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metformin for weight loss
i have the best job in the world. i'm a doctor. no! believe me that's not why. i'm an obesity doctor. i have the honor of workingwith the group of people
metformin for weight loss, subject to the last widelyaccepted prejudice: being fat. these people have suffered a lotby the time they see me: shame, guilt, blameand outright discrimination. the attitude that many take,including those in healthcare,
is that these peopleare to blame for their situation. if they could just control themselves,they wouldn't be overweight, and they are not motivated to change. please let me tell youthis is not the case. the blame, if we've gotto extend some here, has been with our advice. and it's time we change that. obesity is a disease, it's not somethingcreated by lack of character. it's a hormonal disease,and there are many hormones involved.
and one of the main onesis a hormone called insulin. most obese individualsare resistant to this hormone, insulin. so, what does that mean exactly,to be resistant to insulin? well, insulin resistance is essentiallya state of pre-pre-type 2 diabetes. insulin's job is to drive glucose,or blood sugar, into the cells where it can be used. in a nutshell, when someoneis insulin resistant, they are having troublegetting blood sugar where it needs to go, into those cells.
and it just can't hang outin the blood after we eat or we would all have a diabetic crisisafter every meal! so, when someone is resistant to insulin, the body's response to thisis to just make more of it. and insulin levels will rise and rise, and for a while, years even,this is going to keep up, and blood sugar levels can remain normal. however, usually it can't keep up forever, and even those elevated levels of insulin
are not enough to keep blood sugarin the normal range. so it starts to rise. that's diabetes. it probably won't surprise you to hear that most of my patientshave insulin resistance or diabetes. and if you are sitting there thinking,"phew, that's not me," you actually might want to think again, because almost 50% of adult americansnow have diabetes or prediabetes. that is almost 120 million of us.
but that's hardly everyonewho has issues with insulin. because as i was saying, people have elevated insulin levelsdue to insulin resistance for years, even decades, before the diagnosisof even prediabetes is made. plus it's been shown that 16-25%of normal-weight adults are also insulin resistant. so, in case you're keeping track,this is a heck of a lot of us. so, the troublewith insulin resistance is:
if it goes up, we are at great riskfor developing type 2 diabetes. but also, insulin makes us hungry, and the food we eatmuch more likely to be stored as fat. insulin is our fat storage hormone. so we can start to seehow it's going to be a problem for diseases like obesityand metabolic issues like diabetes. but what if we traced this problemback to the beginning, and we just didn't haveso much glucose around that insulin needed to deal with?
let's take a look at how that could be. everything you eat is either a carbohydrate,a protein or a fat, and they all have very different effecton glucose and therefore insulin levels, as you can see on the graph. so when we eat carbohydrates, our insulin and glucoseare going to spike up fast. and with proteins it looks a lot better. but take a look at what happenswhen we eat fat.
essentially nothing, a flat line. and, this is going to wind upbeing very important. so, now i want to translatethat graph for you into a real-world situation. i want you to go back and think about the last time you atean american version of chinese food. we all know there's rulesassociated with this, right? and the first rule is:you're going to overeat. because the stop signal doesn't get sent
until you are literallybusting at the seams. rule number two is:in an hour you're starving. why? well, because the rice in that mealcaused glucose and insulin to skyrocket, which triggered hunger,fat storage and cravings. so, if you are insulinresistant to begin with, and your insulin levelsare already higher, you really are hungrier all the time. and we have this setup:
eat carbs, your glucose goes up,your insulin goes up, and you have hunger and fat storage. so, how do we recommendto these people to eat, because it seems like that would bereally important, and it is. let's focus just on type 2 diabetes, because the general recommendationsare to tell patients with type 2 diabetes to consume 40 to 65 gramsof carbohydrates per meal, plus more at snacks. trust me on this, that's a lot of carbs.
and remember what's going to happento glucose and insulin, blood sugar and insulin, when we eat them? yes, we are essentially recommending that they eat exactlywhat's causing their problem. sound crazy? it really, really is. because, at its root, diabetesis a state of carbohydrate toxicity. we can't get the blood sugarinto the cells,
and that causes a problemin the short term. but the long-term consequencesare even greater. and insulin resistance is essentiallya state of carbohydrate intolerance. so why, oh why, do we want to continueto recommend to people to eat them? the american diabetesassociation guidelines specifically state that there isinconclusive evidence to recommenda specific carbohydrate limit. but those guidelines go right onto say what we all know: our carbohydrate intake is the single,biggest factor in blood sugar levels,
and therefore need for medication. these guidelines then go on to say: hey look, if you are takingcertain diabetic medications, you actually have to eat carbs,otherwise your blood sugar can go too low. okay, so let's take a look at the vicious cyclethat that advice just set up. so it's: eat carbs so you haveto take medicine, then you have to eat more carbs so you avoid the side-effectof those medications,
and around and around we go. even worse is that nowherein the ada guidelines is the goal of reversing type 2 diabetes. this needs to be changed, because type 2 diabetes can be reversed,in many, if not most, situations, especially if we start early. not only do we needto let people know this, but we have to start giving themthe practical advice so they can do this. consider carbs.
first, here's a shocker for you:we don't need them. seriously! our minimum daily requirementfor carbohydrates is zero. we have essential amino acids,those are proteins, essential fatty acids, but, nope, no essential carb. a nutrient is essential if we have to have it to function,and we can't make it from something else. we make glucose,plenty of it, all the time, it's called gluconeogenesis.
so, we don't need them, the overconsumption of themis making us very sick, yet we are continuingto recommend to patients to consume close to, if not more than, half of their total energy intakeevery day from them. it doesn't make sense. let's talk about what does. cutting carbs, a lot. yes, in my clinic we teach patients
to eat with carbsas the minority of their intake, not the majority. so, how does that work? well, when our patientsdecrease their carbs their glucose goes down,and they don't need as much insulin. so those insulin levels drop, and fast. and this is very important, because a study looking at our national healthand nutrition examination survey data,
better known as nhanes, showed that the single,biggest risk factor for coronary artery disease is insulin resistance. it is responsiblefor a whopping 42% of heart attacks. low-carb intervention works so fast that we can literally pull people offof hundreds of units of insulin in days to weeks. one of my favorite storiesis a very recent one.
a young gal, but who had an almost20-year history of type 2 diabetes, came in when a physician from anotherclinic told her she was just sick, and she'd probably get used to it. her diabetes was way out of control. this despite the fact that shewas on multiple medications, including almost 300 units of insulin, that was being injected into hercontinuously every day via a pump. all of this, remember,blood sugar still out of control. so we put her on a low-carb diet,and now let's fast-forward four months.
she lost weight, yes,but, better than that, sick no more. her blood sugar levelswere now normal all of the time. this on, get this, no diabetes medication. gone was the 300 units of insulin, no more insulin pump, no more pricking her fingermultiple times each day, gone, all of it, no more diabetes. one of the greatest joys of my jobis to be able to tell a patient like this that they no longer have diabetes,
and we ceremoniously take it offtheir problem list together. so, are they cured, is this a miracle? we'll leave that grandstandingto doctor oz. cured would imply that it can't come back. and if they start eatingexcessive carbs again, it will. so no not cured, but they don't havediabetes any longer. it's resolved, and it can stay that wayas long as we keep away the cause. so, what does this look like then?how does somebody eat this way? well, first, let me tell youwhat it's not.
low-carb is not zero carb,and it is not high protein. these are common criticismthat are so frustrating because they are not true. next, if we take the carbs out,what are we going to put in? because, remember,there's only three macronutrients: if one goes down, one has to go up. my patients eat fat, and a lot of it. "what!?" you say. what's goingto happen when you eat fat? well, let me tell you, you'regoing to be happy,
because fat tastes great,and it is incredibly satisfying. (applause) (laughter) but, remember, fatis the only macronutrient that's going to keep our glucose -blood sugar - and insulin levels low, and that is so important. so, i want you to now hearmy simple rules for eating. these rules, you have to remember,are even going to be more important if you are one of the tensof millions of americans
who have trouble with insulin levels. rule number one: if it says light, low fator fat-free, stays in grocery store. because they took the fat out,they put carbs and chemicals in. rule number two: eat food. the most important rulein low-carb nutrition: real food does not come in a box, and no-one should have to tell youreal food is natural. you should know that when you look at it. don't eat anything you don't like.
and eat when you're hungry;don't eat when you're not, no matter what the clock says. and number five is a simple wayto remember what we want to avoid. no gps: no grains,no potatoes and no sugar. that last one is a biggie,right, no grains? na, no grains. but we have to have them. nope, they're a carb. but whole grains are so good for us.
well, first of all, there are actuallyvery few foods out there that are truly whole graineven when they say they are. most foods that purport themselvesto be wholegrain are highly processedand the fiber benefit ruined. or they're comingwith highly refined flour, usually both of these things. so if you are one of the trulyinsulin-sensitive people, you can eat real, whole grain. but if you're in the enormous sliceof our population with insulin issues,
it's making things worse. so what if you are oneof the real insulin-sensitive people? can you still eat this way? yes! i am a great example. over a year ago i decidedi would cut my carbs as low as i recommendto my diabetic patients. now, it's not mandatory for my healthlike it is for theirs; i'm not insulin resistant,so would this be a problem? no! that's just the thing.
unless you havean exceedingly rare syndrome, then cutting carbsis going to be good for you, even if it's not necessary. i want to show you a couple of picturesof my radical food. so, this is a common breakfastin my house. so does it look likei just broke my own rule? i didn't because this muffinis made with coconut flour. i bake all the time still. i just use non-grain-based flours:coconut, almond, hazelnut, flax.
they make delicious things. and this is a typical dinner in my housewith a typical starch. that would be the sautã©ed mushrooms. no, my patients and i eat delightful foodall of the time and enjoy it. but what about the research on this? i mean is this just anecdotalevidence now from my clinic? no! there are dozens ofrandomized controlled trials looking at low-carb intervention
for things like diabetes,cardiovascular risk factors, obesity. they're consistent. it works! there are even a large numberof studies showing that low-carb nutritiondecreases inflammatory markers, which is making it really excitingfor diseases like cancer. we just finished a study in our clinic. and what we did is, we took 50 type 2 diabetic patients that were treated withour low-carb-high-fat-based program,
and we compared them to 50 patients who were treated with the ada guidelines. and after six months, not only did we finda significant metabolic advantage for the low-carb group, but, and let's face it, this is important,a huge cost savings. our analysis showed that our patientscould save over $2,000 a year just on the diabetes medsthey were no longer taking. just think how fast that adds up.
we are in a diabetes epidemic now that we are spending$250 billion a year on in this country. so, i want to show you a slide now that demonstrates wherethose savings are coming from. so this is lookingjust at the insulin difference in the two groups after six months. and what we can see is that the low-carb groupwas able to decrease their insulin by almost 500 units a day.
whereas in the ada treated group, they had to increase their insulinby almost 350 units a day. two important things. number one: insulin is expensive. and number two: not all the peoplein this study were even on insulin, which makes these resultseven more impressive. but what i would say isthat this graph really represents two different approachesto treating this disease. the first, our group,with the goal of reversing disease,
meaning they need less medicine. and the second group, which very clearlyaligns with the ada guidelines, which state that diabetesis a progressive disease, requiring more medicine over time. progressive unless we take away the cause. so, what's the problem then? why is this not everywhere?why isn't low carb the norm? there's two big reasons. number one: status quo.it is hard to break.
there are many agendas involved. we got this notion that low fatwas the way to go decades ago. but a recent study just came out showing that there waszero randomized control evidence to recommend to americansto remove the fat from our diet. and that's how the carbs got added in. it was essentially a huge experimenton millions of people, and it failed miserably. the second reason we don'tsee it everywhere is money.
don't be fooled, there's a lot of moneyto be made from keeping you sick. and what we see is,with these specialty guideline panels, they are stackedwith conflict of interest. so, the solution to the diabetes epidemicin my clinic is exceedingly clear: stop using medicine to treat food. and for a diseasewhose root cause is carbohydrates, take away the carbohydrates,or at least cut them, so we can rememberwhat we used to know. we knew it a long time ago,
this was said thousands of years ago, and we need, in this day and age,to get back to that notion. thank you.
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