's a run-in to most people with type 1 diabetes.
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We start to get a bit thirsty.
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We probably lose a bit of weight.
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We're probably going to the loo to pass urine a lot more frequently, and we feel a bit more tired as our blood glucose goes up.
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So I was doing a lot of work as a junior doctor really at the time.
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I was doing a lot of work.
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I was working days and nights and I was do- doing jobs where I was working at lots of different places, so I was very busy.
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And my first inkling was when somebody tapped on my car window about a month before I was diagnosed and asked me to move out of the car wash 'cause I'd put my car into a car wash and fell asleep, and that was a sign that I was obviously my he- my blood sugar was very high.
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But I didn't know it at the time.
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So I just moved on, thinking I'm just tired.
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I had no reference points at that point.
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And then one day I just developed extreme thirst.
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I- I've never known thirst like it.
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It was extreme thirst.
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And guess what I tried to quench my thirst with?
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Coca-Cola.
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So nothing better than diagnosing your diabetes by adding something that's going up uncontrollably in your bloodstream at the same time.
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And then I was passing urine so frequently.
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I was in the car driving an hour, and I had to really stop very frequently to relieve myself.
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So I… And by then I'd diagnosed it and when I got to my destination, which was a GP surgery, I just tested my blood sugar, and it was in the mid-20s.
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20 times 18, 300 and odd.
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F- 300, 400 milligrams per deciliter.
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Yeah.
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So it was quite high.
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And then I kept myself to myself overnight and just didn't eat knowing that I could be in trouble here, but I managed to get through to the morning, turned myself in and got sorted out.
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What a shock to diagnose yourself with a condition that you know is not a good condition to have.
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I've seen all the complications of type 1 diabetes, and here I was, a person about to go on that journey, and i- it was quite a shock really.
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And I was really just told about all of the complications again, and as doctors seem to be quite keen to tell you about all the complications, what's gonna happen to you.
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And yeah, I know that.
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I know that, thank you very much.
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But what I didn't know was how difficult it is to manage type 1 diabetes.
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Literally, you get given a pen.
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Pens in those days, I'm still on pens 'cause I can't get a pump right now on the National Health Service.
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You get a pen, and you get told roughly count your carbs about 10 to one, and off you go.
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You're a doctor, you should know what you're doing, and good luck.
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And three months later I was reviewed, and just kept going on that really.
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N- I never ended up in massive trouble.
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Some people don't.
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Some people have bad luck, and they end up with hypos and diabetic ketoacidosis quite frequently.
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But I was one of those lucky ones that hovered in the middle.
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I wasn't a bother to anyone.
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I never ended up in hospital, never ended up in trouble.
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So I just kept hovering around the middle zone really, accepting that my glu- glucose surged Yeah.
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It's mentally very taxing.
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Yeah.
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It's certainly interesting to hear your perspective, right?
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We as doctors and there are many scenarios like this where we give patients instructions on how to manage, whatever condition they have, but we might not really realize how difficult following those instructions are, right?
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And, I'm sure, before this you probably… when you took care of diabetics and you gave them, the goal of keeping your blood sugar under control, and like you said, just do the calculations and figure out what you're eating and how much insulin to give and, when to give it, and that's, and that's how we control diabetes.
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But as you discovered, and I think as if we're being honest as physicians, we see patients struggling with this all the time.
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It is very hard, right?
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The magic that our body figures it out in people that are not diabetic, right?
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It's really pretty amazing the complexity of what our body has to do to balance insulin and glucose on a constant basis.
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A- absolutely.
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A meal is not just a straightforward meal.
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You have to plan for your meals.
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Restaurants are quite fun.
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You don't quite know what you're going to get, so you try to- … to get the sort of the pattern right of the, of when to inject how much to inject, and hope the meal arrives on time.
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How to inject.
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Do you inject, do you go to the loo and inject or do you ra- you know, roll up your shirt and stick it in and get your pen out and show off?
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Or what I tend to do is just inject under the table through my trousers and some people do that.
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So it… The day-to-day, it- it's quite a difficult gig.
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My insulin takes half an hour to work.
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Your insulin's already finished working 15 minutes before mine even starts working.
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My insulin lasts two to three hours, and some of the long-acting, basal insulin, lasts up to 30 hours.
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Your insulin's finished in 15 minutes.
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So we have to factor in that our insulin's gonna be working for a lot longer than people with no diabetes.
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I liken it to driving a car and having to input a steering correction to the wheel 30 minutes before you go around the bend.
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It's quite hard to do that all the time.
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So everything's an estimation really.
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It becomes quite stressful sometimes because- Type 1 diabetes, just by correcting blood sugars with protecting your carbohydrates and injecting your insulin is an im- virtually impossible task, and we can do the same thing two days in a row, live exactly the same life two days in a row, and get completely different results.
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Einstein said, "If you do the same thing over and over again, that's the definition of insanity." Our insanity is doing the same thing and getting completely different results.
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A- and it leads to quite a lot of stress, to be honest, because you're never quite on it.
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You're never quite in control.
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There's all, there's this background noise going on of anxiety about am I gonna be okay, I've gotta come on this podcast.
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Am I gonna last for an hour?
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Yes, I am, but I've had to plan to last for an hour.
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It's so much easier with the diet I have because I don't even have to think about it.
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But before, I'd have to plan and hope, I had some supper about two hours ago, hope that my glucose didn't plummet with the high doses of insulin I'd typically have had.
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Say I had a a pasta meal.
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It might be coming down to hypo levels halfway through this conversation.
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So there's a lot of noise around.
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People who've got problems around food it, it impacts them as well because diabetes is all about food.
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So if you've got a food issue, it's, the diabetes is certainly gonna amplify that for you.
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So it's a constant background noise of stress, planning.
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It never really goes away.
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You have to be on it 24 hours a day.
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And then you go to bed, your blood glucose is whatever it is.
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Do you inject insulin to bring it down?
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Do you leave it or let it drift up or hope it might come down?
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Do you have hypos in the night?
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So is, it's constantly in, on your mind.
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You get used to it.
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We all get used to it, but it's one of those things we have to plan for all the time, the constant noise.
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I, I liken it to a chainsaw really.
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You got this constant noise going on in the background.
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Yeah.
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And, it's interesting the history of diabetes, right?
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Th- this disease was described, thousands of years ago literally.
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And the original way it was discovered was centered on sugar.
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Doctors used to actually taste the high sugar in patients' urine essentially was the way to diagnose this.
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And insulin was only really discovered, within the past 100 years or so, a little over 100 years ago that we knew what insulin was.
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So the whole focus of the disease has remained around the sugar, right?
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And, controlling the sugar at first in the urine, and then when we were able to measure sugar in blood how to control that.
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But in reality, it's a di- i- it's a disease of insulin.
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And there's this interesting paradox around type 1 diabetics that you alluded to earlier that y- to avoid the ultimate complications of diabetes that we worry about, things like blindness, and heart disease, and, vascular disease leading to amputations and infections you have to control the blood sugar, but we know that the more insulin you end up using to do that that in and of itself accelerates or worsens the complications.
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Again, as a physician but also as a patient contrast you talked about these two approaches, right?
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You spent 20 years doing the sort of traditional approach, and then you discovered Dr.
00:19:22.645 --> 00:19:32.605
Bernstein's work which is a very different approach of essentially trying to manage the insulin rather than manage the glucose primarily.
00:19:32.855 --> 00:19:43.105
And talk about those contrasting approaches and, again, a little bit what that change in mindset was like for you as a physician and as a patient.
00:19:44.693 --> 00:19:57.223
Yeah, that, that's a very good point, and that's the nub of what I'm trying to get at now w- with my learning is at the, my route of travel is at the stage where I think insulin is as important or if not more as important as controlling glucose.
00:19:57.594 --> 00:20:03.894
But strangely, if you control insulin well, your glucose will follow, and it isn't the same the other way around.
00:20:04.493 --> 00:20:12.334
Glucose was the symptom that sym- that, that told you had very little insulin that was operating in your body.
00:20:12.844 --> 00:20:36.533
So when Banting, Best, Macleod, and Collip, the four people that got the prizes for discovering insulin injected into a 10-year-old boy who lived 10 years in 1923, which is incredible they were making sure that the insulin was given to control the blood sugar, and they had very primitive methods, what we call primitive now, we all have continuous glucose meters, of measuring the sugar in the urine.
00:20:37.023 --> 00:20:38.673
But the insulin was the key thing.
00:20:38.683 --> 00:20:40.384
And of course, the insulin was very crude.
00:20:40.384 --> 00:20:44.303
It was a mixture of short-acting, long-acting, eventually became long-acting.
00:20:44.763 --> 00:20:47.073
And it was all about controlling your diet.
00:20:47.084 --> 00:20:56.644
So before the insulin was used o- on humans, we were recommended to have a diet that tried to work with a lack of insulin.
00:20:57.433 --> 00:21:00.663
Insulin does not raise that much when you eat fat.
00:21:00.673 --> 00:21:06.533
It does not raise that much when you eat protein, but it goes up a hell of a lot when you eat carbohydrates.
00:21:06.923 --> 00:21:11.104
So their approach was to remove the carbohydrates from the diet.
00:21:11.713 --> 00:21:21.104
And in adults, they added spirit alcohol, because we know that spirit alcohol, such as whiskey will inhibit the, some of the hormones that raise the blood sugar.
00:21:21.563 --> 00:21:25.953
So their approach was based around trying to work with the, what they had in the body.
00:21:26.344 --> 00:21:29.463
When insulin was dis- was used, it was a revolution.
00:21:29.463 --> 00:21:32.394
People were literally resurrected from death.
00:21:32.453 --> 00:21:33.763
It was such a wonderful drug.
00:21:34.433 --> 00:21:44.063
And it was subsequently purified and became a very, I think we got so used to it we ignored it, and we were chasing sugars, and sugar became the gold standard, and still is the gold standard.
00:21:44.114 --> 00:21:47.344
It's all about HbA1c, our long-term sugar control.
00:21:47.604 --> 00:21:53.953
Time and range of glucose is the defining standard of good practice in Type 1 diabetes.
00:21:54.313 --> 00:21:55.483
Insulin isn't considered.
00:21:55.563 --> 00:21:57.854
They don't… It doesn't matter how much insulin you use.
00:21:57.854 --> 00:21:59.644
I always called it a hedonistic approach.
00:22:00.053 --> 00:22:02.903
Eat what you like and shoot up what it takes, shoot to suit.
00:22:03.303 --> 00:22:07.723
And I think we're not thinking about insulin in the right way.
00:22:08.114 --> 00:22:12.653
And my approach used to be count your carbs, inject insulin.
00:22:12.653 --> 00:22:17.823
Now it's definitely how does insulin work in the body across all the foundations of health?
00:22:18.344 --> 00:22:21.124
What is a healthy hu- what does a healthy human being look like?
00:22:21.864 --> 00:22:24.884
What does someone without Type 1 diabetes, what's their insulin doing?
00:22:25.263 --> 00:22:31.283
'Cause their blood sugar's always well-controlled because they have a functioning metabolic system that includes insulin.
00:22:31.693 --> 00:22:39.344
But we have to inject it, so how much do we need to inject considering it's imperfect, we inject at the wrong time, the wrong place, and it lasts too long.
00:22:39.923 --> 00:22:49.334
But how do we look at a healthy human being and say, "What do they look like? I want some of that." And a healthy human being, I think, has fairly low insulin levels typically.
00:22:49.913 --> 00:22:58.144
There's lots of evidence now that, that- Now real quick, just because I'm not a doctor, when you say low insulin levels, you're talking about the insulin that's in the blood- In your body.
00:22:58.193 --> 00:22:58.344
Yeah.
00:22:58.683 --> 00:22:59.673
In your body, yeah.
00:22:59.864 --> 00:23:01.144
In the whole body, okay.
00:23:01.233 --> 00:23:01.523
Yeah.
00:23:01.993 --> 00:23:06.473
So typically insulin is released when there's this the blood glucose rises.
00:23:06.503 --> 00:23:08.443
Now, the blood glucose can rise due to diet.
00:23:08.493 --> 00:23:17.703
It can also rise due to stress hormones such as growth hormone, adrenaline, cortisol and other hormones have an effect to, to stop the insulin working as effectively as it might.
00:23:18.243 --> 00:23:21.394
So insulin is a primary metabolic regulator.
00:23:21.403 --> 00:23:26.963
One of its functions is to reduce blood glucose, but it has many functions bey- beyond that.
00:23:27.013 --> 00:23:29.063
It's a regulator of energy in cells.
00:23:29.753 --> 00:23:50.624
Now- If you have if I think a healthy human being does a lot of exercise, or should do, eats two meals a day, has a period of fasting, p- eats primarily protein and fat gets outside a lot, has good mental health, and and has respect to their circadian rhythm.
00:23:50.624 --> 00:23:55.073
So for example, middle of the night we want all these blue lights on you'd be cutting down your light.
00:23:55.533 --> 00:24:01.683
So we need to, what I've decided we need to do is look at w- what makes a healthy human being, so can us type 1s have a bit of that, please?
00:24:02.303 --> 00:24:06.844
So one of the features I think of a healthy human being is something called metabolic flexibility.
00:24:07.293 --> 00:24:15.163
It's being able to choo- for your cells of your body, your organs of your body, to choose the fuel that they require at the time.
00:24:15.834 --> 00:24:25.063
So Dr. Phil Ovadia you are a cardiologist, you know that the heart h- is quite happy on fatty acids and ketones, and it will also use glucose.
00:24:25.513 --> 00:24:38.303
But if you have type 1 diabetes and you take a lot more insulin than your body needs, and because of where we put it in our body, into the skin, we've already got more insulin than we, we really should have because of the absorption issues that we have.
00:24:38.854 --> 00:24:58.728
So if you have too much insulin, what happens is you stop your metabolic flexibility from happening because if you have too much insulin in your body you cannot burn fat to produce fatty acids and ketones to produce those other energy molecules which the body can happily use So if you have too much insulin in your body, you're a fat storer.
00:24:58.768 --> 00:24:59.728
You're a fat storer.
00:24:59.788 --> 00:25:00.498
That's what you do.
00:25:01.147 --> 00:25:11.397
If you have little insulin in your body, you're a fat burner, so you can produce other nutrients that will provide energy, fatty acids and ketone bodies which derive from fat.
00:25:11.957 --> 00:25:14.018
Your body will make all the glucose you need.
00:25:14.018 --> 00:25:18.137
You do not need to eat sugar or carbohydrates in order to survive.
00:25:18.467 --> 00:25:25.917
Those poor people that get dragged out of earthquake zones eight days later, they haven't been secretly, they didn't luckily have a stash in the fridge of candy bars.
00:25:25.917 --> 00:25:27.897
They were pulled out and they were burning their body fat.
00:25:28.427 --> 00:25:33.397
But in type 1 diabetes, on, on the diet we are typically recommended high carbohydrate diet.
00:25:33.807 --> 00:25:36.258
We are denying our body metabolic flexibility.
00:25:36.317 --> 00:25:38.738
We're forcing our body just to use glucose.
00:25:39.197 --> 00:25:54.077
And we know in some conditions, certainly the mental health space which has accelerated our knowledge of metabolism, that you can do very well with bipolar disease, for example with metabolic flexibility, allowing your body to access ketone bodies.
00:25:54.518 --> 00:26:01.288
Because there's some evidence that the meta- the regulatory function of the insulin fails in the brain in a high carbohydrate environment.
00:26:01.798 --> 00:26:11.712
So y- if you've got ketone bodies available, if you've got low insulin levels so you're not storing fat, you're burning it, you are providing the body with what I call metabolic flexibility.
00:26:12.082 --> 00:26:17.012
And the current method of managing type 1 diabetes denies our body access to those fuels.
00:26:17.663 --> 00:26:30.002
And so if you have someone with bipolar disease who is fueling their body on a very low carbohydrate diet and they develop type 1 diabetes, it's a clinical problem at the moment to know how to advise them.
00:26:30.002 --> 00:26:30.893
I know what I would do.
00:26:31.272 --> 00:26:36.212
I would say, "Carry on your ketogenic diet." But some people would say no, you've gotta have carbs.
00:26:36.282 --> 00:26:44.252
You gotta have carbs as part of your treatment." And that will of course take them out of recovery and put them back into their bipolar state.
00:26:44.812 --> 00:27:04.262
So there are lots of clinical questions we need to ask, but over the years I've learned about the f- the positive impact of a multi-fueling system on cancer, on m- mental health, on migraine, on polycystic kidney disease, on type 2 diabetes, and I think it also works on type 1 diabetes as well.
00:27:04.792 --> 00:27:12.532
It's ironic that the one condition where we do best to respect metabolic flexibility is the one condition that we're not actually helping out.
00:27:14.820 --> 00:27:16.610
I wish I was surprised.
00:27:18.330 --> 00:27:18.820
Yeah.
00:27:18.990 --> 00:27:22.911
Now it it's hard enough just managing type 1 diabetes.
00:27:22.941 --> 00:27:29.610
You've added a extra layer of complexity by being an athlete, an endurance athlete.
00:27:29.971 --> 00:27:39.780
You have done such what many people would view as crazy things, such as running 100 miles in five days as a type 1 diabetic.
00:27:39.810 --> 00:27:41.830
You did that completely fasted.
00:27:42.060 --> 00:27:48.431
And then in your new book you talk about a thousand-mile bike ride as a type 1 diabetic.
00:27:48.431 --> 00:27:58.350
So talk a little bit about, what that then adds if you're not just trying to get through your day-to-day, you're trying to, perform as an athlete at a high level.
00:27:59.436 --> 00:28:05.326
So the Zero Five 100, the project we did a few years ago now, was two people with type one diabetes and six others.
00:28:05.726 --> 00:28:26.956
We I conceived this because I was… I thought how can we actually show to my clinical colleagues that, the main problems that, that they're worried about aren't actually, they really don't need to worry about them." The fact that if you're in what's called nutritional ketosis, if you're not eating carbohydrates and you're burning fats, producing this energy molecule called a ketone body it's not dangerous.
00:28:26.956 --> 00:28:31.366
It doesn't lead to diabetic ketoacidosis, that you don't need sugar for sport.
00:28:31.416 --> 00:28:38.396
You can fuel on fat for sport, certainly the level I was performing at which is not Usain Bolt sort of level where he eats.
00:28:38.446 --> 00:28:42.856
And if you're taking insulin, you don't need to take carbohydrates.
00:28:42.856 --> 00:28:49.226
So we proved all of those things, and I thought just doing that alone should convince my colleagues that, hey, this is actually safe.
00:28:49.406 --> 00:28:58.797
Unfortunately, it was so radical, it was designed to be radical to actually rule out any issues that I might be, there might be other reasons for why we're doing so well.
00:28:59.257 --> 00:29:03.626
But I thought it was seen as so radical it wasn't relatable which is a shame really.
00:29:03.956 --> 00:29:19.656
So I got a chance to go to Saint Moritz to do a talk to Keto Life, which is a, sort of a keto conference which covers w- things that we're talking about, mental health neuropsychiatry, neurology cancer, diabetes, et cetera.
00:29:20.037 --> 00:29:21.616
And it was to do with type one and sports.
00:29:21.626 --> 00:29:23.966
So I thought I'll cycle there." I had a bit of time on my hands.
00:29:24.406 --> 00:29:29.017
But it wasn't done as a Lycra-fest man of a certain age sort of type of project.
00:29:29.037 --> 00:29:33.946
It was done as a, I'm just an old bloke who's cycling 65 miles a day, 60 miles a day, whatever.
00:29:34.446 --> 00:29:50.876
And it was conceived as a ketogenic, a very low carbohydrate diet, and I measured all of my carbohydrates every five minutes through a continuous glucose meter, and I measured all of my ketones every five minutes through a continuous ketone meter for three whole weeks and published them in the book, which is a big thing to do, I tell you.
00:29:51.406 --> 00:29:52.446
It's not all perfect.
00:29:52.876 --> 00:29:58.996
And it I also started to explore the roots of health and how insulin works.
00:29:59.356 --> 00:30:01.206
So it's half a travel journal, half textbook.
00:30:01.666 --> 00:30:05.146
And it's a textbook written at the non-specialist non, non-medic.
00:30:05.606 --> 00:30:13.452
So h- it was to explore- How insulin works and how do we manage insulin across all of the roots of health?
00:30:13.452 --> 00:30:14.663
So how does insulin operate?
00:30:14.673 --> 00:30:16.163
Insulin has its own circadian rhythm.
00:30:16.173 --> 00:30:19.072
We're more insulin sensitive at certain times of day than other times of day.
00:30:19.582 --> 00:30:20.512
So let's look at that.
00:30:20.522 --> 00:30:24.153
Let's see if we can manipulate our insulin to get a good result on that.
00:30:24.663 --> 00:30:29.353
How does insulin, how is insulin affected by the sleep process or bad light?
00:30:29.782 --> 00:30:35.562
How does infrared, ultraviolet, how does that impact on our insulin sensitivity and our inflammation in our bodies?
00:30:35.952 --> 00:30:40.232
How does mindset, stress hormones, how do they impact on insulin and what can we do about it?
00:30:40.552 --> 00:30:42.143
Then of course, physical activity.
00:30:42.423 --> 00:30:53.502
The great work by Tim Noakes and Jeff Volek and Dom D'Agostino and others who have shown really that you can burn fat at a high level of exercise, and it can perform just as well as sugar.
00:30:54.143 --> 00:30:56.173
So we thought we'll take advantage of that then.
00:30:56.232 --> 00:30:58.182
So that's great that they produced that.
00:30:58.262 --> 00:31:02.052
So it means that people with type 1, we can perform at a good level if we want to.
00:31:02.292 --> 00:31:07.393
I'm not in that category, but we looked at that, and we also looked at diet in great detail.
00:31:07.853 --> 00:31:15.267
So the whole of that, the book is based- how can we understand insulin?
00:31:15.267 --> 00:31:21.916
How can we use it wisely to, to give our bodies the metabolic flexibility that we need?
00:31:22.446 --> 00:31:27.168
And of type 1 diabetes every day.
00:31:27.598 --> 00:31:38.658
And I think the book w- is gonna be helpful to people with type 1 to show that, yes it, it is logical scientifically to be able to cut your carbs.
00:31:38.999 --> 00:31:42.019
Yes, you can skip breakfast if you want to.
00:31:42.398 --> 00:31:45.858
But y- you can control the noise of diabetes.
00:31:45.918 --> 00:31:52.188
I did a chapter I called it Silencing the Chainsaw to Hear the Birds Sing, quite a romantic sort of idea.
00:31:52.528 --> 00:32:06.598
But really- … once you're on to optimize insulin, your glucose follows and once the glucose is quiet you can tune into all of those subtle bodily functions which are hidden by this constant noise of carbohydrates and insulin trying to balance one with the other.
00:32:06.948 --> 00:32:10.798
You get a really smooth profile overall and you don't worry.
00:32:11.378 --> 00:32:21.628
There's one phrase in the book, I said I've s- I've injected my insulin, my glucose is now set, and I don't need to worry for the rest of the day," and I still had 40 miles to cycle, and I didn't need to worry for the rest of the day.
00:32:22.019 --> 00:32:24.178
So that is remarkable if you think about it.
00:32:24.178 --> 00:32:33.568
I had to double take on that thought because as most people with type 1 diabetes, you don't have that luxury of just cycling for 40 miles and not even having to worry about carb fueling or anything like that.
00:32:34.158 --> 00:32:36.259
I was fat burning, quite happily fat burning.
00:32:36.269 --> 00:32:37.588
I was in a ketogenic state.
00:32:38.068 --> 00:32:42.469
I was r- really alert with my body, my blood glucose was following that.
00:32:42.858 --> 00:32:49.219
So that's what that's all about really, trying to understand how to use as much insulin as necessary, but as little as possible.
00:32:49.588 --> 00:32:52.979
There are days when you need more insulin, and I wrote about that in the book.
00:32:53.048 --> 00:32:57.528
I needed more insulin on a couple of days than than ideal because you have to go with it.
00:32:57.538 --> 00:32:58.148
If you need it.
00:32:58.538 --> 00:33:01.769
And there are days when I use less insulin like a few units of insulin.
00:33:02.178 --> 00:33:08.948
So it's all about metabolic flexibility insulin optimization I call it and looking at all of the roots of health holistically.
00:33:13.078 --> 00:33:17.658
So let's talk about… Let's apply this to the broader public.
00:33:17.709 --> 00:33:20.078
Let's ap-apply this to everybody.
00:33:20.628 --> 00:33:20.898
Yeah.
00:33:20.908 --> 00:33:39.148
What I'm hearing is as it applies to folks who are not diabetic or not injecting insulin, you said something quite a bit earlier that I thought was noteworthy something about a focus on glucose rather than on, on insulin.
00:33:39.759 --> 00:33:56.459
And you've talked about optimizing was the word you used, optimizing insulin exposure across your diet, your movement, your sleep, your stress, and your environment.
00:33:57.209 --> 00:34:01.499
That's not just applicable to type 1 diabetics.
00:34:01.729 --> 00:34:03.959
That's applicable to all of us.
00:34:04.418 --> 00:34:19.186
So if you would, unpack that idea of insulin optimization for those of us who don't have to inject it So every single person produces insulin.
00:34:20.047 --> 00:34:21.137
Pancreas produces it.
00:34:21.746 --> 00:34:41.206
People with type one don't produce it-… And other categories But so we are in a difficult situation, but we need to know what someone without diabetes is doing with their insulin, and we can find that out by need- looking at how much we need to inject.
00:34:41.597 --> 00:34:45.266
But we can only find that out when we isolate each variable.
00:34:45.277 --> 00:34:52.696
So if we're running under a constant noise of carbohydrates we haven't got a clue what the subtle signs of circadian rhythms, day, night cycle.
00:34:52.696 --> 00:35:00.996
We haven't got a clue what's happening there because it's hidden by this constant high insulin level, and we're not sensitive enough to it.
00:35:01.476 --> 00:35:09.496
So insulin is secreted by everyone and insulin is secreted as a metabolic regulator and in response to blood glucose control.
00:35:09.797 --> 00:35:19.666
We know that carbohydrates, so you know, pasta, rice, potatoes, bread, et cetera, that they all convert to sugar in the bloodstream and raise the blood sugar.
00:35:19.976 --> 00:35:27.916
So insulin will be secreted by your pancreas to bring the blood sugar down, and that happens for everybody with every meal.
00:35:28.436 --> 00:35:34.296
Now, your blood sugar would be perfect, but your insulin levels might be going up and down like that all the time.
00:35:34.756 --> 00:35:40.706
If you're stressed your blood sugar will go up because of the stress hormones raise blood sugar.
00:35:40.956 --> 00:35:45.066
So your body will in concert produce insulin to try to bring that blood sugar down.
00:35:45.546 --> 00:35:51.756
If you're having a poor sleep, you'll, you become more resistant to your insulin, so your body produces more to overcome that.
00:35:52.186 --> 00:35:56.716
So over time, you end up with more and more insulin in your body throughout the whole day.
00:35:57.076 --> 00:36:00.346
And of course we know that insulin's an inflammatory hormone.
00:36:00.806 --> 00:36:02.626
We know that it leads to weight gain.
00:36:02.626 --> 00:36:05.706
We know that it leads to salt retention and high blood pressure.
00:36:06.216 --> 00:36:12.146
And we know that it can, because of the way insulin stores fat, lead to these conditions called fatty liver, et cetera.
00:36:12.146 --> 00:36:15.676
So insulin will eventually lead to what I call metabolic syndrome.
00:36:16.186 --> 00:36:30.496
And we know that if you're eating all the time, you're denying your body metabolic flexibility, so you're making your body more vulnerable to those, to making your, some of the tissues in your body more vulnerable to tho- to those that need ketone bodies or need fatty acids and things like that.
00:36:31.106 --> 00:36:36.436
So for someone without type one, you will produce, be producing insulin.
00:36:36.456 --> 00:36:37.756
We just have to inject it.
00:36:38.226 --> 00:36:44.296
So we can pretty well tell you, the book will tell you if you don't have type one, what's going on in your body pretty well.
00:36:44.766 --> 00:36:52.796
So- and high insulin levels we know are associated, as I've talked about in this talk with diseases.
00:36:53.156 --> 00:37:04.186
Glucose is a s- is e- eventually a symptom of type 2 diabetes when the insulin just cannot cope with the sheer metabolic load that it has to cope with as the insulin's overwhelmed.
00:37:04.236 --> 00:37:06.486
But that process has been going on for years before.
00:37:06.546 --> 00:37:09.006
So it a- it applies.
00:37:09.016 --> 00:37:13.286
So type 1 insulin requirements apply to people with type 2.
00:37:13.606 --> 00:37:17.416
So how can we get insulin low to enable metabolic flexibility?
00:37:17.746 --> 00:37:24.636
It's all about understanding the five foundations of health which lead to situations where we're raising insulin all the time.
00:37:25.196 --> 00:37:28.426
So insulin, I think, is as important as blood sugar.
00:37:28.426 --> 00:37:29.276
Blood sugar's a symptom.
00:37:29.276 --> 00:37:32.756
Cholesterol's a symptom of metabolic disruption.
00:37:32.756 --> 00:37:34.086
Fatty liver's a symptom.
00:37:34.086 --> 00:37:35.256
High blood pressure's a symptom.
00:37:35.586 --> 00:37:36.526
Weight's a symptom.
00:37:37.146 --> 00:37:42.986
So we can look at all these symptoms and modify them, which of course we do with endless medications.
00:37:43.436 --> 00:37:49.566
But if you have type 1 diabetes just respecting the insulin will improve all of those symptoms with just with one drug.
00:37:50.016 --> 00:37:51.516
But you're lowering the insulin.
00:37:52.006 --> 00:37:54.846
And in- No you're going too fast here 'cause that was profound.
00:37:55.826 --> 00:38:09.164
If you have type 1 diabetes And you manage it with insulin, you will reduce all those symptoms or manage all those symptoms.
00:38:09.374 --> 00:38:09.674
Yeah.
00:38:09.754 --> 00:38:13.724
I… And again, if you would please, list those symptoms.
00:38:13.734 --> 00:38:16.134
Those, this is important stuff, folks.
00:38:16.504 --> 00:38:28.034
We really the reason this caught my attention is your long list of things that are symptoms that we have drugs for, but the drugs are treating the symptoms.
00:38:29.024 --> 00:38:47.674
And what I inferred from what you said is the root cause is something that we use insulin to manage the expression of the root cause, which is these various symptoms with, rather than just muting the noise of the symptom.
00:38:48.074 --> 00:38:52.134
I'm… I don't mean to distort it, but if you would, just go back again.
00:38:52.364 --> 00:38:54.214
These things are symptoms.
00:38:55.374 --> 00:38:55.554
Yeah.
00:38:55.624 --> 00:39:02.794
So someone with type one diabetes, over time you start to learn that insulin has more effects than just lowering blood sugar.
00:39:03.554 --> 00:39:11.094
So too much insulin and that is caused by having a diet that is high in carbohydrates, so you need far more insulin to control that.
00:39:11.324 --> 00:39:16.354
And we're vulnerable because we already, because of where we inject our insulin, have too much of it anyway.
00:39:16.644 --> 00:39:20.104
So too much insulin will lead to constant fat storage state.
00:39:20.804 --> 00:39:31.764
You're always in fat storage state, and if you're eating all of the time, three meals a day plus snacks pl- and nighttime drink, which some people have as well you're constantly putting carbohydrates into the body.
00:39:31.774 --> 00:39:38.274
60%, 50% of our diet, in the US now they- they've recommended that people invert the pyramid.
00:39:38.554 --> 00:39:40.224
But in, in my country, they haven't.
00:39:40.344 --> 00:39:51.794
In fact, a funny aside on that, I wrote to one of the major charities over here and said, "What do you think to the American guidelines?" They said,"Oh we're sticking with the EU- Euro- with the UK guidelines." I said I'm an American living in the UK.
00:39:51.864 --> 00:40:00.976
What should I do?" And they said, "Oh follow which ones you want." So there's a lot of science behind that Oh yeah, lots of science there.
00:40:00.976 --> 00:40:01.666
The old guidelines.
00:40:01.716 --> 00:40:11.816
So high levels of insulin caused by mostly diet and inactivity, I think, i- insulin's a very good meta- physical activity's very good for regulating metabolism.
00:40:11.826 --> 00:40:17.266
It you can hoover up a lot of sugar into muscle if you're exercising and make your body more insulin sensitive.
00:40:17.706 --> 00:40:18.476
So there are two things.
00:40:18.476 --> 00:40:34.246
There's too much insulin and insulin resistance, and eventually your body becomes resistant to insulin, so you need to make more and more of it to cope with the metabolic load caused by your lifestyle, which is predominantly driven by too many carbohydrates in the diet in people who are vulnerable.
00:40:34.436 --> 00:40:40.996
People are… a lot of people now are overweight and obese, and they're clinically vulnerable to too much insulin.
00:40:41.386 --> 00:40:47.906
And fat storage is not a feature of fat more a feature of too much carbohydrate.
00:40:48.266 --> 00:40:55.576
So the sugar gets taken out of your blood, and so the biggest source of fat in, in our bodies is carbohydrate not fat, strangely.
00:40:56.146 --> 00:41:05.486
So too much carbohydrate leads to the need to clear the blood sugar out of the bloodstream because our bloodstream is, has a very tight level of control.
00:41:05.786 --> 00:41:18.346
It the blood glucose needs to be very tight because the tissues are surrounded by something called interstitial fluid, and they need a very tight regulated level of glucose in order to work properly.
00:41:18.386 --> 00:41:21.796
Too much glucose will damage the receptors in the cell.
00:41:22.036 --> 00:41:25.616
So as soon as the blood sugar goes up, insulin's out of the traps instantly.
00:41:25.666 --> 00:41:26.426
It's ready to go.
00:41:26.436 --> 00:41:31.226
I- insulin in your body is stored in granules and released as soon as blood glucose goes up.
00:41:31.706 --> 00:41:33.686
And then they get rid of the blood sugar.
00:41:33.796 --> 00:41:41.436
So if you're exercising, that insulin will augment the ac- the clearance of blood glucose into the muscles.
00:41:41.616 --> 00:41:48.216
If you're not exercising like we're not now the insulin will direct that to the liver, and the liver will make that sugar into fat.
00:41:48.902 --> 00:41:50.562
And then so people put on weight.
00:41:50.612 --> 00:41:56.162
And if we're continually eating carbohydrates, we're continually producing insulin, we're continually producing fat.
00:41:56.542 --> 00:42:01.782
And we know that people with type 1 diabetes tend to put on weight as they go through their diabetes journey.
00:42:02.112 --> 00:42:07.392
When you're producing a lot of fat, your liver's got- So is it the excess insulin that cause… Okay, I'm I'm following you.
00:42:07.392 --> 00:42:08.622
I think I'm following you.
00:42:08.762 --> 00:42:08.782
Yeah.
00:42:08.782 --> 00:42:08.942
All right.
00:42:08.942 --> 00:42:14.282
So the excess insulin causes excess fat, and then the excess fat builds up in the liver and causes fatty liver.
00:42:14.362 --> 00:42:19.762
But before that, the excess fat is sprayed around the body and d- deposited into fatty tissues.
00:42:20.212 --> 00:42:25.362
And of course, that excess fat also is packaged with cholesterol, and that's where all the problems start.
00:42:25.362 --> 00:42:28.992
All, you know- … all of the cholesterol evidence is based around high-fat diets.
00:42:29.392 --> 00:42:33.942
Cholesterol profiles alter with a low-fat diet, a ketogenic type of diet.
00:42:34.412 --> 00:42:41.582
But we apply the high-fat research to… So we apply fat storage research into fat burning.
00:42:41.932 --> 00:42:50.632
So it's difficult to know how to interpret cholesterol on a ketogenic diet based around the fact that 99% of evidence is based on a high-carbohydrate diet.
00:42:51.142 --> 00:42:54.242
So we have cholesterol as a as a symptom of high glucose.
00:42:55.232 --> 00:42:55.752
High insulin.
00:42:55.822 --> 00:43:05.942
High insulin makes the kidney retain salt, and with the salt comes the fluid, and with the salt and the fluid in a closed system like the blood vessel system, unless you're bleeding, you get high blood pressure.
00:43:06.722 --> 00:43:15.442
So insulin generates high blood pressure, and we know that when people go on a keto diet, they flush out a huge amount of fluid and the blood pressure drops within six to eight weeks and it's all sorted out.
00:43:16.112 --> 00:43:27.832
So all of those things, the high blood pressure, the abnormal cholesterol profiles, the fatty liver the weight gain, are all caused by too much insulin in the body and metabolic dysregulation.
00:43:28.202 --> 00:43:40.552
So it's not just insulin by itself, it's how that insulin impact, impacts or is impacted by the other 30 or o- th- 30 or 40 other hormones that are produced in the body, and insulin interacts with nearly all of those.
00:43:40.852 --> 00:43:46.952
So it's a metabolic dysregulation caused by an abnormal amount of insulin in the body, in my view.
00:43:47.462 --> 00:43:54.912
So it's like every system, every complex system you inject a variable constantly and things change i- in the whole body.
00:43:54.922 --> 00:43:58.592
If you've got water that contains a lot of lime, eventually your pipes are gonna fur up.
00:43:59.282 --> 00:44:05.922
But if you reduce the lime, the pipes won't fur up, if so it's getting the metabolism right in the body for your body.
00:44:06.162 --> 00:44:17.092
I'm not saying it's for everybody, but I think everyone should be aware of it so they can make an informed choice rather than just blindly follow eating, counting carbs, and injecting insulin on the assumption that insulin is not important.
00:44:17.112 --> 00:44:18.522
It's very important indeed.
00:44:19.032 --> 00:44:20.302
That's the basis of the book, really.
00:44:22.470 --> 00:44:25.560
Yeah the the complex interrelationship, right?
00:44:25.640 --> 00:44:26.730
A- and you've mentioned it.
00:44:26.740 --> 00:44:35.830
Insulin it the regulation of glucose is o- only one of many things that insulin actually does in our bodies.
00:44:36.170 --> 00:44:40.480
And again, that, that is a incredibly complex system.
00:44:40.800 --> 00:45:05.250
And there's just, at a high level we sit back today, knowing Dr. Bernstein's work, seeing, all the work that's being done around ketogenic and low carb diets in both diabetics and non-diabetics, and, it's almost insane to think that the mainstream recommendations around type 1 diabetes are what they are, right?
00:45:05.260 --> 00:45:21.040
To just tell people, not… a- and, to be clear there is guidance that is given to type 1 diabetics that are diagnosed, today that eating low carbohydrate is actually dangerous, right?
00:45:21.040 --> 00:45:24.470
You need to have a minimum amount of carbohydrates.
00:45:24.710 --> 00:45:43.760
And, to just think about how we got here it really is insane that this is where we ended up with the management of type 1 diabetes, let alone the implications that then has for type 2 diabetes and even for, dietary recommendations around non-diabetics.
00:45:44.330 --> 00:45:49.090
What what's your thinking on what it will take to change this?
00:45:49.380 --> 00:45:56.490
Obviously, something you're a big proponent of, and really all of us in this low carb community are big proponents of.
00:45:56.710 --> 00:46:09.750
But again knowing what you know from the inside as a doctor and as a patient what kind of response do you get from your type 1 diabetic patients today when you present this information to them?
00:46:11.262 --> 00:46:12.802
There are two angles to this.
00:46:12.802 --> 00:46:20.192
I use my website and I a- attract a certain type of type 1 who's interested, so they're already pretty well easily convertible.
00:46:20.662 --> 00:46:31.102
And then in my NHS practice, I, most of the type 1 people with type 1 are specialist led, so it's a secondary care special- specialism and generalists like me don't really get involved.
00:46:31.542 --> 00:46:37.892
But I, I feel an ethical responsibility really to say th- this is something you might want to look at." Not everyone's interested.
00:46:37.942 --> 00:46:40.492
People have all sorts of reasons why they don't want to change.
00:46:40.522 --> 00:46:45.312
A lot of people have got a formula that works, and they've struggled for years to get that formula that works for them.
00:46:45.752 --> 00:46:49.862
So I offer that up to people and support it if that's what they want to do.
00:46:50.332 --> 00:46:56.532
I think those converted people the commonest question I get is, "Why didn't you… Why wasn't I told this at the start?
00:46:56.572 --> 00:47:10.652
Why have I wasted 10 years of my life with complications when th- this could have made me so much better?" I had one person who said even if they could, got a cure for diabetes type 1 tomorrow, I wouldn't change my lifestyle now I know what is required.
00:47:10.652 --> 00:47:12.052
I feel so much better.
00:47:12.452 --> 00:47:16.072
And that's what we alluded to, the low insulin lifestyle for a healthy human being.
00:47:16.542 --> 00:47:19.342
It makes people feel so much better and more active.
00:47:19.342 --> 00:47:26.412
So even if you don't have diabetes, there's a lot of unfit people who don't have type 1 diabetes out there and due to driven by lifestyle.
00:47:26.902 --> 00:47:37.942
I had someone w- who's been 20 years on a pump, and he says the best ever control he's ever had was with a ins- when he started to understand how to use his insulin doctors are difficult people to deal with.
00:47:37.952 --> 00:47:43.042
They're under a huge amount of pressure to to operate on a, certainly generalists across many levels.
00:47:43.402 --> 00:47:48.182
But somehow the ketogenic, the word keto in, in diabetes freezes the room.
00:47:49.102 --> 00:47:50.902
It, it just cannot get through to people.
00:47:50.962 --> 00:47:53.322
And once you mention keto, you've lost the whole of the room.
00:47:53.482 --> 00:47:55.552
So it has to be, I think education.
00:47:55.552 --> 00:47:56.252
We're all doing a bit.
00:47:56.262 --> 00:47:57.422
We're all chipping away at the rock.
00:47:57.782 --> 00:48:03.452
The journalists who report on it, the people the, the experimenters like me who just put stuff out on social media.
00:48:03.862 --> 00:48:08.152
S- the mental health space, the polycystic kidney space, the diabetes space, the heart space.
00:48:08.422 --> 00:48:11.352
Everyone's working together and the message is getting out there.
00:48:11.662 --> 00:48:14.682
So my book is written really for my fellow type 1s.
00:48:14.772 --> 00:48:34.242
I thought I'd write it a- as a hybrid to attract clinicians, but I genuinely think that the fastest route to progress is to write it for people with the condition 'cause they will resonate with it a lot, and they will be able to implement their own changes or certainly have a very good conversation with their healthcare s- specialist about why they're doing what they're doing.
00:48:34.292 --> 00:48:44.392
And then if the healthcare specialists do not want to go along with I, I would call it updating the knowledge really, 'cause over the last five to 10 years we've updated our knowledge.
00:48:44.822 --> 00:48:51.392
And e- and if some specialists don't want to update their knowledge they can say what they like, but they'll become irrelevant because people will just be getting on with it.
00:48:51.852 --> 00:48:55.452
And type 1s get on with it 365 days a year.
00:48:55.482 --> 00:48:58.622
You'll never find- … a diabetologist at 3:00 in the morning when you're in trouble.
00:48:59.262 --> 00:49:00.402
You might find an ambulance.
00:49:00.412 --> 00:49:05.592
So t- type 1 diabetes are very flexible people and very adept at keeping out of trouble.
00:49:05.592 --> 00:49:05.682
Good.
00:49:05.732 --> 00:49:17.892
And once they know that they're not the only ones in the world with that condition and they're living with it alone, and once they've, see that I've been very vulnerable here and I told it how it is for me, and it's not like a doctor, I tell you.
00:49:17.902 --> 00:49:22.522
It's someone who's not brilliantly controlled but good enough to make the book work.
00:49:22.822 --> 00:49:32.802
Once they realize that it is a condition you can un- you can understand more deeply and manage more easily and you don't have to worry about it every day, I think that will start to lead the change.
00:49:32.802 --> 00:49:43.122
That's my contribution to this space is to support people who are otherwise not even find out about other ways of living with type 1, and those on their own that think,"Oh, he does that as well.
00:49:43.762 --> 00:49:46.312
Oh, he should know what he's doing," and "Oh, he has
00:49:46.332 --> 00:49:47.672
00 in the morning.
00:49:48.182 --> 00:49:49.982
Oh, he forgets to inject his insulin as well.
00:49:50.092 --> 00:49:52.702
Oh, so do I." It's relatable I hope.
00:49:53.362 --> 00:49:53.692
All right.
00:49:53.692 --> 00:49:57.152
Let's talk about how folks who want to f- find the book can get the book.
00:49:59.012 --> 00:50:01.322
So it's on Amazon all all Amazons.
00:50:01.322 --> 00:50:03.892
It's a e-book as well as a paperback, and it's
00:50:03.892 --> 00:50:10.892
The Thousand Mile Ride That Changed My Mindset on Type 1 Diabetes, so quite a handful.
00:50:11.482 --> 00:50:11.652
Yeah.
00:50:11.652 --> 00:50:12.062
Yeah.
00:50:12.122 --> 00:50:16.082
If you just Go- If you just put in Shifting Gears Ian Lake, it'll come up.
00:50:16.082 --> 00:50:16.212
Yes.
00:50:16.212 --> 00:50:16.602
There we go.
00:50:16.602 --> 00:50:16.822
Yes.
00:50:17.102 --> 00:50:23.102
And having done the search for just Shifting Gears on Amazon- Yeah … there's all kinds of stuff that is not what we're looking for.
00:50:23.102 --> 00:50:23.122
Yeah.
00:50:23.122 --> 00:50:26.382
I think there's quite a few TV series out there on Shifting Gears.
00:50:26.382 --> 00:50:28.182
Oh.
00:50:28.182 --> 00:50:28.332
Oh.
00:50:28.572 --> 00:50:29.562
Very good.
00:50:29.572 --> 00:50:34.432
And w- and where can people go to find out more about your work outside of the book?
00:50:34.872 --> 00:50:38.842
Type1keto.com and IFixHearts is a good place.
00:50:38.842 --> 00:50:41.772
I've had two podcasts on your show now, so thank you very much.
00:50:42.092 --> 00:50:42.642
Yes.
00:50:42.692 --> 00:50:45.552
It's always great being able to catch up with you.
00:50:45.552 --> 00:50:50.852
And yeah, certainly want to encourage people to check out your website Type 1 Keto.
00:50:50.852 --> 00:50:52.662
It's a great great website.
00:50:52.662 --> 00:51:02.722
And like I said, it's the information that we're learning from the work that you're doing is very applicable to those of us that are not Type 1 diabetics as well.
00:51:02.762 --> 00:51:21.332
And I think your focus on A- and I think it's a great way to reframe the conversation, not necessarily as a ketogenic diet, but as an insulin-controlling diet, essentially is what you're advocating for, and I think it makes a lot of sense and it will help a lot of people.
00:51:23.976 --> 00:51:24.176
Thank you.
00:51:24.176 --> 00:51:25.746
So do I. I hope it helps a lot of people.
00:51:27.086 --> 00:51:27.526
All right.
00:51:27.536 --> 00:51:29.486
Our guest has been Dr. Ian Lake.
00:51:29.486 --> 00:51:32.306
His book is Shifting Gears on Amazon.
00:51:32.396 --> 00:51:34.076
Search for his name as well.
00:51:34.596 --> 00:51:37.126
And the website Type 1 Keto.
00:51:37.216 --> 00:51:39.916
One is the numeral, it's not spelled out.
00:51:40.026 --> 00:51:42.426
Type numeral 1 keto.com.
00:51:43.836 --> 00:51:47.696
For Dr. Philip Ovadia, this has been Stay Off My Operating Table.
00:51:47.696 --> 00:51:48.706
Thanks for joining us.
00:51:48.726 --> 00:51:50.756
We look forward to talking to you next time
00:00:56.250 --> 00:00:59.390
It is Stay Off My Operating Table with Dr. Philip Ovadia.
00:00:59.790 --> 00:01:03.880
Today we're going to be discussing type 1 diabetes.
00:01:03.920 --> 00:01:05.230
But wait, don't run away.
00:01:05.640 --> 00:01:12.930
Dr. Ian Lake, who is our guest has got information that is going to appeal to literally everyone.
00:01:13.650 --> 00:01:22.400
It just so happens that type 1 diabetics focus the light on a problem that affects all of us.
00:01:22.659 --> 00:01:24.620
I've probably already said too much, Phil.
00:01:24.930 --> 00:01:25.669
I'll shut up.
00:01:27.778 --> 00:01:28.299
Awesome.
00:01:28.300 --> 00:01:32.938
Yeah, I'm really excited to be having another conversation with Dr. Ian Lake.
00:01:33.219 --> 00:01:52.019
And I'm gonna let him get into his background, but yes, he is doing some groundbreaking work around Groundbreaking work both as a practitioner but also as a self experimenter, a citizen scientist as we often talk about on the show around type 1 diabetes.
00:01:52.049 --> 00:01:59.100
And like you were alluding to, it can teach us a lot that goes beyond type 1 diabetes.
00:01:59.329 --> 00:02:04.079
And really excited for his new book that just came out, Shifting Gears.
00:02:04.380 --> 00:02:07.030
And so we're gonna be talking about that as well.
00:02:07.230 --> 00:02:15.180
Dr. Lake why don't you give a little bit of your background to our audience, and then we'll start talking about all of the great work that you've been doing.
00:02:15.710 --> 00:02:17.129
Thank you very much for inviting me on.
00:02:17.129 --> 00:02:21.939
Yes, don't go away everyone because I inject the hormone that you naturally produce.
00:02:22.000 --> 00:02:26.469
It's not quite an analogy, but what I do is what your body does.
00:02:26.480 --> 00:02:34.829
So I think it's important for us to understand how insulin works, and type 1s are a good model for how insulin works in people without type 1 diabetes really.
00:02:35.460 --> 00:02:37.120
So I'm getting on a bit now.
00:02:37.120 --> 00:02:41.629
I was diagnosed with type 1 diabetes in my 30s, and I've had it for over 30 years now.
00:02:42.100 --> 00:02:48.980
I'm a general practitioner primary care physician in the UK, and I have been now for nearly 40 years, so I've done my time, as it were.
00:02:49.639 --> 00:03:01.579
When I was diagnosed, I really stuck to the system that I knew 'cause I couldn't think that there's any other option but to c- count my carb- The thing about type 1 diabetes, it's a lack of insulin.
00:03:01.660 --> 00:03:08.250
Our bodies cannot produce insulin, and i- if type 1, it's di- it's defined as an autoimmune reaction really.
00:03:08.540 --> 00:03:12.360
But other people have to inject insulin for other reasons.
00:03:12.399 --> 00:03:15.560
But when you inject insulin it obviously lowers the blood sugar.
00:03:15.819 --> 00:03:18.259
That's what it, one of its roles is.
00:03:18.579 --> 00:03:22.589
It is a master metabolic regulator as well, which I hope to get into a bit later on.
00:03:23.100 --> 00:03:30.839
But I was taught to count my carbohydrates, which are the prime macronutrient, the prime nutrient that raises blood sugar.
00:03:31.019 --> 00:03:35.509
And because blood sugar goes up, insulin is the only hormone we have in our body that brings it down.
00:03:35.656 --> 00:03:39.365
There's plenty of hormones that bring it up, but insulin's the only one that brings it down.
00:03:39.766 --> 00:03:44.355
So my model of care was really counting carbohydrates and injecting insulin.
00:03:44.355 --> 00:03:55.995
And the whole idea is to choreograph this so that you estimate how much insulin you need per meal, estimate how long it's gonna take for that meal to get absorbed into your bloodstream to raise the blood sugar.
00:03:56.305 --> 00:04:04.550
Then you time your insulin and the estimated dose to choris- to c- to choreograph, if you like, with a raised blood sugar.
00:04:04.550 --> 00:04:07.571
So the, as the blood sugar's going up, the insulin will bring it down.
00:04:07.930 --> 00:04:11.091
And it sounds such a no-brainer and such an easy thing to do.
00:04:11.451 --> 00:04:15.201
It is actually virtually impossible to get it right every time.
00:04:15.620 --> 00:04:19.610
But that's the model I grew up with, and that's the model I believed was the right way to go.
00:04:20.300 --> 00:04:27.201
Because the funny thing about having type 1 is that, I'm in a privileged position, as a doctor, that I know a lot of people with type 1 diabetes.
00:04:27.201 --> 00:04:33.060
It's part of what I see every day or m- couple or three times a week i- in my job.
00:04:33.500 --> 00:04:37.670
So I, I understand type 1 and the people who live with it quite well.
00:04:38.110 --> 00:04:41.920
But a lot of people I speak to have never met anyone with the condition.
00:04:41.930 --> 00:04:43.290
They're literally on their own.
00:04:43.341 --> 00:04:49.571
And it's a funny thing really,'cause when I was diagnosed, I thought, "Yeah I know what to do." But then I was shocked that I actually couldn't do it.
00:04:50.060 --> 00:04:51.740
And every Monday was a reset.
00:04:51.911 --> 00:04:53.700
Every Monday, I thought, i'm gonna start today.
00:04:53.700 --> 00:04:54.781
I'm gonna really try really hard.
00:04:54.800 --> 00:04:55.920
I'm gonna count my carbohydrates.
00:04:55.930 --> 00:04:59.940
I'm gonna weigh my porridge, have my porridge for breakfast, inject the right amount of insulin.
00:05:00.000 --> 00:05:06.810
Then I cycle to work, get some exercise." Half, halfway through my morning, I was crashing, and then I was having to correct with sugar.
00:05:07.050 --> 00:05:09.010
That's quite hard when your doctor's hypo.
00:05:09.360 --> 00:05:11.190
You gotta try to avoid that at all costs.
00:05:11.450 --> 00:05:16.290
So I believed a lot in that model and realized really it's almost impossible to do.
00:05:16.790 --> 00:05:19.091
But I spent 20 years doing that.
00:05:19.370 --> 00:05:24.250
And as I said, people with type 1 don't know anyone else, and I didn't really know anyone well.
00:05:25.202 --> 00:05:27.913
To talk to about how they manage their condition.
00:05:28.072 --> 00:05:33.002
In fact, I was so embarrassed that I couldn't manage it that I ha- kept it to myself a lot.
00:05:33.092 --> 00:05:34.832
And I think a lot of people identify with that.
00:05:34.832 --> 00:05:37.992
You just don't want other people to know, especially if you're not doing very well.
00:05:38.372 --> 00:05:41.332
And that's the thing about about being isolated.
00:05:41.332 --> 00:05:45.112
You- what you've got and how you manage it is as good as it gets.
00:05:45.112 --> 00:05:52.952
You think everyone knows it's a difficult condition so it must be as bad as it is because I'm not doing very well." A- and that's my type of type 1 diabetes.
00:05:53.283 --> 00:05:54.673
So I grew up with that.
00:05:54.752 --> 00:06:02.862
20 years later I discovered the brilliant Richard Bernstein's book on how to lower carbohydrates to ma- to manage your diabetes better.
00:06:03.483 --> 00:06:05.413
And I put it down for a year.
00:06:05.473 --> 00:06:20.022
I thought, "Now my training tells me that fat's gonna be really bad for me, so I'm not gonna do that. I'm just stick with what I know." Then I had a ne- not a near fatal, but a very serious hypo when I was o- I was on my own and which shook me quite a lot.
00:06:20.092 --> 00:06:22.272
It's the first big one I'd ever had where I was out of control.
00:06:22.272 --> 00:06:23.663
A serious what?
00:06:24.043 --> 00:06:26.002
Hypo- hypoglycemia, low blood sugar.
00:06:26.002 --> 00:06:26.592
Oh, Okay.
00:06:26.642 --> 00:06:29.492
And I didn't have any any glucose tablets to correct it.
00:06:29.492 --> 00:06:43.512
I was away camping on my own, and I was in dire straits, but I re- I recovered from it and soon after that I got my first letters from the retinal screening department to say that I've got a few little sign, a few signs of early diabetic retinopathy.
00:06:43.533 --> 00:06:52.512
Not serious, but it's there So when you can see it in your eyes, it's, you know it's happening in your brain, around your heart, in your joints, in your liver, in your kidneys.
00:06:52.783 --> 00:06:55.252
You know that process is starting to take hold.
00:06:55.832 --> 00:07:09.052
So I quickly got Richard Bernstein's book out again and thought I've nothing to lose now, I'll try it." And for the last 13 years I've been doing something that is not r- routinely recommended for diabetes management.
00:07:09.082 --> 00:07:16.072
I'm on a high fat, h- moderate to high protein diet, and the very first meal I had was a revelation to me.
00:07:16.072 --> 00:07:17.492
It was such an emotional meal.
00:07:17.492 --> 00:07:18.423
I still remember it.
00:07:18.892 --> 00:07:28.582
Because after three, a three-egg omelet, my blood sugar didn't budge, and that was the first time in 20 years I'd actually got away with a breakfast that didn't alter my blood glucose.
00:07:28.913 --> 00:07:32.382
And the next meal, and the next meal, and the next meal, et cetera, et cetera.
00:07:33.092 --> 00:07:44.952
And ever since, I've been adopting a very low carbohydrate diet because it makes so much sense, and I've I've researched it quite a lot ever since, done some studies of my own, done some experiments of my own.
00:07:44.952 --> 00:07:50.012
Because, as a doctor, when you're swimming against the tide you really question yourself every day.
00:07:50.062 --> 00:07:55.723
"Is this the right thing to be doing?" Am I … is everybody else driving the wrong way down the road or is it me?
00:07:55.772 --> 00:07:58.242
And i- in most cases it's probably ourselves.
00:07:58.252 --> 00:08:08.582
So every single day I question myself, "Is this the right thing to do?" But more and more the evidence is in favor of, the science of m- metabolism is becoming mature now.
00:08:08.592 --> 00:08:12.913
We're starting to find that, yes, it is the logical thing to do for type one diabetes.
00:08:13.163 --> 00:08:14.022
So that's me really.
00:08:14.022 --> 00:08:24.103
So I, I now promote not just car- low carbohydrate diets, but what I call insulin optimization, how to understand insulin as well as we understand glucose.
00:08:24.892 --> 00:08:36.682
Because, if w- with the automated insulin devices now the artificial pancreas, not, but that's what it's promoted as with those you can get a pretty reasonable glucose trace.
00:08:37.123 --> 00:08:45.712
But I put it to people, say, what if you're using, what if your pump is whirring away so f- so hot that it's burning your skin because it's using a huge amount of insulin?
00:08:46.092 --> 00:08:49.773
Is that healthy to have a normal blood glucose but use a lot of insulin?
00:08:50.332 --> 00:09:00.243
'Cause I think insulin, from lots and lots of studies in different areas, metabolic sorry, mental health lots of neurological conditions et cetera.
00:09:00.653 --> 00:09:06.393
W- with c- cancer is promoted by insulin, but probably not caused by it, but insulin doesn't help.
00:09:06.723 --> 00:09:14.663
So there are many conditions, polycystic kidney disease, all respond well to low-carb diets and all don't respond well to high insulin.
00:09:15.182 --> 00:09:23.913
So I'm looking really that we should be m- not just worrying about glucose, which seems to be the gold standard, but equally about insulin as well.
00:09:24.383 --> 00:09:25.273
So that's where I'm coming from.
00:09:26.429 --> 00:09:30.709
Can we talk a little bit about your original diagnosis, right?
00:09:30.709 --> 00:09:50.763
Because being diagnosed with type 1 diabetes in your 30s is fairly atypical and as a physician going through that, I would love to hear how that came about, what your thinking was around this It's about, about a third of people are in the adult age range when they develop type 1.
00:09:50.763 --> 00:09:59.185
There's a peak in the sort of five to seven-year-olds, then again 12 to 14, puberty a- age, and then when we get older, we tend to get… we can get it as adults.
00:09:59.195 --> 00:10:08.254
So about a third of people get… their insulin in their body stops working, and it's thought to be an autoimmune disease where the pancreas is destroyed by the body's immune system.
00:10:08.855 --> 00:10:16.375
Yeah, so I, my first inkling was about a month before because it doesn't always appear all of a sudden.
00:10:16.485 --> 00:10:19.675
I think there's a run-in to most people with type 1 diabetes.
00:10:20.195 --> 00:10:21.645
We start to get a bit thirsty.
00:10:21.645 --> 00:10:22.975
We probably lose a bit of weight.
00:10:22.985 --> 00:10:29.225
We're probably going to the loo to pass urine a lot more frequently, and we feel a bit more tired as our blood glucose goes up.
00:10:29.655 --> 00:10:32.855
So I was doing a lot of work as a junior doctor really at the time.
00:10:32.905 --> 00:10:33.884
I was doing a lot of work.
00:10:33.884 --> 00:10:40.254
I was working days and nights and I was do- doing jobs where I was working at lots of different places, so I was very busy.
00:10:40.745 --> 00:10:55.595
And my first inkling was when somebody tapped on my car window about a month before I was diagnosed and asked me to move out of the car wash 'cause I'd put my car into a car wash and fell asleep, and that was a sign that I was obviously my he- my blood sugar was very high.
00:10:55.665 --> 00:10:56.915
But I didn't know it at the time.
00:10:57.545 --> 00:10:59.895
So I just moved on, thinking I'm just tired.
00:11:00.004 --> 00:11:01.905
I had no reference points at that point.
00:11:02.365 --> 00:11:06.745
And then one day I just developed extreme thirst.
00:11:06.805 --> 00:11:08.355
I- I've never known thirst like it.
00:11:08.485 --> 00:11:10.065
It was extreme thirst.
00:11:10.065 --> 00:11:12.665
And guess what I tried to quench my thirst with?
00:11:13.245 --> 00:11:13.935
Coca-Cola.
00:11:15.275 --> 00:11:21.125
So nothing better than diagnosing your diabetes by adding something that's going up uncontrollably in your bloodstream at the same time.
00:11:21.615 --> 00:11:23.795
And then I was passing urine so frequently.
00:11:23.875 --> 00:11:28.945
I was in the car driving an hour, and I had to really stop very frequently to relieve myself.
00:11:28.945 --> 00:11:36.745
So I… And by then I'd diagnosed it and when I got to my destination, which was a GP surgery, I just tested my blood sugar, and it was in the mid-20s.
00:11:36.775 --> 00:11:40.105
20 times 18, 300 and odd.
00:11:40.105 --> 00:11:40.915
F- 300, 400 milligrams per deciliter.
00:11:41.405 --> 00:11:41.425
Yeah.
00:11:41.754 --> 00:11:42.675
So it was quite high.
00:11:42.855 --> 00:11:54.175
And then I kept myself to myself overnight and just didn't eat knowing that I could be in trouble here, but I managed to get through to the morning, turned myself in and got sorted out.
00:11:54.195 --> 00:11:59.185
What a shock to diagnose yourself with a condition that you know is not a good condition to have.
00:11:59.515 --> 00:12:07.865
I've seen all the complications of type 1 diabetes, and here I was, a person about to go on that journey, and i- it was quite a shock really.
00:12:08.717 --> 00:12:16.757
And I was really just told about all of the complications again, and as doctors seem to be quite keen to tell you about all the complications, what's gonna happen to you.
00:12:16.777 --> 00:12:17.427
And yeah, I know that.
00:12:17.427 --> 00:12:18.567
I know that, thank you very much.
00:12:18.887 --> 00:12:23.477
But what I didn't know was how difficult it is to manage type 1 diabetes.
00:12:23.507 --> 00:12:24.807
Literally, you get given a pen.
00:12:25.447 --> 00:12:29.257
Pens in those days, I'm still on pens 'cause I can't get a pump right now on the National Health Service.
00:12:29.767 --> 00:12:35.047
You get a pen, and you get told roughly count your carbs about 10 to one, and off you go.
00:12:35.047 --> 00:12:37.576
You're a doctor, you should know what you're doing, and good luck.
00:12:38.177 --> 00:12:41.397
And three months later I was reviewed, and just kept going on that really.
00:12:42.057 --> 00:12:44.187
N- I never ended up in massive trouble.
00:12:44.387 --> 00:12:45.167
Some people don't.
00:12:45.177 --> 00:12:50.607
Some people have bad luck, and they end up with hypos and diabetic ketoacidosis quite frequently.
00:12:50.937 --> 00:12:53.067
But I was one of those lucky ones that hovered in the middle.
00:12:53.237 --> 00:12:54.567
I wasn't a bother to anyone.
00:12:54.617 --> 00:12:57.211
I never ended up in hospital, never ended up in trouble.
00:12:57.972 --> 00:13:06.278
So I just kept hovering around the middle zone really, accepting that my glu- glucose surged Yeah.
00:13:07.448 --> 00:13:08.788
It's mentally very taxing.
00:13:09.078 --> 00:13:09.638
Yeah.
00:13:09.688 --> 00:13:13.588
It's certainly interesting to hear your perspective, right?
00:13:13.598 --> 00:13:29.478
We as doctors and there are many scenarios like this where we give patients instructions on how to manage, whatever condition they have, but we might not really realize how difficult following those instructions are, right?
00:13:29.478 --> 00:13:49.028
And, I'm sure, before this you probably… when you took care of diabetics and you gave them, the goal of keeping your blood sugar under control, and like you said, just do the calculations and figure out what you're eating and how much insulin to give and, when to give it, and that's, and that's how we control diabetes.
00:13:49.057 --> 00:13:57.628
But as you discovered, and I think as if we're being honest as physicians, we see patients struggling with this all the time.
00:13:57.908 --> 00:13:59.508
It is very hard, right?
00:13:59.568 --> 00:14:04.688
The magic that our body figures it out in people that are not diabetic, right?
00:14:04.718 --> 00:14:15.198
It's really pretty amazing the complexity of what our body has to do to balance insulin and glucose on a constant basis.
00:14:17.400 --> 00:14:18.270
A- absolutely.
00:14:18.270 --> 00:14:20.870
A meal is not just a straightforward meal.
00:14:20.940 --> 00:14:22.650
You have to plan for your meals.
00:14:22.750 --> 00:14:24.030
Restaurants are quite fun.
00:14:24.129 --> 00:14:34.690
You don't quite know what you're going to get, so you try to- … to get the sort of the pattern right of the, of when to inject how much to inject, and hope the meal arrives on time.
00:14:35.730 --> 00:14:36.700
How to inject.
00:14:36.720 --> 00:14:43.890
Do you inject, do you go to the loo and inject or do you ra- you know, roll up your shirt and stick it in and get your pen out and show off?
00:14:43.910 --> 00:14:49.280
Or what I tend to do is just inject under the table through my trousers and some people do that.
00:14:49.379 --> 00:14:53.170
So it… The day-to-day, it- it's quite a difficult gig.
00:14:53.390 --> 00:14:55.770
My insulin takes half an hour to work.
00:14:55.820 --> 00:15:00.110
Your insulin's already finished working 15 minutes before mine even starts working.
00:15:00.870 --> 00:15:06.990
My insulin lasts two to three hours, and some of the long-acting, basal insulin, lasts up to 30 hours.
00:15:07.290 --> 00:15:09.160
Your insulin's finished in 15 minutes.
00:15:09.840 --> 00:15:16.400
So we have to factor in that our insulin's gonna be working for a lot longer than people with no diabetes.
00:15:16.750 --> 00:15:23.220
I liken it to driving a car and having to input a steering correction to the wheel 30 minutes before you go around the bend.
00:15:24.570 --> 00:15:26.730
It's quite hard to do that all the time.
00:15:26.730 --> 00:15:29.080
So everything's an estimation really.
00:15:29.420 --> 00:15:50.948
It becomes quite stressful sometimes because- Type 1 diabetes, just by correcting blood sugars with protecting your carbohydrates and injecting your insulin is an im- virtually impossible task, and we can do the same thing two days in a row, live exactly the same life two days in a row, and get completely different results.
00:15:51.618 --> 00:15:58.378
Einstein said, "If you do the same thing over and over again, that's the definition of insanity." Our insanity is doing the same thing and getting completely different results.
00:15:58.748 --> 00:16:02.348
A- and it leads to quite a lot of stress, to be honest, because you're never quite on it.
00:16:02.378 --> 00:16:03.838
You're never quite in control.
00:16:04.408 --> 00:16:10.888
There's all, there's this background noise going on of anxiety about am I gonna be okay, I've gotta come on this podcast.
00:16:10.888 --> 00:16:12.177
Am I gonna last for an hour?
00:16:12.228 --> 00:16:14.557
Yes, I am, but I've had to plan to last for an hour.
00:16:14.778 --> 00:16:18.348
It's so much easier with the diet I have because I don't even have to think about it.
00:16:18.348 --> 00:16:26.818
But before, I'd have to plan and hope, I had some supper about two hours ago, hope that my glucose didn't plummet with the high doses of insulin I'd typically have had.
00:16:27.168 --> 00:16:28.778
Say I had a a pasta meal.
00:16:28.818 --> 00:16:32.398
It might be coming down to hypo levels halfway through this conversation.
00:16:32.788 --> 00:16:35.068
So there's a lot of noise around.
00:16:35.408 --> 00:16:40.908
People who've got problems around food it, it impacts them as well because diabetes is all about food.
00:16:41.518 --> 00:16:46.138
So if you've got a food issue, it's, the diabetes is certainly gonna amplify that for you.
00:16:46.618 --> 00:16:49.348
So it's a constant background noise of stress, planning.
00:16:49.348 --> 00:16:50.598
It never really goes away.
00:16:50.858 --> 00:16:52.858
You have to be on it 24 hours a day.
00:16:53.268 --> 00:16:56.158
And then you go to bed, your blood glucose is whatever it is.
00:16:56.188 --> 00:16:58.328
Do you inject insulin to bring it down?
00:16:58.338 --> 00:17:02.018
Do you leave it or let it drift up or hope it might come down?
00:17:02.048 --> 00:17:03.418
Do you have hypos in the night?
00:17:03.938 --> 00:17:06.698
So is, it's constantly in, on your mind.
00:17:06.708 --> 00:17:07.657
You get used to it.
00:17:07.708 --> 00:17:13.008
We all get used to it, but it's one of those things we have to plan for all the time, the constant noise.
00:17:13.008 --> 00:17:15.028
I, I liken it to a chainsaw really.
00:17:15.087 --> 00:17:17.307
You got this constant noise going on in the background.
00:17:18.086 --> 00:17:18.756
Yeah.
00:17:18.796 --> 00:17:22.405
And, it's interesting the history of diabetes, right?
00:17:22.435 --> 00:17:26.586
Th- this disease was described, thousands of years ago literally.
00:17:26.766 --> 00:17:32.036
And the original way it was discovered was centered on sugar.
00:17:32.076 --> 00:17:39.456
Doctors used to actually taste the high sugar in patients' urine essentially was the way to diagnose this.
00:17:39.846 --> 00:17:49.165
And insulin was only really discovered, within the past 100 years or so, a little over 100 years ago that we knew what insulin was.
00:17:49.426 --> 00:17:55.066
So the whole focus of the disease has remained around the sugar, right?
00:17:55.096 --> 00:18:02.296
And, controlling the sugar at first in the urine, and then when we were able to measure sugar in blood how to control that.
00:18:02.516 --> 00:18:06.365
But in reality, it's a di- i- it's a disease of insulin.
00:18:06.385 --> 00:19:11.066
And there's this interesting paradox around type 1 diabetics that you alluded to earlier that y- to avoid the ultimate complications of diabetes that we worry about, things like blindness, and heart disease, and, vascular disease leading to amputations and infections you have to control the blood sugar, but we know that the more insulin you end up using to do that that in and of itself accelerates or worsens the complications.
00:19:11.326 --> 00:19:18.536
Again, as a physician but also as a patient contrast you talked about these two approaches, right?
00:19:18.536 --> 00:19:25.786
You spent 20 years doing the sort of traditional approach, and then you discovered Dr.
00:19:22.645 --> 00:19:32.605
Bernstein's work which is a very different approach of essentially trying to manage the insulin rather than manage the glucose primarily.
00:19:32.855 --> 00:19:43.105
And talk about those contrasting approaches and, again, a little bit what that change in mindset was like for you as a physician and as a patient.
00:19:44.693 --> 00:19:57.223
Yeah, that, that's a very good point, and that's the nub of what I'm trying to get at now w- with my learning is at the, my route of travel is at the stage where I think insulin is as important or if not more as important as controlling glucose.
00:19:57.594 --> 00:20:03.894
But strangely, if you control insulin well, your glucose will follow, and it isn't the same the other way around.
00:20:04.493 --> 00:20:12.334
Glucose was the symptom that sym- that, that told you had very little insulin that was operating in your body.
00:20:12.844 --> 00:20:36.533
So when Banting, Best, Macleod, and Collip, the four people that got the prizes for discovering insulin injected into a 10-year-old boy who lived 10 years in 1923, which is incredible they were making sure that the insulin was given to control the blood sugar, and they had very primitive methods, what we call primitive now, we all have continuous glucose meters, of measuring the sugar in the urine.
00:20:37.023 --> 00:20:38.673
But the insulin was the key thing.
00:20:38.683 --> 00:20:40.384
And of course, the insulin was very crude.
00:20:40.384 --> 00:20:44.303
It was a mixture of short-acting, long-acting, eventually became long-acting.
00:20:44.763 --> 00:20:47.073
And it was all about controlling your diet.
00:20:47.084 --> 00:20:56.644
So before the insulin was used o- on humans, we were recommended to have a diet that tried to work with a lack of insulin.
00:20:57.433 --> 00:21:00.663
Insulin does not raise that much when you eat fat.
00:21:00.673 --> 00:21:06.533
It does not raise that much when you eat protein, but it goes up a hell of a lot when you eat carbohydrates.
00:21:06.923 --> 00:21:11.104
So their approach was to remove the carbohydrates from the diet.
00:21:11.713 --> 00:21:21.104
And in adults, they added spirit alcohol, because we know that spirit alcohol, such as whiskey will inhibit the, some of the hormones that raise the blood sugar.
00:21:21.563 --> 00:21:25.953
So their approach was based around trying to work with the, what they had in the body.
00:21:26.344 --> 00:21:29.463
When insulin was dis- was used, it was a revolution.
00:21:29.463 --> 00:21:32.394
People were literally resurrected from death.
00:21:32.453 --> 00:21:33.763
It was such a wonderful drug.
00:21:34.433 --> 00:21:44.063
And it was subsequently purified and became a very, I think we got so used to it we ignored it, and we were chasing sugars, and sugar became the gold standard, and still is the gold standard.
00:21:44.114 --> 00:21:47.344
It's all about HbA1c, our long-term sugar control.
00:21:47.604 --> 00:21:53.953
Time and range of glucose is the defining standard of good practice in Type 1 diabetes.
00:21:54.313 --> 00:21:55.483
Insulin isn't considered.
00:21:55.563 --> 00:21:57.854
They don't… It doesn't matter how much insulin you use.
00:21:57.854 --> 00:21:59.644
I always called it a hedonistic approach.
00:22:00.053 --> 00:22:02.903
Eat what you like and shoot up what it takes, shoot to suit.
00:22:03.303 --> 00:22:07.723
And I think we're not thinking about insulin in the right way.
00:22:08.114 --> 00:22:12.653
And my approach used to be count your carbs, inject insulin.
00:22:12.653 --> 00:22:17.823
Now it's definitely how does insulin work in the body across all the foundations of health?
00:22:18.344 --> 00:22:21.124
What is a healthy hu- what does a healthy human being look like?
00:22:21.864 --> 00:22:24.884
What does someone without Type 1 diabetes, what's their insulin doing?
00:22:25.263 --> 00:22:31.283
'Cause their blood sugar's always well-controlled because they have a functioning metabolic system that includes insulin.
00:22:31.693 --> 00:22:39.344
But we have to inject it, so how much do we need to inject considering it's imperfect, we inject at the wrong time, the wrong place, and it lasts too long.
00:22:39.923 --> 00:22:49.334
But how do we look at a healthy human being and say, "What do they look like? I want some of that." And a healthy human being, I think, has fairly low insulin levels typically.
00:22:49.913 --> 00:22:58.144
There's lots of evidence now that, that- Now real quick, just because I'm not a doctor, when you say low insulin levels, you're talking about the insulin that's in the blood- In your body.
00:22:58.193 --> 00:22:58.344
Yeah.
00:22:58.683 --> 00:22:59.673
In your body, yeah.
00:22:59.864 --> 00:23:01.144
In the whole body, okay.
00:23:01.233 --> 00:23:01.523
Yeah.
00:23:01.993 --> 00:23:06.473
So typically insulin is released when there's this the blood glucose rises.
00:23:06.503 --> 00:23:08.443
Now, the blood glucose can rise due to diet.
00:23:08.493 --> 00:23:17.703
It can also rise due to stress hormones such as growth hormone, adrenaline, cortisol and other hormones have an effect to, to stop the insulin working as effectively as it might.
00:23:18.243 --> 00:23:21.394
So insulin is a primary metabolic regulator.
00:23:21.403 --> 00:23:26.963
One of its functions is to reduce blood glucose, but it has many functions bey- beyond that.
00:23:27.013 --> 00:23:29.063
It's a regulator of energy in cells.
00:23:29.753 --> 00:23:50.624
Now- If you have if I think a healthy human being does a lot of exercise, or should do, eats two meals a day, has a period of fasting, p- eats primarily protein and fat gets outside a lot, has good mental health, and and has respect to their circadian rhythm.
00:23:50.624 --> 00:23:55.073
So for example, middle of the night we want all these blue lights on you'd be cutting down your light.
00:23:55.533 --> 00:24:01.683
So we need to, what I've decided we need to do is look at w- what makes a healthy human being, so can us type 1s have a bit of that, please?
00:24:02.303 --> 00:24:06.844
So one of the features I think of a healthy human being is something called metabolic flexibility.
00:24:07.293 --> 00:24:15.163
It's being able to choo- for your cells of your body, your organs of your body, to choose the fuel that they require at the time.
00:24:15.834 --> 00:24:25.063
So Dr. Phil Ovadia you are a cardiologist, you know that the heart h- is quite happy on fatty acids and ketones, and it will also use glucose.
00:24:25.513 --> 00:24:38.303
But if you have type 1 diabetes and you take a lot more insulin than your body needs, and because of where we put it in our body, into the skin, we've already got more insulin than we, we really should have because of the absorption issues that we have.
00:24:38.854 --> 00:24:58.728
So if you have too much insulin, what happens is you stop your metabolic flexibility from happening because if you have too much insulin in your body you cannot burn fat to produce fatty acids and ketones to produce those other energy molecules which the body can happily use So if you have too much insulin in your body, you're a fat storer.
00:24:58.768 --> 00:24:59.728
You're a fat storer.
00:24:59.788 --> 00:25:00.498
That's what you do.
00:25:01.147 --> 00:25:11.397
If you have little insulin in your body, you're a fat burner, so you can produce other nutrients that will provide energy, fatty acids and ketone bodies which derive from fat.
00:25:11.957 --> 00:25:14.018
Your body will make all the glucose you need.
00:25:14.018 --> 00:25:18.137
You do not need to eat sugar or carbohydrates in order to survive.
00:25:18.467 --> 00:25:25.917
Those poor people that get dragged out of earthquake zones eight days later, they haven't been secretly, they didn't luckily have a stash in the fridge of candy bars.
00:25:25.917 --> 00:25:27.897
They were pulled out and they were burning their body fat.
00:25:28.427 --> 00:25:33.397
But in type 1 diabetes, on, on the diet we are typically recommended high carbohydrate diet.
00:25:33.807 --> 00:25:36.258
We are denying our body metabolic flexibility.
00:25:36.317 --> 00:25:38.738
We're forcing our body just to use glucose.
00:25:39.197 --> 00:25:54.077
And we know in some conditions, certainly the mental health space which has accelerated our knowledge of metabolism, that you can do very well with bipolar disease, for example with metabolic flexibility, allowing your body to access ketone bodies.
00:25:54.518 --> 00:26:01.288
Because there's some evidence that the meta- the regulatory function of the insulin fails in the brain in a high carbohydrate environment.
00:26:01.798 --> 00:26:11.712
So y- if you've got ketone bodies available, if you've got low insulin levels so you're not storing fat, you're burning it, you are providing the body with what I call metabolic flexibility.
00:26:12.082 --> 00:26:17.012
And the current method of managing type 1 diabetes denies our body access to those fuels.
00:26:17.663 --> 00:26:30.002
And so if you have someone with bipolar disease who is fueling their body on a very low carbohydrate diet and they develop type 1 diabetes, it's a clinical problem at the moment to know how to advise them.
00:26:30.002 --> 00:26:30.893
I know what I would do.
00:26:31.272 --> 00:26:36.212
I would say, "Carry on your ketogenic diet." But some people would say no, you've gotta have carbs.
00:26:36.282 --> 00:26:44.252
You gotta have carbs as part of your treatment." And that will of course take them out of recovery and put them back into their bipolar state.
00:26:44.812 --> 00:27:04.262
So there are lots of clinical questions we need to ask, but over the years I've learned about the f- the positive impact of a multi-fueling system on cancer, on m- mental health, on migraine, on polycystic kidney disease, on type 2 diabetes, and I think it also works on type 1 diabetes as well.
00:27:04.792 --> 00:27:12.532
It's ironic that the one condition where we do best to respect metabolic flexibility is the one condition that we're not actually helping out.
00:27:14.820 --> 00:27:16.610
I wish I was surprised.
00:27:18.330 --> 00:27:18.820
Yeah.
00:27:18.990 --> 00:27:22.911
Now it it's hard enough just managing type 1 diabetes.
00:27:22.941 --> 00:27:29.610
You've added a extra layer of complexity by being an athlete, an endurance athlete.
00:27:29.971 --> 00:27:39.780
You have done such what many people would view as crazy things, such as running 100 miles in five days as a type 1 diabetic.
00:27:39.810 --> 00:27:41.830
You did that completely fasted.
00:27:42.060 --> 00:27:48.431
And then in your new book you talk about a thousand-mile bike ride as a type 1 diabetic.
00:27:48.431 --> 00:27:58.350
So talk a little bit about, what that then adds if you're not just trying to get through your day-to-day, you're trying to, perform as an athlete at a high level.
00:27:59.436 --> 00:28:05.326
So the Zero Five 100, the project we did a few years ago now, was two people with type one diabetes and six others.
00:28:05.726 --> 00:28:26.956
We I conceived this because I was… I thought how can we actually show to my clinical colleagues that, the main problems that, that they're worried about aren't actually, they really don't need to worry about them." The fact that if you're in what's called nutritional ketosis, if you're not eating carbohydrates and you're burning fats, producing this energy molecule called a ketone body it's not dangerous.
00:28:26.956 --> 00:28:31.366
It doesn't lead to diabetic ketoacidosis, that you don't need sugar for sport.
00:28:31.416 --> 00:28:38.396
You can fuel on fat for sport, certainly the level I was performing at which is not Usain Bolt sort of level where he eats.
00:28:38.446 --> 00:28:42.856
And if you're taking insulin, you don't need to take carbohydrates.
00:28:42.856 --> 00:28:49.226
So we proved all of those things, and I thought just doing that alone should convince my colleagues that, hey, this is actually safe.
00:28:49.406 --> 00:28:58.797
Unfortunately, it was so radical, it was designed to be radical to actually rule out any issues that I might be, there might be other reasons for why we're doing so well.
00:28:59.257 --> 00:29:03.626
But I thought it was seen as so radical it wasn't relatable which is a shame really.
00:29:03.956 --> 00:29:19.656
So I got a chance to go to Saint Moritz to do a talk to Keto Life, which is a, sort of a keto conference which covers w- things that we're talking about, mental health neuropsychiatry, neurology cancer, diabetes, et cetera.
00:29:20.037 --> 00:29:21.616
And it was to do with type one and sports.
00:29:21.626 --> 00:29:23.966
So I thought I'll cycle there." I had a bit of time on my hands.
00:29:24.406 --> 00:29:29.017
But it wasn't done as a Lycra-fest man of a certain age sort of type of project.
00:29:29.037 --> 00:29:33.946
It was done as a, I'm just an old bloke who's cycling 65 miles a day, 60 miles a day, whatever.
00:29:34.446 --> 00:29:50.876
And it was conceived as a ketogenic, a very low carbohydrate diet, and I measured all of my carbohydrates every five minutes through a continuous glucose meter, and I measured all of my ketones every five minutes through a continuous ketone meter for three whole weeks and published them in the book, which is a big thing to do, I tell you.
00:29:51.406 --> 00:29:52.446
It's not all perfect.
00:29:52.876 --> 00:29:58.996
And it I also started to explore the roots of health and how insulin works.
00:29:59.356 --> 00:30:01.206
So it's half a travel journal, half textbook.
00:30:01.666 --> 00:30:05.146
And it's a textbook written at the non-specialist non, non-medic.
00:30:05.606 --> 00:30:13.452
So h- it was to explore- How insulin works and how do we manage insulin across all of the roots of health?
00:30:13.452 --> 00:30:14.663
So how does insulin operate?
00:30:14.673 --> 00:30:16.163
Insulin has its own circadian rhythm.
00:30:16.173 --> 00:30:19.072
We're more insulin sensitive at certain times of day than other times of day.
00:30:19.582 --> 00:30:20.512
So let's look at that.
00:30:20.522 --> 00:30:24.153
Let's see if we can manipulate our insulin to get a good result on that.
00:30:24.663 --> 00:30:29.353
How does insulin, how is insulin affected by the sleep process or bad light?
00:30:29.782 --> 00:30:35.562
How does infrared, ultraviolet, how does that impact on our insulin sensitivity and our inflammation in our bodies?
00:30:35.952 --> 00:30:40.232
How does mindset, stress hormones, how do they impact on insulin and what can we do about it?
00:30:40.552 --> 00:30:42.143
Then of course, physical activity.
00:30:42.423 --> 00:30:53.502
The great work by Tim Noakes and Jeff Volek and Dom D'Agostino and others who have shown really that you can burn fat at a high level of exercise, and it can perform just as well as sugar.
00:30:54.143 --> 00:30:56.173
So we thought we'll take advantage of that then.
00:30:56.232 --> 00:30:58.182
So that's great that they produced that.
00:30:58.262 --> 00:31:02.052
So it means that people with type 1, we can perform at a good level if we want to.
00:31:02.292 --> 00:31:07.393
I'm not in that category, but we looked at that, and we also looked at diet in great detail.
00:31:07.853 --> 00:31:15.267
So the whole of that, the book is based- how can we understand insulin?
00:31:15.267 --> 00:31:21.916
How can we use it wisely to, to give our bodies the metabolic flexibility that we need?
00:31:22.446 --> 00:31:27.168
And of type 1 diabetes every day.
00:31:27.598 --> 00:31:38.658
And I think the book w- is gonna be helpful to people with type 1 to show that, yes it, it is logical scientifically to be able to cut your carbs.
00:31:38.999 --> 00:31:42.019
Yes, you can skip breakfast if you want to.
00:31:42.398 --> 00:31:45.858
But y- you can control the noise of diabetes.
00:31:45.918 --> 00:31:52.188
I did a chapter I called it Silencing the Chainsaw to Hear the Birds Sing, quite a romantic sort of idea.
00:31:52.528 --> 00:32:06.598
But really- … once you're on to optimize insulin, your glucose follows and once the glucose is quiet you can tune into all of those subtle bodily functions which are hidden by this constant noise of carbohydrates and insulin trying to balance one with the other.
00:32:06.948 --> 00:32:10.798
You get a really smooth profile overall and you don't worry.
00:32:11.378 --> 00:32:21.628
There's one phrase in the book, I said I've s- I've injected my insulin, my glucose is now set, and I don't need to worry for the rest of the day," and I still had 40 miles to cycle, and I didn't need to worry for the rest of the day.
00:32:22.019 --> 00:32:24.178
So that is remarkable if you think about it.
00:32:24.178 --> 00:32:33.568
I had to double take on that thought because as most people with type 1 diabetes, you don't have that luxury of just cycling for 40 miles and not even having to worry about carb fueling or anything like that.
00:32:34.158 --> 00:32:36.259
I was fat burning, quite happily fat burning.
00:32:36.269 --> 00:32:37.588
I was in a ketogenic state.
00:32:38.068 --> 00:32:42.469
I was r- really alert with my body, my blood glucose was following that.
00:32:42.858 --> 00:32:49.219
So that's what that's all about really, trying to understand how to use as much insulin as necessary, but as little as possible.
00:32:49.588 --> 00:32:52.979
There are days when you need more insulin, and I wrote about that in the book.
00:32:53.048 --> 00:32:57.528
I needed more insulin on a couple of days than than ideal because you have to go with it.
00:32:57.538 --> 00:32:58.148
If you need it.
00:32:58.538 --> 00:33:01.769
And there are days when I use less insulin like a few units of insulin.
00:33:02.178 --> 00:33:08.948
So it's all about metabolic flexibility insulin optimization I call it and looking at all of the roots of health holistically.
00:33:13.078 --> 00:33:17.658
So let's talk about… Let's apply this to the broader public.
00:33:17.709 --> 00:33:20.078
Let's ap-apply this to everybody.
00:33:20.628 --> 00:33:20.898
Yeah.
00:33:20.908 --> 00:33:39.148
What I'm hearing is as it applies to folks who are not diabetic or not injecting insulin, you said something quite a bit earlier that I thought was noteworthy something about a focus on glucose rather than on, on insulin.
00:33:39.759 --> 00:33:56.459
And you've talked about optimizing was the word you used, optimizing insulin exposure across your diet, your movement, your sleep, your stress, and your environment.
00:33:57.209 --> 00:34:01.499
That's not just applicable to type 1 diabetics.
00:34:01.729 --> 00:34:03.959
That's applicable to all of us.
00:34:04.418 --> 00:34:19.186
So if you would, unpack that idea of insulin optimization for those of us who don't have to inject it So every single person produces insulin.
00:34:20.047 --> 00:34:21.137
Pancreas produces it.
00:34:21.746 --> 00:34:41.206
People with type one don't produce it-… And other categories But so we are in a difficult situation, but we need to know what someone without diabetes is doing with their insulin, and we can find that out by need- looking at how much we need to inject.
00:34:41.597 --> 00:34:45.266
But we can only find that out when we isolate each variable.
00:34:45.277 --> 00:34:52.696
So if we're running under a constant noise of carbohydrates we haven't got a clue what the subtle signs of circadian rhythms, day, night cycle.
00:34:52.696 --> 00:35:00.996
We haven't got a clue what's happening there because it's hidden by this constant high insulin level, and we're not sensitive enough to it.
00:35:01.476 --> 00:35:09.496
So insulin is secreted by everyone and insulin is secreted as a metabolic regulator and in response to blood glucose control.
00:35:09.797 --> 00:35:19.666
We know that carbohydrates, so you know, pasta, rice, potatoes, bread, et cetera, that they all convert to sugar in the bloodstream and raise the blood sugar.
00:35:19.976 --> 00:35:27.916
So insulin will be secreted by your pancreas to bring the blood sugar down, and that happens for everybody with every meal.
00:35:28.436 --> 00:35:34.296
Now, your blood sugar would be perfect, but your insulin levels might be going up and down like that all the time.
00:35:34.756 --> 00:35:40.706
If you're stressed your blood sugar will go up because of the stress hormones raise blood sugar.
00:35:40.956 --> 00:35:45.066
So your body will in concert produce insulin to try to bring that blood sugar down.
00:35:45.546 --> 00:35:51.756
If you're having a poor sleep, you'll, you become more resistant to your insulin, so your body produces more to overcome that.
00:35:52.186 --> 00:35:56.716
So over time, you end up with more and more insulin in your body throughout the whole day.
00:35:57.076 --> 00:36:00.346
And of course we know that insulin's an inflammatory hormone.
00:36:00.806 --> 00:36:02.626
We know that it leads to weight gain.
00:36:02.626 --> 00:36:05.706
We know that it leads to salt retention and high blood pressure.
00:36:06.216 --> 00:36:12.146
And we know that it can, because of the way insulin stores fat, lead to these conditions called fatty liver, et cetera.
00:36:12.146 --> 00:36:15.676
So insulin will eventually lead to what I call metabolic syndrome.
00:36:16.186 --> 00:36:30.496
And we know that if you're eating all the time, you're denying your body metabolic flexibility, so you're making your body more vulnerable to those, to making your, some of the tissues in your body more vulnerable to tho- to those that need ketone bodies or need fatty acids and things like that.
00:36:31.106 --> 00:36:36.436
So for someone without type one, you will produce, be producing insulin.
00:36:36.456 --> 00:36:37.756
We just have to inject it.
00:36:38.226 --> 00:36:44.296
So we can pretty well tell you, the book will tell you if you don't have type one, what's going on in your body pretty well.
00:36:44.766 --> 00:36:52.796
So- and high insulin levels we know are associated, as I've talked about in this talk with diseases.
00:36:53.156 --> 00:37:04.186
Glucose is a s- is e- eventually a symptom of type 2 diabetes when the insulin just cannot cope with the sheer metabolic load that it has to cope with as the insulin's overwhelmed.
00:37:04.236 --> 00:37:06.486
But that process has been going on for years before.
00:37:06.546 --> 00:37:09.006
So it a- it applies.
00:37:09.016 --> 00:37:13.286
So type 1 insulin requirements apply to people with type 2.
00:37:13.606 --> 00:37:17.416
So how can we get insulin low to enable metabolic flexibility?
00:37:17.746 --> 00:37:24.636
It's all about understanding the five foundations of health which lead to situations where we're raising insulin all the time.
00:37:25.196 --> 00:37:28.426
So insulin, I think, is as important as blood sugar.
00:37:28.426 --> 00:37:29.276
Blood sugar's a symptom.
00:37:29.276 --> 00:37:32.756
Cholesterol's a symptom of metabolic disruption.
00:37:32.756 --> 00:37:34.086
Fatty liver's a symptom.
00:37:34.086 --> 00:37:35.256
High blood pressure's a symptom.
00:37:35.586 --> 00:37:36.526
Weight's a symptom.
00:37:37.146 --> 00:37:42.986
So we can look at all these symptoms and modify them, which of course we do with endless medications.
00:37:43.436 --> 00:37:49.566
But if you have type 1 diabetes just respecting the insulin will improve all of those symptoms with just with one drug.
00:37:50.016 --> 00:37:51.516
But you're lowering the insulin.
00:37:52.006 --> 00:37:54.846
And in- No you're going too fast here 'cause that was profound.
00:37:55.826 --> 00:38:09.164
If you have type 1 diabetes And you manage it with insulin, you will reduce all those symptoms or manage all those symptoms.
00:38:09.374 --> 00:38:09.674
Yeah.
00:38:09.754 --> 00:38:13.724
I… And again, if you would please, list those symptoms.
00:38:13.734 --> 00:38:16.134
Those, this is important stuff, folks.
00:38:16.504 --> 00:38:28.034
We really the reason this caught my attention is your long list of things that are symptoms that we have drugs for, but the drugs are treating the symptoms.
00:38:29.024 --> 00:38:47.674
And what I inferred from what you said is the root cause is something that we use insulin to manage the expression of the root cause, which is these various symptoms with, rather than just muting the noise of the symptom.
00:38:48.074 --> 00:38:52.134
I'm… I don't mean to distort it, but if you would, just go back again.
00:38:52.364 --> 00:38:54.214
These things are symptoms.
00:38:55.374 --> 00:38:55.554
Yeah.
00:38:55.624 --> 00:39:02.794
So someone with type one diabetes, over time you start to learn that insulin has more effects than just lowering blood sugar.
00:39:03.554 --> 00:39:11.094
So too much insulin and that is caused by having a diet that is high in carbohydrates, so you need far more insulin to control that.
00:39:11.324 --> 00:39:16.354
And we're vulnerable because we already, because of where we inject our insulin, have too much of it anyway.
00:39:16.644 --> 00:39:20.104
So too much insulin will lead to constant fat storage state.
00:39:20.804 --> 00:39:31.764
You're always in fat storage state, and if you're eating all of the time, three meals a day plus snacks pl- and nighttime drink, which some people have as well you're constantly putting carbohydrates into the body.
00:39:31.774 --> 00:39:38.274
60%, 50% of our diet, in the US now they- they've recommended that people invert the pyramid.
00:39:38.554 --> 00:39:40.224
But in, in my country, they haven't.
00:39:40.344 --> 00:39:51.794
In fact, a funny aside on that, I wrote to one of the major charities over here and said, "What do you think to the American guidelines?" They said,"Oh we're sticking with the EU- Euro- with the UK guidelines." I said I'm an American living in the UK.
00:39:51.864 --> 00:40:00.976
What should I do?" And they said, "Oh follow which ones you want." So there's a lot of science behind that Oh yeah, lots of science there.
00:40:00.976 --> 00:40:01.666
The old guidelines.
00:40:01.716 --> 00:40:11.816
So high levels of insulin caused by mostly diet and inactivity, I think, i- insulin's a very good meta- physical activity's very good for regulating metabolism.
00:40:11.826 --> 00:40:17.266
It you can hoover up a lot of sugar into muscle if you're exercising and make your body more insulin sensitive.
00:40:17.706 --> 00:40:18.476
So there are two things.
00:40:18.476 --> 00:40:34.246
There's too much insulin and insulin resistance, and eventually your body becomes resistant to insulin, so you need to make more and more of it to cope with the metabolic load caused by your lifestyle, which is predominantly driven by too many carbohydrates in the diet in people who are vulnerable.
00:40:34.436 --> 00:40:40.996
People are… a lot of people now are overweight and obese, and they're clinically vulnerable to too much insulin.
00:40:41.386 --> 00:40:47.906
And fat storage is not a feature of fat more a feature of too much carbohydrate.
00:40:48.266 --> 00:40:55.576
So the sugar gets taken out of your blood, and so the biggest source of fat in, in our bodies is carbohydrate not fat, strangely.
00:40:56.146 --> 00:41:05.486
So too much carbohydrate leads to the need to clear the blood sugar out of the bloodstream because our bloodstream is, has a very tight level of control.
00:41:05.786 --> 00:41:18.346
It the blood glucose needs to be very tight because the tissues are surrounded by something called interstitial fluid, and they need a very tight regulated level of glucose in order to work properly.
00:41:18.386 --> 00:41:21.796
Too much glucose will damage the receptors in the cell.
00:41:22.036 --> 00:41:25.616
So as soon as the blood sugar goes up, insulin's out of the traps instantly.
00:41:25.666 --> 00:41:26.426
It's ready to go.
00:41:26.436 --> 00:41:31.226
I- insulin in your body is stored in granules and released as soon as blood glucose goes up.
00:41:31.706 --> 00:41:33.686
And then they get rid of the blood sugar.
00:41:33.796 --> 00:41:41.436
So if you're exercising, that insulin will augment the ac- the clearance of blood glucose into the muscles.
00:41:41.616 --> 00:41:48.216
If you're not exercising like we're not now the insulin will direct that to the liver, and the liver will make that sugar into fat.
00:41:48.902 --> 00:41:50.562
And then so people put on weight.
00:41:50.612 --> 00:41:56.162
And if we're continually eating carbohydrates, we're continually producing insulin, we're continually producing fat.
00:41:56.542 --> 00:42:01.782
And we know that people with type 1 diabetes tend to put on weight as they go through their diabetes journey.
00:42:02.112 --> 00:42:07.392
When you're producing a lot of fat, your liver's got- So is it the excess insulin that cause… Okay, I'm I'm following you.
00:42:07.392 --> 00:42:08.622
I think I'm following you.
00:42:08.762 --> 00:42:08.782
Yeah.
00:42:08.782 --> 00:42:08.942
All right.
00:42:08.942 --> 00:42:14.282
So the excess insulin causes excess fat, and then the excess fat builds up in the liver and causes fatty liver.
00:42:14.362 --> 00:42:19.762
But before that, the excess fat is sprayed around the body and d- deposited into fatty tissues.
00:42:20.212 --> 00:42:25.362
And of course, that excess fat also is packaged with cholesterol, and that's where all the problems start.
00:42:25.362 --> 00:42:28.992
All, you know- … all of the cholesterol evidence is based around high-fat diets.
00:42:29.392 --> 00:42:33.942
Cholesterol profiles alter with a low-fat diet, a ketogenic type of diet.
00:42:34.412 --> 00:42:41.582
But we apply the high-fat research to… So we apply fat storage research into fat burning.
00:42:41.932 --> 00:42:50.632
So it's difficult to know how to interpret cholesterol on a ketogenic diet based around the fact that 99% of evidence is based on a high-carbohydrate diet.
00:42:51.142 --> 00:42:54.242
So we have cholesterol as a as a symptom of high glucose.
00:42:55.232 --> 00:42:55.752
High insulin.
00:42:55.822 --> 00:43:05.942
High insulin makes the kidney retain salt, and with the salt comes the fluid, and with the salt and the fluid in a closed system like the blood vessel system, unless you're bleeding, you get high blood pressure.
00:43:06.722 --> 00:43:15.442
So insulin generates high blood pressure, and we know that when people go on a keto diet, they flush out a huge amount of fluid and the blood pressure drops within six to eight weeks and it's all sorted out.
00:43:16.112 --> 00:43:27.832
So all of those things, the high blood pressure, the abnormal cholesterol profiles, the fatty liver the weight gain, are all caused by too much insulin in the body and metabolic dysregulation.
00:43:28.202 --> 00:43:40.552
So it's not just insulin by itself, it's how that insulin impact, impacts or is impacted by the other 30 or o- th- 30 or 40 other hormones that are produced in the body, and insulin interacts with nearly all of those.
00:43:40.852 --> 00:43:46.952
So it's a metabolic dysregulation caused by an abnormal amount of insulin in the body, in my view.
00:43:47.462 --> 00:43:54.912
So it's like every system, every complex system you inject a variable constantly and things change i- in the whole body.
00:43:54.922 --> 00:43:58.592
If you've got water that contains a lot of lime, eventually your pipes are gonna fur up.
00:43:59.282 --> 00:44:05.922
But if you reduce the lime, the pipes won't fur up, if so it's getting the metabolism right in the body for your body.
00:44:06.162 --> 00:44:17.092
I'm not saying it's for everybody, but I think everyone should be aware of it so they can make an informed choice rather than just blindly follow eating, counting carbs, and injecting insulin on the assumption that insulin is not important.
00:44:17.112 --> 00:44:18.522
It's very important indeed.
00:44:19.032 --> 00:44:20.302
That's the basis of the book, really.
00:44:22.470 --> 00:44:25.560
Yeah the the complex interrelationship, right?
00:44:25.640 --> 00:44:26.730
A- and you've mentioned it.
00:44:26.740 --> 00:44:35.830
Insulin it the regulation of glucose is o- only one of many things that insulin actually does in our bodies.
00:44:36.170 --> 00:44:40.480
And again, that, that is a incredibly complex system.
00:44:40.800 --> 00:45:05.250
And there's just, at a high level we sit back today, knowing Dr. Bernstein's work, seeing, all the work that's being done around ketogenic and low carb diets in both diabetics and non-diabetics, and, it's almost insane to think that the mainstream recommendations around type 1 diabetes are what they are, right?
00:45:05.260 --> 00:45:21.040
To just tell people, not… a- and, to be clear there is guidance that is given to type 1 diabetics that are diagnosed, today that eating low carbohydrate is actually dangerous, right?
00:45:21.040 --> 00:45:24.470
You need to have a minimum amount of carbohydrates.
00:45:24.710 --> 00:45:43.760
And, to just think about how we got here it really is insane that this is where we ended up with the management of type 1 diabetes, let alone the implications that then has for type 2 diabetes and even for, dietary recommendations around non-diabetics.
00:45:44.330 --> 00:45:49.090
What what's your thinking on what it will take to change this?
00:45:49.380 --> 00:45:56.490
Obviously, something you're a big proponent of, and really all of us in this low carb community are big proponents of.
00:45:56.710 --> 00:46:09.750
But again knowing what you know from the inside as a doctor and as a patient what kind of response do you get from your type 1 diabetic patients today when you present this information to them?
00:46:11.262 --> 00:46:12.802
There are two angles to this.
00:46:12.802 --> 00:46:20.192
I use my website and I a- attract a certain type of type 1 who's interested, so they're already pretty well easily convertible.
00:46:20.662 --> 00:46:31.102
And then in my NHS practice, I, most of the type 1 people with type 1 are specialist led, so it's a secondary care special- specialism and generalists like me don't really get involved.
00:46:31.542 --> 00:46:37.892
But I, I feel an ethical responsibility really to say th- this is something you might want to look at." Not everyone's interested.
00:46:37.942 --> 00:46:40.492
People have all sorts of reasons why they don't want to change.
00:46:40.522 --> 00:46:45.312
A lot of people have got a formula that works, and they've struggled for years to get that formula that works for them.
00:46:45.752 --> 00:46:49.862
So I offer that up to people and support it if that's what they want to do.
00:46:50.332 --> 00:46:56.532
I think those converted people the commonest question I get is, "Why didn't you… Why wasn't I told this at the start?
00:46:56.572 --> 00:47:10.652
Why have I wasted 10 years of my life with complications when th- this could have made me so much better?" I had one person who said even if they could, got a cure for diabetes type 1 tomorrow, I wouldn't change my lifestyle now I know what is required.
00:47:10.652 --> 00:47:12.052
I feel so much better.
00:47:12.452 --> 00:47:16.072
And that's what we alluded to, the low insulin lifestyle for a healthy human being.
00:47:16.542 --> 00:47:19.342
It makes people feel so much better and more active.
00:47:19.342 --> 00:47:26.412
So even if you don't have diabetes, there's a lot of unfit people who don't have type 1 diabetes out there and due to driven by lifestyle.
00:47:26.902 --> 00:47:37.942
I had someone w- who's been 20 years on a pump, and he says the best ever control he's ever had was with a ins- when he started to understand how to use his insulin doctors are difficult people to deal with.
00:47:37.952 --> 00:47:43.042
They're under a huge amount of pressure to to operate on a, certainly generalists across many levels.
00:47:43.402 --> 00:47:48.182
But somehow the ketogenic, the word keto in, in diabetes freezes the room.
00:47:49.102 --> 00:47:50.902
It, it just cannot get through to people.
00:47:50.962 --> 00:47:53.322
And once you mention keto, you've lost the whole of the room.
00:47:53.482 --> 00:47:55.552
So it has to be, I think education.
00:47:55.552 --> 00:47:56.252
We're all doing a bit.
00:47:56.262 --> 00:47:57.422
We're all chipping away at the rock.
00:47:57.782 --> 00:48:03.452
The journalists who report on it, the people the, the experimenters like me who just put stuff out on social media.
00:48:03.862 --> 00:48:08.152
S- the mental health space, the polycystic kidney space, the diabetes space, the heart space.
00:48:08.422 --> 00:48:11.352
Everyone's working together and the message is getting out there.
00:48:11.662 --> 00:48:14.682
So my book is written really for my fellow type 1s.
00:48:14.772 --> 00:48:34.242
I thought I'd write it a- as a hybrid to attract clinicians, but I genuinely think that the fastest route to progress is to write it for people with the condition 'cause they will resonate with it a lot, and they will be able to implement their own changes or certainly have a very good conversation with their healthcare s- specialist about why they're doing what they're doing.
00:48:34.292 --> 00:48:44.392
And then if the healthcare specialists do not want to go along with I, I would call it updating the knowledge really, 'cause over the last five to 10 years we've updated our knowledge.
00:48:44.822 --> 00:48:51.392
And e- and if some specialists don't want to update their knowledge they can say what they like, but they'll become irrelevant because people will just be getting on with it.
00:48:51.852 --> 00:48:55.452
And type 1s get on with it 365 days a year.
00:48:55.482 --> 00:48:58.622
You'll never find- … a diabetologist at 3:00 in the morning when you're in trouble.
00:48:59.262 --> 00:49:00.402
You might find an ambulance.
00:49:00.412 --> 00:49:05.592
So t- type 1 diabetes are very flexible people and very adept at keeping out of trouble.
00:49:05.592 --> 00:49:05.682
Good.
00:49:05.732 --> 00:49:17.892
And once they know that they're not the only ones in the world with that condition and they're living with it alone, and once they've, see that I've been very vulnerable here and I told it how it is for me, and it's not like a doctor, I tell you.
00:49:17.902 --> 00:49:22.522
It's someone who's not brilliantly controlled but good enough to make the book work.
00:49:22.822 --> 00:49:32.802
Once they realize that it is a condition you can un- you can understand more deeply and manage more easily and you don't have to worry about it every day, I think that will start to lead the change.
00:49:32.802 --> 00:49:43.122
That's my contribution to this space is to support people who are otherwise not even find out about other ways of living with type 1, and those on their own that think,"Oh, he does that as well.
00:49:43.762 --> 00:49:46.312
Oh, he should know what he's doing," and "Oh, he has
00:49:46.332 --> 00:49:47.672
00 in the morning.
00:49:48.182 --> 00:49:49.982
Oh, he forgets to inject his insulin as well.
00:49:50.092 --> 00:49:52.702
Oh, so do I." It's relatable I hope.
00:49:53.362 --> 00:49:53.692
All right.
00:49:53.692 --> 00:49:57.152
Let's talk about how folks who want to f- find the book can get the book.
00:49:59.012 --> 00:50:01.322
So it's on Amazon all all Amazons.
00:50:01.322 --> 00:50:03.892
It's a e-book as well as a paperback, and it's
00:50:03.892 --> 00:50:10.892
The Thousand Mile Ride That Changed My Mindset on Type 1 Diabetes, so quite a handful.
00:50:11.482 --> 00:50:11.652
Yeah.
00:50:11.652 --> 00:50:12.062
Yeah.
00:50:12.122 --> 00:50:16.082
If you just Go- If you just put in Shifting Gears Ian Lake, it'll come up.
00:50:16.082 --> 00:50:16.212
Yes.
00:50:16.212 --> 00:50:16.602
There we go.
00:50:16.602 --> 00:50:16.822
Yes.
00:50:17.102 --> 00:50:23.102
And having done the search for just Shifting Gears on Amazon- Yeah … there's all kinds of stuff that is not what we're looking for.
00:50:23.102 --> 00:50:23.122
Yeah.
00:50:23.122 --> 00:50:26.382
I think there's quite a few TV series out there on Shifting Gears.
00:50:26.382 --> 00:50:28.182
Oh.
00:50:28.182 --> 00:50:28.332
Oh.
00:50:28.572 --> 00:50:29.562
Very good.
00:50:29.572 --> 00:50:34.432
And w- and where can people go to find out more about your work outside of the book?
00:50:34.872 --> 00:50:38.842
Type1keto.com and IFixHearts is a good place.
00:50:38.842 --> 00:50:41.772
I've had two podcasts on your show now, so thank you very much.
00:50:42.092 --> 00:50:42.642
Yes.
00:50:42.692 --> 00:50:45.552
It's always great being able to catch up with you.
00:50:45.552 --> 00:50:50.852
And yeah, certainly want to encourage people to check out your website Type 1 Keto.
00:50:50.852 --> 00:50:52.662
It's a great great website.
00:50:52.662 --> 00:51:02.722
And like I said, it's the information that we're learning from the work that you're doing is very applicable to those of us that are not Type 1 diabetics as well.
00:51:02.762 --> 00:51:21.332
And I think your focus on A- and I think it's a great way to reframe the conversation, not necessarily as a ketogenic diet, but as an insulin-controlling diet, essentially is what you're advocating for, and I think it makes a lot of sense and it will help a lot of people.
00:51:23.976 --> 00:51:24.176
Thank you.
00:51:24.176 --> 00:51:25.746
So do I. I hope it helps a lot of people.
00:51:27.086 --> 00:51:27.526
All right.
00:51:27.536 --> 00:51:29.486
Our guest has been Dr. Ian Lake.
00:51:29.486 --> 00:51:32.306
His book is Shifting Gears on Amazon.
00:51:32.396 --> 00:51:34.076
Search for his name as well.
00:51:34.596 --> 00:51:37.126
And the website Type 1 Keto.
00:51:37.216 --> 00:51:39.916
One is the numeral, it's not spelled out.
00:51:40.026 --> 00:51:42.426
Type numeral 1 keto.com.
00:51:43.836 --> 00:51:47.696
For Dr. Philip Ovadia, this has been Stay Off My Operating Table.
00:51:47.696 --> 00:51:48.706
Thanks for joining us.
00:51:48.726 --> 00:51:50.756
We look forward to talking to you next time
