Tue, Nov 08, 2022 4:48PM • 1:59:48
SUMMARY KEYWORDS
diabetes, patients, diet, insulin, low carbohydrate diet, disease, carbohydrates, glucose, ultimately, diabetic, ketones, higher, oxytocin, type, studies, glycemic control, familiar, non diabetic, linked, fact
SPEAKERS
Bill Clearfield
03:08
Now dollar shopping, there’s no question that’s a word. The question is, is there a many high profile sites thanks there was The. Well that’s it
Bill Clearfield 05:32
thank you for joining us. We’re happy to have you. And we’re here every Tuesday at this time. And we always have a different speaker different topic.
05:47
And we will
Bill Clearfield 05:54
be happy to answer any questions you have and anything we could do to any questions. Thanks, so we’ll just hang out till everybody comes back comes in and our speakers not here just yet. So.
06:41
So I never made it out of the office, Joe. So
06:50
I kind of figured
06:53
Can you hear me? I hear you fine. Okay, good. Good. Okay. Okay,
07:02
rename. Did I hear you say you had your student tonight?
07:10
No, no Thursday, okay. So
Bill Clearfield 07:26
I know where everybody else is. We’ve had a lovely day in Reno. It’s been snowing all day.
07:32
was still five till
07:42
I got my exercise in for the day.
07:45
Yeah, no. Thank you for that so, anyway, so Okay, let me see if I could find this guy
08:22
What was his name? Tell Tale you t and I’d say That’s right. We’re folks joining us here should have some music or something I could take care of that. Happy to see we’re seeing some new names also. So just nice Hello, John.
10:10
Jaw
Bill Clearfield 10:13
Yeah, you are listed as John you’re listed as John here. You’re fooling us.
10:19
I’m a Johnny Boy.
10:20
That’s right. I,
10:25
I made a I made a video that I was gonna put up on the chat. You guys want to watch a preliminary comic video? I did a lot of naked women basically. Well, we got to keep it clean here some violent man, but it’s all original graphic. So it’s not like I stole I photographed it or something. So
Bill Clearfield 10:46
yeah, well, it’s very good guys have if you have
10:50
a mood for a naked women medical comic strip. I can like I can put it on chat tonight.
10:59
Perfect opportunity to invite them as long as you send it to a good
11:07
60 attended a small crowd by today’s standards. But early conventions like this one. Help the Bible students see just how ability to bless to meet with fellow believers from other areas. Eventually, conventions became an annual events. Some are held outdoors or in a tent, like the 1908 convention at a summer resort on Lake Erie Ohio. Do
11:39
you want to hear that?
11:43
Didn’t know if he wanted us to hear it or not?
Bill Clearfield 11:46
Is that you, John? No.
11:49
No, it was it was Stuart to I think there’s Andrew.
Bill Clearfield 11:53
Okay, here’s our your speaker has arrived.
11:57
Amen. As soon as he gets settled, so right at five Can you guys hear me okay?
Bill Clearfield 12:11
We hear you fine. All right. Great. Thank you. Thank you for joining us.
12:16
Yeah, apologize. It was a little. We’re good on time.
Bill Clearfield 12:20
So yeah, it’s all good. So we usually have folks filter in, sometimes up to a half hour after we after we get started. So I’m usually at right right at five or a little after we you know, let you get going. I’ll just, I usually let let our speakers you know, introduce themselves. And we’re happy to have you thank you for taking this time. For this. We have a couple of new names on here that I’m not familiar with, which was always makes us happy also. So we get to get our word out. So we’ve been doing this for over two years now. Who here every Tuesday night at this time, and we have some sort of integrative medical legal or lecture webinar discussion. Sometimes we have a little knock down drag out fight you know, at least orally. But it’s a you know, it’s all in the spirit of learning and helping each other. So we are efficiently the American Osteopathic Society of integrative medicine, though we’re not affiliated with anybody at the moment. And we have been around for 50 years Believe it or not. John is that is that link? Is that your is that your cartoon video?
13:52
So with that, say naked comic strip Android. Well, it’s it’s a it’s a one and a half minute film on micro RNA and its effect on cancer. It’s just it’s the only thing in the film so far the naked women. So
Bill Clearfield 14:12
we’re supposed to keep this. We’re supposed to keep this as a family show, John.
14:16
Well, it’s okay. But at some point we’re going to talk about micro RNA and its effect on regulatory genes with non protein production as a regulatory agent. So
Bill Clearfield 14:30
that sounds like something you’re going to talk about, right?
14:32
No, my job is to make little cute movies and have you smart guys do the research. And present the info That’s the game.
14:43
So
14:45
that way, you can watch it. That’s what we’re gonna do.
14:49
Okay. So
Bill Clearfield 14:54
so my, my interest is I’m sort of a hormone guy Andrew is in the in the group and we we have we have quite a bit of literature we put together and John and I just been discussing making, making maybe making a hormone, a hormone affiliated comic book Making into a college, making, making something interesting instead of the usual nonsense that you see up there, so yeah, so he’s been practicing. So my dad I I’ve unleashed the whirlwind here. There we go. Good. So it’s, it’s a little bit after five. So we Why don’t we get started and like I said, we usually have stragglers coming in, you know, up to the half hour even later sometimes. So, our speaker tonight is Andrew, and forgive me if I could, Nick.
15:48
Is that how you been? Excellent. Most people don’t get that first shot. So yeah, well, well,
Bill Clearfield 15:53
I’m I don’t know if you have an Eastern European background, but you know, I grew up in Wilkes Barre, Pennsylvania, so I’m very familiar with those pronunciation. So. So, with that, I’m gonna let you I’m gonna let you introduce yourself and take it away. Good deal.
16:15
Well, I appreciate the opportunity to be here guys. Thank you for taking the time to listen to this talk. I hope to make it interesting. And I am full game for a as William had referred to before a knockout drag out fight so to speak, but I’m free all questions. So everything’s free game. Please be skeptical of everything I have to say and ask questions. And don’t be afraid to ask interesting questions or to maybe kick back on some of the things I say here. But let me go ahead and share my screen
16:49
all right. If you can’t see this, or you can’t hear me talking, well, it’s probably not a good thing. But let me know. We can see it. We’re good. Good deal. All right. So I’m gonna go ahead start. So the title of today’s talk is titled Nivea outcomes, therapies and future innovations. A highlight of this talk obviously is going to be revolving around nutrition potential role it may have in this disease management. As an introduction of myself as William had asked me to do, I’m interviewed Nick, I have a doctorate in biomedical sciences and a background in exercise physiology and biomedical sciences of going all the way back to Florida State where I trained on looking at unique interventions to mitigate either disease. A lot of this was mental health related and looking at cardiovascular autonomic function. Then I transitioned to look at lifestyle as an intervention with a lot of that work focused around low carbohydrate diets and or ketone metabolism and how they may or may not play a role in health disease in performance applications. We also did some other work during that time. I ran two projects on a NASA related project during that period and then went to work with a institute that was specifically studying die diet mimetics things called like ketone exogenous ketone bodies, in unique special populations, military populations, so we did a lot of Department of Defense work in NASA work. So now I’ve been have been for the last over well for a long period of time, but happens increasingly more and more focus of my time and efforts and type one diabetes. In fact, I’ve made a major transition recently to exclusively try to work on type one diabetes to advance outcomes, which I’ll be talking about here today. So I have so I do have a Twitter. I do actually keep active on Twitter. I used to hate social media, but I find it’s an unbelievably valuable opportunity to share message connect and learn a lot. So I do engage on that now. And I was a full time research scientist at the Institute for Human Machine cognition and human healthspan residents performance, but actually back off my effort and went to a visiting science position to advance what I’m doing and type one diabetes disclosures. I do have them I don’t know if I have to give this or not, but I think it’s relevant for everyone. Now I’ve received funding from the Department defense ops a research Defense Advanced Research Program Agency I have received honorariums from ACSM. My university My name is Stanford metabolic health summit and I have been on Grant panels for the Department of Defense before and got paid to do so I am a patent vendor, but what I am a patent veteran isn’t relevant to what we’re speaking about here today. And I have consulted for somebody who’s not a physician, not medical advice. So table of contents. So today’s talk is going to first discuss type one diabetes as the so what is the disease itself? What is the glycemic impact of this disease? And then ultimately, what are the outcomes and what are the therapeutic interventions to patients who have this disease, and I want to back up for a second the reason I’m talking about this today, and why I’m particularly passionate about it, is because I’ve been living with this disease for a decade and a half I myself have type one diabetes, and also happen to study this disease and also implications of lifestyle not only in this disease, but other diseases. So I’m very, very passionate about this topic on a personal level, but also from an advocacy level and a research perspective. Then we’re going to talk about nutrition, so many hours of study for over a decade, and this is looking at dietary impacts. I wanted to find what we’re talking about when we talk about nutrition, past and present evidence, concerns, criticism, etc, etc. So, when we talk about type one diabetes, the stats right now say that one in 300 People have type one diabetes. Now that number is growing. But the previous numbers indicated, such as the case and the question is, well, why me? Why Andrew coot Nick was diagnosed with this disease. And at present, we don’t completely understand it. But what we do appreciate is it appears to be that our body causes an autoimmune reaction. Our immune cells ultimately target and kill part of our body that produces insulin. These are the beta cells in the pancreas. So in essence, for those who aren’t familiar imagine most are especially William because you’re interested in hormones. But our body essentially plays a thermostat. So as the temperature or as the blood sugar in the body from things like carbohydrate based foods are consumed, blood sugar goes up, our body does a great job of attacking, and then ultimately releasing insulin in a dose dependent and appropriate manner to bring down those blood sugars into normal homeostatic and healthy ranges. But in the absence of that, things change pretty robustly and we lose that control. So when we talk about type one diabetes, I’m going to give a little bit more of a descriptive visual presentation of what that actually means from a dietary perspective. And the best way to illustrate that is of course, carbohydrates. It doesn’t obviously have to be a donor. It could be any field. It’s just a great example because I think it gives an extreme example and people know immediately what it means. But any car that comes in any sort, ultimately, when it’s consumer can be potatoes, it can be rice, it could be this doughnut, it could be squash, although it has more fiber and much less glycemic impact. But all of these when they’re consumed, will ultimately raise blood sugar in a dose dependent manner related to the amount of carbs consumed. Of course the pancreas will detect these levels in the beta cells and ultimately release an appropriate amount of insulin and circulation. This insulin will act to store this blood glucose primarily when endogenously released into the ER allow for insulin to bind to the liver. And ultimately cause glucose to be stored in the liver tissue. Also peripheral tissues like muscle as an energy substrate and also he’s converted to fat as a fuel substrate in that form. But ultimately, that brings down glucose into normal homeostatic range. This is the purpose of insulin primarily, most people would argue so but when the immune cells come in and ultimately destroyed part of the papers that produces these insulin producing cells, the beta cells, we lose the ability for these molecules molteni blushers stays up and high and response to food in the absence of insulin. And of course, that’s just showing an elevation of blood glucose. So ultimately, a patient with type one diabetes as as ie myself, has an outtake of exogenous forms of insulin because my body doesn’t produce anymore and this is just an example no vlog, but right here in front of me I have two types of insulin. I just took my basal insulin, they usually take at night because you’re on the eastern time zone. It’s it’s eight o’clock. So we take these insulins and ultimately this was found to be a life saving drug for many patients, but type one diabetes back in 1922, I believe, and ultimately ended with a Nobel Prize and has basically extend the life of patients with my disease from anywhere from days, maybe for lucky two to three years prior to the onset of insulin to actually a normal or almost normal lifespan, which we’ll speak about here today. So when we talk about the elevation and glucose when we talk about what this elevated glucose effects could be, what are these effects? Why would we care to about these elevated blood sugar levels? Well, on the left graph, there is someone who does not have type one diabetes and has normal blood sugar regulation. And you can see in that normal range, the bottom range of 70, the top range, and 120 the blood sugar is reliably staying within this range for the vast majority of the day. But on the right hand side you can see an illustration of actually myself when I was on a standard American diet, and you can see it almost every single meal of the upward swing and glucose and that come crashing down after the injection of insulin. That’s very symbolic of what most patients experience on a diet such as any standard diet and taking exogenous insulin, but as you see the vast majority that day for someone, in this case, a single example of myself, but actually a lot of patients are actually the vast majority of patients experienced the same thing, living the vast majority of their life well outside of the normal range of seven to 120, where you can accumulate symptoms of hypoglycemia and hyperglycemia. A lot of which are mental health symptoms, as well as things like fatigue, irritability, and ultimately inability to think optimally, such as disrupted concentration and otherwise, but these can also be fatal scenarios. hyperglycemia and uncontrollably can ultimately can in some circumstances lead to diabetic ketoacidosis. Any physicians listening here will understand that DKA is potentially fatal if not treated within a short period of time. Usually patients find out they have type one diabetes when they go to the hospital with DKA. Now and the hyperglycemia and most physicians are very, very terrified of this. Because it’s very, it can happen quickly. I can take the wrong amount of insulin right now and two hours from now I could be in a hypoglycemic coma. That’s how risky it gets every single day of every meal for someone with type one diabetes. And ultimately you can go unconscious you can have a coma Caesar and ultimately death. So the consequences of this disease in its management and I have to do so every single day without the help of anyone else is very real.
26:15
So, the question is, what are the average outcome? So I’m saying I’m telling you okay, this this graph on the right hand side is what we expect to see in a type one diabetic population, but doesn’t really represent the norms. And this is actually a cluster of studies looking at some of the most advanced technologies. So in this case, looking at studies that looked at standard of care versus things like closed loop technologies, now closed loop technologies for those who aren’t familiar, is actually these innovative next generation technologies that actually take insulin, along with devices called continuous glucose monitors was continuously monitor your glucose levels, and automatically through continued computer algorithms releases insulin level to ultimately regulate your blood sugar level. But what you find is that the average even in these, these studies, is still 164 milligrams per deciliter with a standard deviation of 63. Now when you compare that to studies using similar devices and normal, healthy non diabetic populations, you can see with even the best next generation technology in pharmacology available to type one diabetes. Most patients are creeping up of almost double that mean blood glucose and they are four times larger in their variants and blood sugar levels as well. Usually fluctuating totality of over 120 milligrams per deciliter around the mean. But what are we what beyond that? What about more chronic levels of blood glucose? Well, what I showed you before is a trace. Previously as tracings of continuous monitoring of glucose which happens minute by minute in patients with new technology. But what we’ve usually looked at historically when we consider risk is something called HBA one c. Now, it was discovered I believe back in the 1960s, if I’m correct, where they found that a subunit of the hemoglobin molecule called the a one c sub unit, actually had more glucose binding to it as glucose levels were readily higher on average, and they found this in type two diabetic patients and it wasn’t in the United States. I forget which country it was. I think it might have been Afghanistan. It was definitely African country. But either way, they found that elevations in his glycosylation of the hemoglobin molecule occurred as blood sugar got higher more readily across patients. And over time, we have come to appreciate especially with big trials, such as the DCC and EDIC that was a hundreds of hundreds of millions of dollars put into it that allowed us to appreciate that the elevation hboc is directly linked to increased acute and chronic complications of particular microvascular complications such as retinopathy, kidney disease and neuropathy. And in fact, most patients with type one diabetes are expected to get retinopathy within two decades of diagnosis or at least some form of it before it gets fully progressive. So this is just an illustration of studies also confirming or showing across a number of studies, international studies that that some of which are some from some of the best institutions in the world, including that foster also those 19 That’s actually from a cluster of the best 30 institutes in the United States from the type one diabetes exchange amongst others around the world. Showing that across some of the largest data sets we have available to us that the average HB one see across all these studies is around 8.2. Now normal HB one c is less than 5.7, meaning that usually somewhere in the low to five range as you can illustrate below here in larger data sets of the US population of non diabetic cohorts. So healthy cohorts. You can see the patients are living well above the normal range on an average basis. And those who are most affected are actually kids kids are usually the ones who’ve got the worse GLite worse and glycemic control until they get into their adult years. And so it’s kind of disheartening of course to see that patients on average, even with the most advanced technologies of pharmacology is available to them still fail to get anywhere close to what would be deemed normal. And that’s ultimately the goal of any disease. Right? When you have a disease you hope that you can go to the doctor and walk into the clinic and they say well yeah, you have this this new disease but hey, we have a solution to get you just like your your friend down the street. But you have to do things a little differently. Well, that’s not an option, or at least it doesn’t appear to be based on the most advanced technologies to type one diabetes are based on this evidence. And unfortunately, based on the most up to date evidence, this is a study in 2000 was looking at comparison of two different decades, from 2020 or 2010 to 2012, compared to 2016 and 2018. So essentially, a decade, they looked at the 30 best institutes, diabetic institutes in the United States. So some of the most, in fact the most premier institutes in diabetes, and looked at their average outcomes and HBA one see and what was happening as you can see, that blue line is an illustration that even with more improved technology over the last decade, the rates of HB one C are actually rising there they were they’re not improving the regressing in spite of these advancements, and there’s a number of reasons that might be facilitating that But suffice it to say, the theme here is that things were not good and they don’t appear to be getting better, particularly the focus on glycemic control. So why do we care about glycemic control? Well, as said, you know, we know the type one diabetics are about 1.6 times higher even with the most advanced technologies available to them to compare to the general population. We know the standard deviation around their glycemic norms is about 4.2 times higher and their HB one C is about 1.5 times higher and worsening. But what are these outcomes? Why why why do we even care if these blood sugar levels don’t translate anything? Then we don’t care, right? Well, they do. And this is just one illustration of what that looks like. And one of the largest tech cores and type one diabetics out of Sweden, where they looked at a number of metrics and one of which was looking at many of the top thing leading causes of death around the world. And every single one is the left hand side of cancer, heart disease, etc. Anywhere where I highlight in in red is an illustration of where there’s an increased risk for a patient with type one diabetes and suffice to say we looked at males and females and type one diabetic versus the general population across all age groups. And what we see here is that almost if not all of these conditions have elevated risk for type one diabetic patients, some of which are arguably invisible diseases such as mental health disorders, as well. But that’s not really the worst of it. We actually know that patients with type one diabetes are expected to live about a little over a decade shorter with females getting a little worse. And the data actually says that the earlier diagnose, the worse it is. So there’s good evidence now to say from the best trials we have available to us, that even if you correct your blood sugar levels and improve it later on in life, you don’t completely reverse the prior bad blood sugar levels that you had. So the earlier we can correct these problems, the better. But even with the best and most advanced technologies, those patients are still expected to live less about 10 to 11, sorry, 11 to 13 years shorter lifespan with this disease. Now, there’s a published study that came out in 20. So essentially last month, September 2020, and they were looking at 96 different countries. So there’s a largest data set that I haven’t heard of in type one diabetes, and it looked at 96 different countries, and they were looking at a modeling study. It was published in a very high profile diabetes journal, one of the most high profile and what they found was that the diabetic population was expected to double by 2040. Waiting the next 20 years is expected to double but of the current 8.4 million patients with type one diabetes worldwide. 30.6% of that population, so over 3 million things 3.7 million had would have been alive today, but were not they had died because of some complication related to type one diabetes and early death. Meaning that we currently have lost a third of our, our community to early deaths related to this disease. And it’s this disease is not going away. It’s expected to increase in incidence even more. And this data is just reconfirming some of what I’ve told you already. This is the most recent data that has come out looking at lifespan expectancy. This is the most robust data I’ve actually ever seen I’ve ever published. They looked at every single individual conference country and then categorize them by high upper middle, lower middle and low income countries. And what you see as the high income countries those numbers match quite expectedly with the Swedish population also the US population 11 years last but as you go down the social, economic, economic ladder on a global scale, you start to see that these numbers get from 11 years to 24 years to 36 years to 47 years lost. So over half the life expectancy of an individual is gone. If you’re on the very low end, you’re in a country that isn’t a low income countries. This is in my opinion as a patient completely unacceptable.
36:08
Now, what about increased risk and outcomes? Well, we know in total that the acute complications of this disease include things like hyperglycemia and hypoglycemia symptoms. A lot of which are mental health symptoms, severe hyperglycemia in the form of emergencies, like coma or seizures, and ultimately diabetic ketoacidosis. But we also know the chronic complications that come with this disease that are well cited including micro vascular disease and infinitely higher macro vascular disease risk and increased risk for all 10 leading causes of death, shorten life expectancy 11 to 18 years depending on where you live. And that really only encompasses the higher income countries, the lower income countries we’re looking at anywhere between two to four decades loss, and obviously other conditions such as psychiatric disorders. stunted growth and cognitive decline. We know that kids with type one diabetes, because of the worsening glycemic control can actually see brain MRI changes. So their neuroanatomy changes within three years of being diagnosed with type one diabetes. And we also know that that their IQ begins to drop as well in all of these are linked to glycemic control. In fact, the only thing that truly is changing in a type one diabetic besides the slight alteration in the immune response to a part of our own body is truly just losing the ability to produce insulin, and then ultimately, control glucose type one diabetics are using normal weight usually have normal lipids. The rest of these other categories are typically normal, but the one thing not the only thing but the primary one thing that changes with type one diabetes is glycemic control and everything on the left hand side there has been linked to it. So what therapeutic options do patients with my disease currently have to regulate this disease and improve it and I must say, we’ve come a very, very long way. I in fact, use some of these tools. Right now. For example, I wear a continuous glucose monitor on a regular basis. It’s a wonderful tool and it gives you a continuous reading of your blood sugar over almost every single minute of every single day and gives you examples of I don’t know if you guys can see this or not because the cameras probably not see my name very well. Either way. So I I regularly use these tools. They’re incredible. But some of the options to give you a breadth of what’s out there is most patients when they’re diagnosed, they they start doing something called a carbohydrate counting strategy, which is you count the amount of carbohydrates you consume, and you’ll learn to bolus a certain amount of insulin accordingly for how many carbs you take. There’s a lot of tools like an insulin pump, so instead of having to take syringes, which I have here with insulin every single day and actually stick a you know syringe into your stomach or your arm or wherever it might be. They have these continuous infusion pumps, which lowers the visual burden of this disease, and also the necessity to continuously inject yourself. There are tools like a continuous glucose monitor, which I already spoke about. And there’s the idea of linking the pump with the CGM together to automatically release insulin someone which I spoke to you about earlier about some of the numbers you expect to achieve with type one diabetes with these devices. Now this is just an illustration of some of those tools, both current and exploratory. And I won’t go through each one. But I just want to just quickly state there’s only two therapies on this list. Amongst those that are currently available and exploratory. That actually reduced insulin on total, at least one absolute unit point. So this one is intensive treat therapy. This is the DCC and EDIC trial, where they found that just injecting more than two times per day, which was standard care before this trial came out, improved glycemic control in spite of increasing the total total insulin load and body weight of patients with type one diabetes, they still had better outcomes and in response to lower improving their glycemic control. But this is the only intervention that has reliably improved glycemic control through the form of HPA once the more than one absolute unit point, except this one down here, which is Islet Cell Transplant therapies. So there was a study in 2000 that came out, that actually illustrated the ability to completely normalize glucose control within three months of a patient undergoing this therapeutic intervention. The only caveat to that intervention is that Iowa cell transplant therapies require major surgical intervention. They require you to be on a chronic immunosuppressants only a subset of a very, very small subset of the diabetic population who have asymptomatic hyperglycemia and potentially pre existing microvascular disease is even eligible for it and most patients who get on these transplant therapies ultimately ended up having their Islet Cell Transplant regress and they end up having an HB one C that ends up getting back up to 6.5. And they end up getting a subset of these population gets back on insulin. So ultimately these this is not available to everyone but not also University successful but there is some hope within these therapies for sure. If they can ever get around to fixing the immune system, which is a hell of a problem to understand and and fix. So we’re not there yet, and might not be for quite some time. So all these things combined the idea that glucose control is paramount to the disease, the the inability to control with advanced technologies and tools available to us the direct link between this poor glycemic control and type one diabetes, in fact that worsening glycemic control we’ve seen the last decade and it’s linked to both acute and chronic complications. As well as other conditions in a short lifespan. It may lead patients to think What about diet? Is there a role for diet does it matter and can it have an impact? Well, this is an illustration of fat, protein and carbohydrates and the impact it can actually have on our blood sugar. Level. Obviously, blood sugar is a central device theme of what we’re talking about here today because that’s what patients with my disease ultimately cannot control anymore. And we know that fat can have an effect on blood sugar level using a dose dependent manner. But it’s it’s it’s marginal at best now protein we know protein can have an elevation of named blood sugar levels, but usually in patients who have normal or they’ll say not patients, so those without type one diabetes would never even see an elevation and they’re CGM reading, if they work on and response to protein because the bodies is so quickly the handles the elevation of glucose and response to protein that’s much smaller and more prolonged and carbohydrates. We know that carbohydrates are ultimately the most profound postprandial impact on on glucose levels. They’re rapidly absorbed and have a dose dependent response and the amount of glucose elevating effect proportional to the grams of carbohydrates ingested. But keep in mind that all these illustrations on the no these are just ways of visualizing the total impact of these on glycemia are all in the context of insulin patients with my disease don’t have insulin, they have to inject it. So in the absence of insulin, what ends up happening is the rise is actually much larger and continuous until the injection of insulin occurs. Now, it is important to appreciate and I’ll just reiterate some of these things I’ve already said is that acute carbohydrates, what is that impact? Well, we know what’s the most potent lifestyle factor on postprandial so post meal hyperglycemia. So elevations in blood sugar above the normal upper level threshold. We also know that the most potent factor for hyperglycemia and the type one diabetics life is insulin. We also know that insulin and carbohydrates are directly linked to each other. So the more carbs you consume, the more insulin you require. And this is a direct relationship. So these are the two most important factors and the directly linked to one another. So could we do something about modulating something like this? Well, let’s first define the idea of a low carbohydrate diet because the idea the theme here is if you have a lot of carbohydrates in your diet, and it’s directly linked to insulin, and we know that elevation and blood glucose levels we have worse outcomes. What if we just reduce the amount of carbohydrates in the food and reduce subsequently the amount of insulin required on a regular basis and thus, the amount of medications and hypoglycemic agents put into the body? But first, let’s define what we’re talking about when we talk about diets that are reduced in carbohydrates. we’re usually talking about diets that are low or absent and sugary, starchy carbohydrates, that the form of the diet that has been most associated with many of the popular benefits or health benefits of low carb diets are actually termed very low carbohydrate diets and they’re less usually less than 50 grams of carbohydrates per day. You can look in the published literature right now and find all sorts of studies that talk about high fat diets or low carbohydrate diets. These are not necessarily the same thing. Many of those diets are actually much higher in carbohydrates encroaching on the levels of a Western diet, which is high in carbs and high in fat and this is not similar, in fact, dis slimmer, dissimilar to this dietary strategy. So the DIS define it. Most of the time when we talk about benefits of a very low carbohydrate diet. It’s in this low carbohydrate range. And we know objectively, these dietary strategies can ultimately result not always but often result in the elevation of ketone bodies in the body in the production of ketones in the body through something called keto Genesis, where the body switches as fuel substrate, primary fuel substrate from glucose over to fat and a sign of that is the elevation and ketone bodies because ketone ketogenic says is a byproduct of fat oxidation.
45:58
Now, when we talk about defining these diets, the various forms of carbohydrates in the diet, where did these definitions come from? So the definition that I’m giving here today have actually been historically given by the American Diabetes Association, United States or us, I’ll just say USDA because most people know what that is. And then human health services. These definitions are high carbohydrate, moderate carbohydrate, low carbohydrate and very low carbohydrate diet. As a quick glance on these though, the high moderate and low carbohydrate diet is based on intake norms, and not based on the type one diabetes population needs, and they’re not objectively defined, whereas these bottom categories are based on a physiological phenotype a physiological state, it are objectively defined where the popularity arises. To quickly go through this high carbohydrates were originally defined by the ADEA, USDA and human health services as the recommended carbohydrate intake for health. Now, those reasons were based on the diets higher in carbohydrates like a miniature last necessarily Mediterranean diet per se, but diets higher in carbohydrates has shown some health benefits to the literature. And also because generally most people were consuming that many carbohydrates. So the assumption was, okay, well, we’re going to define hard carbohydrate based on general and take norms and prior recommendations of carbohydrate intake by the governing bodies. Well, moderate carbohydrate just came in because it was between high carb and low carb, low carb was defined because it was once believed that 130 grams of carbohydrates per day was required for optimal brain health function. We know that brain the brain can function optimally on zero carbohydrates per day. And you actually don’t need any consumption of carbohydrates to maintain brain energy metabolism sufficiently. So this definition was was wants to find based on our thought process that it was important to have this main carbohydrates we now know that’s not true, but the definitions of course, have not changed. So monitor carbohydrate was just stuck in between these two values. Now, very low carbohydrate diet is actually based on a defined phenotype. It actually results pretty reliably in the reduction of insulin. The lowest sufficient threshold to alter the body’s fat oxidation, glucose oxidation, and ultimately increases the amount of adipose tissues that are released from your own fat and then ultimately oxidized. So it is a defined phenotype and we do see reliable metabolic changes occurring at this level of carbohydrate intake. So it is objectively changing, where the only difference between that and a ketogenic form of that diet is the elevation of ketones within the circulation, typically at point five millimolar or point 3 million more or above that is when you are actually becoming quote keto on a ketogenic diet because ketones are actually elevated. Now it is important to mention the ADEA now actually recommends individualized carbohydrate targets and therapies as of recent and diabetes Canada actually has come out with a statement on many of these topics that is probably the most progressive and data driven to date. But this is where these definitions arose and came from. So when we talk about a low carbohydrate diet, we’re really taking this old concept of food pyramid that doesn’t actually they don’t use anymore they use a food plate, but it’s this idea of looking at this is grain carbohydrates. Centric diet, and kind of flipping it with the foundation of having healthy forms of fat and or protein. Adding and fibers, carbohydrates, and ultimately fat to provide sufficient energy with on a diet and an ideal forum is healthy, nutrient dense forms. of fat, not processed forms. And these foods obviously Whole Foods are always shown to be associated with better health outcomes. And of course, the absence of these starchy sugary carbohydrates. This is how most people who have tried to implement these diets successfully are doing so especially in a type one diabetes population. But this is actually not a new idea in type one diabetes. We’ve known that early prior to the onset or the availability of insulin. We knew that patients because there’s reports out of Joslin Diabetes Center and some of the most premier diabetes institutes that doctors were actually starving and or putting patients on ketogenic diets to extend their life when they were diagnosed with type one diabetes, because actually providing glucose in the diet, exaggerated diabetic ketoacidosis and ultimately led to earlier deaths. And many patients. So the idea was, well, what if we were to just put them on a protein or fat driven diet, reduce the carbohydrates in the diet and manage the amount of glucose we were seeing in the urine? And in fact, it worked. It just didn’t have the life of patients quite a bit. Although not beyond a decade. Most patients never lived that long, because ultimately they will eventually atrophy and what was happening for the patients who are extending their life was that there was almost certainly some residual beta cell function that was sufficient to allow for the storage of the fat and the protein that was being simulated complete absence of insulin altogether is not survivable, you will ultimately result in diabetic ketoacidosis and will eventually die if your insulin is actually zero. So it was a it was a means to extend life in patients with my disease prior to insulin. But as you can see as the monitoring tools insulin therapies came along, the emphasis on medical nutrition therapy waned over time, in fact, became a side conversation of disinterest. The idea was if you get diagnoses, you can eat whatever you want. Not everyone was saying that of course, you need to count your carbohydrates, etc. But the idea was you didn’t have to restrict yourself and eat differently than your peers and the emphasis on using the pharmacological and technological advancements to allow for that to happen. But suffice it to say, the earlier data I showed you in the talk has illustrated that it’s in fact not working. And in fact, we know the rates of things like obesity and overweight etc are just as high in prevalence. The type one diabetes population were patients with this disease used to be normal body weight. So the problems of glycemic control and or other issues like obesity and becoming overweight are our new growing prevalent problems in type one diabetes population. So the idea of potentially using a low carbohydrate diet might have some popularity or interest in this in this group. So is it in fact popular? Well, we know that when looking at actual objective metric metrics and popularity in the general population, we can look at something called Google Trends. So Google has gathered data of every search ever made on its website since 2004, January 1 2004. And if you actually go on Google Trends, search the term diet and I did this earlier this year. So it may not be exactly the same it is now but you find diet under the category of nutrition. You find that the ketogenic diet makes up five of the top 25 terms and the highest cited search topic and the associated with any specific dietary therapy. In fact, you have to get all the way to 13 before you find a different one, which is the Paleolithic diet. But it’s quite prevalent in related topics and also related queries when searching diet is under the subcategory of nutrition, but what about diabetes itself? Well, the interest in this as searched earlier this year in the last five years just in the United States alone that the topic of ketosis is actually the top rising term of interest in and when searching diabetes as a disorder as a related topic. When researching this for the context of type one diabetes two weeks ago, the ketogenic diet is in fact number one and rising terms for type one diabetes in the United States for the past five years. So even as of two weeks ago, at least for the contents of type one diabetes, interest clearly for the patients, caregivers and people treating these disease. People with this disease is high and is still very, very high. But we also know there’s a number of increased citations and ketogenic diets, low carbohydrate diets, they have not slowed down they get higher and higher every single year. So this scientific interest as well, but we know they’re cited patient entries, a number of published books that have come out, some of which have been around for over a decade, but many are very new and just came out in fact,
54:39
all by the Bernstein’s Diabetes Solution but are all new in available for patients with my disease to read and consider when thinking about a ketogenic diet and type one diabetes, although I wouldn’t necessarily recommend them all. But they are available. So what is the data actually say for low carbohydrate diets and type are in diabetes in general? Well, in type two diabetes, we know there’s a number of meta analysis and systemic reviews that have been put out there all of which are some of the most higher profile ones are here. Although there’s been even more subsequent to that about diabetes remission out of BMJ that I don’t even cite here with a link at the bottom to well over 70 published trials and there’s probably over 100 At this point, looking at this, and actually some of the attendees on this talk that I saw have actually contributed to some of these look looking at very low carbohydrate in very low calorie based diets for type two diabetes and the ability to potentially induce remission of type two diabetes. So we know that they’re a very effective tool and largely what we’d expect to see with these two dietary interventions and categories, obesity, glycemia, insulin resistance, dyslipidemia, inflammation, hypertension, there’s a number of cited commonly cited benefits that we see on these diets a little bit. One thing that we expect, oftentimes is for the increase in LDL particle number, which is a concern for those in the cardiovascular and cardiology community and actually treating that although there are ways to potentially regulate manage that on a diet like this. Alright, what about the disease I’m most interested in obviously a personal bias here with my own diagnosis, a type one diabetes, what does the data say in very low carbohydrates and ketogenic diets and type one diabetes? Well, we had originally looked at 17 publications, and now we’ve extended this to eight. We extended this search. So I’m showing you just some of these was the prior search, not the most up to date data. The most up to date data now includes 89 publications and over 40,000 type one diabetic subjects, but this is a glimpse of what we saw in the original search of the 17 publications. We found a very low carbohydrate group. We looked at various biomarkers including HB one C, because its association with multiple outcomes and type one diabetes acute and chronic. Is it linked to mechanism action for linking to adverse outcomes, long term trials that are confirm it like DCC and add to microvascular disease and beyond? I won’t belabor the points you guys can see this here, and I believe this talk is recorded so you can go back and look but we looked at insulin load the medication to treat this disease and also the most potent hypoglycemic agent like the lipids the concern of cardiovascular risk is this disease intervention or this is treatment intervention in this disease. What about continuous glucose control and also risk for severe adverse outcomes in the form of hyperglycemia and hypoglycemia? Well, here’s a summary of what these very low carbohydrate diets actually showed across the literature and all 17 of those trials, a robust reduction and HPLC in fact, 16 out of 18 of the cohorts in those published studies, had a non diabetic HB one see, I cannot emphasize enough how important that is. There is currently no other intervention available to a type one diabetic besides the ones that require experimental exploratory transplant therapy that allows for a patient to readily achieve non diabetic nondiabetic HB one C so essentially go into the doctor getting your blood work and your glycemic values come back say you don’t have this disease anymore. Except for when you start eating carbohydrates and see that it’s not quickly coming down. You know, you have the disease, but in essence, they’re controlling HB one C, just like you would hope in a normal non diabetic range. In at least 16 out of 18 cohorts, that is insulin insulin load came down both absolute and relative to body weight. And we saw the range of insulin reductions anywhere from 33 to 60%. of the medication required for this disease. And also the most potent hypoglycemic agent, I mean as disease were reduced quite dramatically. We did see reductions in triglycerides. We saw reductions in total cholesterol, but interestingly, even though was a very low carbohydrate diet, one would expect LDL to go up it’s a very common theme when looking at low carbohydrate diets, what you’d expect to have happened because usually because of the elevation and saturated fat diet, which has been linked to higher levels of LDL, but we actually don’t see that there’s a mix of studies that show a decrease, no change an increase of LDL, and these studies and we do see an elevation HDL. So some of this actually goes against what we’d expect we’d expect total cholesterol and LDL to go up based on prior literature. But that’s not actually what we’re seeing here. When we look at type one diabetes in these studies. We’re actually looking at continuous glucose monitoring. So this is really a way of looking into the real day to day life of the patient what is actually happening on a regular basis and like what is our actual glucose levels every day? How much is it going up? How much is it coming down? Because I can tell you that up and down for patient with my disease is it feels like a roller coaster you feel it you know when your blood sugar is high. You know when it’s low and you know when it’s swinging up and down because you feel anything button wrong, even though most patients live their entire life in abnormal, as illustrated by this graph above it. But we see that patients with this disease actually enter using the across the published IVs using a very low carbohydrate diet in type one diabetes. The mean blood glucose is actually almost one for one similar to the non diabetic population healthy non diabetic population and is 105.8 whereas the mean blogland constantly non diabetic population using the same devices is right at 100. The standard deviation has dramatically lowered double double smaller than the average type one diabetic deviation, although still higher than the non diabetic cohort, improvements in the amount of time spent in normal range. It is important to mention though, that there was a slightly increase in hypo glycaemia. When using this diet, I can probably attest that this is most likely because patients when they start achieving more normalized glucose levels, they start dropping their mean blood glucose proportionally, even though sometimes their low end here is getting them into hypo. They feel safer because the swings are much smaller. So they they tend to the tread that a little more, even though they don’t have to, although many do. But we do know that looking at the data right now on especially the larger observational analysis using this data, this intervention that the amount of severe adverse events in the form of hyperglycemia, ie DKA. Our hyperglycemia, ie coma, seizure or death are actually infinitely lower. So even though you might see, you know, 4% hypose versus 2% hypose. With this intervention, the amount of severe adverse events is what we’re really worried about here is actually much lower than historical averages in the type one diabetic population. So when we talk about this, what we’re talking about is the only therapeutic strategy currently right now and type one diabetes, which has repeatedly demonstrated the ability to normalize HB one C, and have a number of other benefits and reducing well known risk biomarkers, and ultimately quality of life biomarkers and patients with my disease. But there are concerns and criticisms of this dietary intervention. Let’s see how I’m doing on time. Think we got about 10 minutes you’re
1:02:28
doing fine. Good deal. All right.
1:02:31
So when we talk about interventions like this, especially very low carbohydrate ketogenic diets, there are a number of criticisms that have been brought up to me over the years as I’ve spoken about this particularly a diabetes clinics from endocrinologist, especially pediatric endocrinologist concerned about a number of these potential consequences or clinical concerns things like if you do a low carbohydrate diet and you produce more ketones, won’t you be at risk for ketoacidosis higher risk? Well, what if I eat less carbohydrates in my diet? Won’t I have lower blood sugars and ultimately have higher risk for hypoglycemia? What if I am a patient I’ve seen data and seizure patients that has used this diet as a as a therapy to manage seizures but also in sometimes cure seizures in patients with neurological disorders. There has been some side of literature that a small percentage of those patients actually have impaired growth. Well, that also happened to those in type one diabetes. What about cardiovascular disease if I dramatically increase the amount of fat in the diet? Am I not increasing my risk for cardiovascular disease as cited based on literature 20 years back that says the high fat diets are not good for your health. What about kidney function? If you have a diet that sometimes can lead to higher protein intake, won’t that hurt my kidneys? As some will say that all diets and there’s enough literature to support this that all diets have compliance issues when trying to help guide a patient on their journey? But what about quality of life? You know, what if I can’t eat you know, the birthday cake at my friend’s party? Will my quality of life be diminished if I can’t eat 60% of the grocery store when I walk in it? Will I have the same quality of life that I would have otherwise? So this is a quick snapshot of what these are on the left hand side are all the concerns I just spoke about. Because this data is so new in this area with 17 published studies. Now that seems like a lot. But what we don’t have is long term randomized control trials using this intervention, the gold standard of what people expect to see when given clinically based decisions. So what do we look at if we don’t have outcome data? For all these biomarkers? We do have some outcome data on ketoacidosis, hyperglycemia and quality of wife but the rest we don’t well, what do you look at you have to look at risk factors for the adverse outcomes. So we’re actually considering risk factors for ketoacidosis hyperglycemia, pediatric growth, cardiovascular disease, and beyond. A lot of these are linked to poor glycemic control. And we know this dietary intervention can dramatically improve glycemic control. Some unique examples is in the case of things like cardiovascular disease, so cardiovascular disease, there was actually a published study using the largest most robust data, not the largest dataset but the most robust data set in type one diabetes, which is over 1000 subjects studied over a 30 year period of time, who had type one diabetes using looking at increased insulin utilization and its impact on glycemic control and then ultimately, hot micro and macrovascular complications. And when they looked at that data set in 2016, it’s almost 30 years since the onset of that trial. They look at what were the risk factors associated with cardiovascular disease. And what they found in bold there were the significant actual risk factors things like glycemic control and HB one C, triglycerides in the form of lipids and an ultimately insulin load. So as HB one C got higher cardiovascular disease risk went up. As triglycerides got higher cardiovascular disease, what insulin will go higher cardiovascular disease went up. But what was interesting is that weight total cholesterol, LDL and HDL things historically shown to be associated with cardiovascular disease in the general population or in diseases like obesity. Were right at around one hazard ratio. Now people aren’t familiar with how the ratio is how to ratio is the fold change elevated risk that someone would have for curing a disease. If you have one fold risk, you have no elevation of risk. If you have a two fold risk or a two fold hazard ratio, you have two times the risk of developing that disease in this in a particular circumstance. And this case weight total cholesterol and LDL and HDL had about a one fold risk meaning there was no elevated meaningful change in risk in these biomarkers, when they were compared to other biomarkers like HB one C, triglycerides and insulin load. Hence, where we should focus on when we think about managing risk biomarkers in cardiovascular disease. Now, kidney dysfunction HPMC has been linked to kidney dysfunction as the it’s a micro vascular disease to destroy the choice the kidneys, but the concern about protein intake is not actually evidence based. We know that protein intake matters when you are on the progressive kidney failure side of the equation where you can’t even process nitrogen that comes downstream and metabolize protein. But we know that in the context of no kidney disease, that elevated protein intake has no adverse effects on kidney health at least the most robust data to date says that compliance we know when we talk about compliance we know that any form of dietary change or restriction honestly if you got a patient, to do exercise to do anything, to improve their lifestyle, improve their health, there’s going to be a lot of patients who have difficulty with that transition. And it has nothing to do with this particular dietary strategy. In fact, all the evidence I’ve seen that most robust randomized clinical trials to date, so the compliance of this diet is no different than any other diet and then quality of life. We know it’s a complicated multifactorial thing, but we do know that HPA will see as it goes higher quality of life goes lower. And we know the accrual of acute and chronic complications, results in lower quality of life. And in this specific situation, we do know that increased self reported quality of life has occurred with very low carbohydrate diets and type one diabetes. But the data is a little biased because it was it’s observational and not randomized or controlled when it’s observed, but it’s worth noting because that’s the evidence we have. So when we talk about a very low carbohydrate diet in the context of type one diabetes, most people often find themselves talking about these hypothetical concerns that sit above the surface, that people think about things like hypoglycemia, pediatric growth, adherence, LDL cholesterol, ketoacidosis, and quality of life, even though only two of those actually have some legitimate evidence that it may be going up. In these scenarios. Although LDL might be questionable based on the evidence specific to type one diabetes, but under the surface what most people are not talking about or even appreciating, until they get and look beyond when they first see is the reported benefits of this dietary strategy like triglycerides H HPMC, insulin low glycemic stability, quality of life and the reduction in incidence of severe adverse events compared to reported averages in type one diabetes not using this diet. And this ultimately leads to the question of really, what about the potential for it to reduce severe disease that comes subsequent to the diagnosis of type one diabetes as well. And so I like to just show this graphic to illustrate that when we talk about disease management, we’re not talking about one problem. We’re talking about a host of considerations and problems that the patient has to consider and encounter on a regular basis, especially with this disease. That is certainly the case and you can consider it as one biomarker and hinge your entire diagnosis and treatment, not diagnosed but the treatment and management of disease based on that you have to consider that so Tality of what other intervention you’re giving the patient and how it may or may not benefit that patient. And here’s just an illustration of the things that have to be brought into consideration the totality of this specific intervention, as has been shown to be one of the most remarkable and improving the primary biomarker outcomes linked to long term outcomes in type one diabetes, glycemic
1:10:38
control.
1:10:40
So there’s also some appreciative and positive and I know it’s not kind of quickly go through this year. This is a friend of mine gave me he’s actually talked about this publicly and gave me this slide to share his son’s name as well as his son’s name. But his father’s name is Lester Hightower, his son when he was diagnosed at 10.6 HPLC. A little bit after starting to manage the disease came down to 7.6, which is actually a little bit better than most patients would experience but usually patients stay at or higher than that, for the duration of their disease. Reduction see that his son at every single appointment since his onset of the very low carbohydrate diet was in normal HBA one see over the years and his son is actually now taller than his father and going on to college next year. So an incredible success story who is a pediatric patient and the link to that is that talking about his story is below. This actual story came from an article from Duke in Harvard bullish study that actually showed a low carbohydrate diet from an observational study from the community I’m a part of had the most remarkable glycemic control outcomes reported in a given intervention type of activities and it happened to be a very low carbohydrate diet and it was the most shared article in 2018 was published in New York Times. So it got a lot of interest. The type of diabetes community is quite a big advocacy community and this is his father speaking about it because his son was actually featured in that New York Times article. I myself have done this diet and I have been type one diabetic for over 15 years. The reason I’m passionate about this topic, not only from the research perspective, but also my personal life experience. I switched to a very low carbohydrate diet and adjusted my insulin some time ago, which meant taking other things like potatoes and fruit from my diet and replacing it with healthy nutrient dense fat sources. Ultimately, that resulted in a pretty robust reduction in the amount of insulin I was taking by over 70%. At one point it was it was quite a bit more than that because it went from about 90 to 100 units per day to about 20 to 30 units per day when switching on this diet. The equated cost of that if I didn’t have health insurance was about $900 per month, about $175 per month. So a huge cost saving not only to the patient, but obviously to the health like health insurance companies and beyond the total global health impact is quite a bit here. And this isn’t uncommon to hear of these level reduction, as I showed you in the cited data about a 33 60% reduction is what’s been reported thus far. And this is my CGM on the left hand side prior to switching on to this diet. And this is after an example of after switching out of this diet. This is not uncommon, and then actually quite normal to me to see much, much dramatically improved glycemic control and this is really work and illustration to me of quality of life. And this is just a 60 day average of that showing that I’m sitting right between the 70 and 120 range. This was a graphic and from a prior presentation I gave but I can pull up a graph from essentially today in the last two weeks and it looks very
1:13:54
similar this I have
1:13:57
with a typical HB one C being much higher and the diabetic range at 6.5 or above and pre diabetic is 5.7 or above I have seen numbers as low as a 4.9 before on this dietary intervention. And I have to say I’m damn proud of that because it’s a dramatically different quality of life of living with this disease having a level glycemic control like that. And there’s now hundreds of 1000s of pediatric to adult patients with type two diabetes is a snapshot from a community of parents who wanted to share their kids story and gave consent to do so here for presentation like this other group called type one grit. These are examples of kids who are doing these interventions, a lot of them holding their meters and their HB one c values and signs of success doing various things to live a normal life, just like your non diabetic peers. And you’d have just more pictures to share of those kids who share their story. And now we talked about this last slide or two. We talked about this from a healthcare provider perspective. There’s huge increase in popularity. But I’ve concerned and of note is the self reported implementation of these diets in the absence or very little input from healthcare providers. And this has been cited because the hesitancy of patients to share their dietary choice with providers because of the hypothesize backlash they may receive because of a lot of healthcare providers view this diet and negatively. And ultimately, it’s critical that healthcare providers understand and appreciate this potential tool in the toolkit to help guide patients because patients doing this in the absence of healthcare and oversight ultimately seems like a recipe for disaster at least it could be better clearly with health care support and more people in the in the core of this patient to help them manage this disease. Better. When talking about this from a clinical perspective, is there eligibility and you know, stability criteria for this population? Well, eligibility for this a certain type one diabetes, but there really isn’t a whole lot of eligibility criteria currently cited although there’s clearly the inability to metabolize fat you would not be able to deal with this or end stage liver failure is currently a contraindication for using this diet. There may be some others that I have failed to mention here but for the most part, it’s it’s not something that has a clear contraindication unless you have a clear metabolic disease beyond type one diabetes. The inability to process some of these fats. And there are things to consider. I give a talk for something called the Institute for Personalized therapeutic nutrition. It’s a very innovative institute that is trying to bring about a lot of information and guidance on these topics from an institutional perspective. And I go into much more details on these topics such as how to overcome predictable and preventable poor diet formulation problems. The inability oftentimes patients or caregivers, or clinicians will put people on these diets without actually adapting insulin which is a big meal. Now you have to know how to change that. Hypoglycemia, patients allowing themselves to get too low on this therapy without actually earning it. Meaning you have to get your standard deviation low enough to where you can drop your mean with it. Dropping the mean before the senior deviation is small enough ultimately is going to lead to more hypose and the inability to know or anticipate medication adjustments if patients are on other hypoglycemic agents or glycemic glucose lowering agents. We know this dietary intervention can often cause a deeper prescription or lowering medications along the way, so there has to be anticipated and accounted for and in fact, maybe proactively presented upfront. And a lot of people are not prepared for the metabolic adaptation when your body goes to the adaptation from being almost predominate glucose burning to fat burning there is some changes in mineral load some fatigue that may accompany the shift in mineral load, etc that can be overcome by adjusting for listening so I’m not gonna go into great detail there at the be its own separate talk, but there is a talk from IPT and I gave that discusses these in more detail for clinicians interested in those topics. So in summary, there’s increased interest of this dietary strategy both globally and within the type one diabetic populations for a whole host of reasons. And the data suggests right now, this intervention in this disease specifically improved HB one C lowers insulin load and medication requirements, improves glycemic control, and ultimately, lipids and severe adverse events appear to either not change or actually improve considerations for common pitfalls in this one your healthcare provider guiding and patients are obvious and should be considered. If not, they are going to potentially arise and they are clearly predictable. So it should be considered and prevented. And then healthcare team plays a critical role ultimately in guiding the patients on this journey. And, and so it’s important to make sure you feel involved, but I want to add something here the very last thing I’ll say, is when we talk about where are we at now, what can ultimately lead to a better future or advance the future of this disease. There’s two key things I want to bring up here. One is that there is not a randomized control trial greater than seven days utilizing a very low carbohydrate diet and type one diabetes. Until that happens. Most physicians or governing bodies won’t pay attention to the data that is currently available even though we have 17 studies that say the result I have described here day they will wait and or prevent the utilization of this therapy until this RCT or an RCT greater than seven days actually comes. I could have a whole different talk about that but suffice it to say obviously this should happen. Obviously it is needed and it gives greater comfort to a physician guiding a patient on this journey or physician healthcare provider, anyone who’s in the healthcare team. So ultimately is funding dependent and to my knowledge has not been funded today. And we’re working to actually get that off the ground. So if you know of anyone who actually wants to philanthropically participate in getting this off the ground, please reach out let me know. And the next thing here is clinical guidelines, ultimately for the very low carbohydrate and type one diabetes. There’s been initiatives by the Institute for Personalized therapy and nutrition to actually bring these to the forefront. We know this is the most popular diet and type one diabetes right now. We know that patients are often doing this without healthcare support, and it’s not necessarily because healthcare supporters don’t want to help their patients. All of them want to help their patients is the lack of ability. To understand how to do that appropriately, is ultimately a barrier that we’re hoping to overcome on all sides of the equation, both patient and the provider. And for that, here’s a resource slide I have a website that’s free and available for anyone to use a much more robust discussion on this topic with sided literature if you want to go back and look at any of these topics, patients related to it and other resources as well. So with that, I appreciate you guys. Stop Sharing the slides here and taking questions. Wow.
Bill Clearfield 1:21:13
Thank you so much. Yeah, we’re where to begin. We have a number of questions in the chat. Usually I like to start with those. Okay. What if this is Dr. Harwood harvests? What about the argument that blood ketones are high but perhaps not being utilized? I’ve seen people who start a keto diet and have higher ketones early on and then less thereafter. Perhaps the ketones are better utilized. The longer one is on keto.
1:21:42
Dr. Horton wits is nailed it. Yeah, so that’s actually true. So we do know that when patients first go on this diet, they can see elevations in ketone bodies. Which is normal, although it’s usually a stain, but we also usually seeing a spilling of it into the urine as well and the spilling of it into the urine. It usually decreases over time. As an illustration, there’s increased uptake and utilization of these molecules. We’ve also done out of our lab chronic feeding studies of these exogenous ketones over time, so not necessarily doing the diet but actually directly feeding ketones. And we know that over time, the kinetics of these exogenous ketone administration change over time and shrink, meaning that the kinetics in the body of these molecules illustrate that over time as you feed more than your body starts to be able to metabolize them more readily. So. So yes, the answer to that is yes, that is happening. It is the case you can’t actually metabolize them so it ketones are present. Some of them will spill out into the urine, but we know that a lot of that is actually being metabolized in and out of preference to have the sights in the body that are higher highest utilize Europe, ketone bodies are actually the brain in the heart these these both these tissues appear to preferentially want to use ketone bodies based on the current evidence we have over other metabolites. So we especially the heart that’s a big hog energy hog of ketones. Now the muscle mass itself from a peripheral tissue skeletal muscle mass because it is so large, also uses a lot of it when it’s readily available. But generally speaking per gram of tissue, the brain and heart are actually the biggest utilizers great
Bill Clearfield 1:23:24
I think the next question you actually answered What have you been able to get your hemoglobin a one C down to using the ketogenic diet? And I think you you you answered that one right.
1:23:34
Yeah. So I I will say that the spread of that has always been less than six. There’s only been one scenario where I was ever above six. And it was when I was not on this diet, trying something called a flexible dieting approach, which is kind of a eat based on the macronutrients in the diet and not necessarily on the food or consistency. And so, but for the vast majority of my life, yes and that 4.9 is the lowest I’ve gotten.
Bill Clearfield 1:24:00
How long should someone be on a very low carbohydrate diet?
1:24:05
So I will say and say that that is up to the individual, right? So if the individual goes on this diet, you know, it isn’t something that necessarily everyone has to do right now or else right is is the individual I think there’s cultural considerations or social economic considerations for the patient. So everyone has to consider their own life, their consideration for going on a diet like this. What usually ends up happening with someone who considers diet like this is they have tried everything that is out there to improve their situation, and they’re just the keep dealing with hypoglycemia. And hyperglycemia is on a regular basis, which is what most patients experience. And so they’re like, there’s got to be a solution out there. And what they do is they eventually come across as intervention. Try it if they’re effective with it. I have not seen a patient turn around and go the other way. Once you get normal glycemic control, it’s very hard to unlearn what normal now feels like. And so once you get there, I’ve never seen a person go back. But the thing is, is how long did someone go on it? It’s up to them. I have chosen to be on this diet for 15 years now. Would I be on this diet for 15 years if I was not a type one diabetic? And this is really the only meaningful therapeutic solution to normalize my glucose control and kind of ensure I’m risk recruiting my biomarkers. I can’t say I can’t say that with confidence that I would, even though health benefits associated with it. Without this disease, I might say I don’t know if I would give up getting to snack on some of the best tasting foods in the entire world, which are other forms of carbohydrates, but I feel lucky in some ways that I stick with this. I have this disease and this is a therapeutic solution because it keeps me from eating a lot of the foods that I probably shouldn’t be touching on a regular basis to ultimately optimize my help. So that’s a long winded way to squirly answer that question, but in essence, up to the patient and their patients who have done this for 60 plus years. So
Bill Clearfield 1:25:59
yeah, I figured that that was the answer. A couple of get back to a couple of questions here but what about gluten issues you deal with that at all?
1:26:12
So I don’t have issues personally with this but also don’t eat a bunch of carbs to know so there’s that but there’s there’s it’s common for type one diabetes also experienced other autoimmune issues. So Celiac disease is actually much higher and the type one diabetic population than it is non type one diabetic population. So type one diabetics in general might be more susceptible to issues related to things like wheat consumption, etc. That ultimately can perpetuate celiac disease at a higher rate than the non diabetic population would. But that’s how that’s my familiarity with disease in the context of type one diabetes, higher rate. And obviously, you’d have to consume carbohydrates to get that you’d remove both those problems on intervention like this.
1:26:54
I’ve got a couple of the other sort of
Bill Clearfield 1:26:58
sister low carbohydrate is FODMAPs for one one, right and there’s another one but any any any of those lectins is another you know you know, sort of buzzword, any of those that you avoid also or
1:27:17
so I’m familiar with lectins can be tough, because I don’t have enough knowledge on the topic to really go in depth with it. But I’m familiar with some of the elimination diets FODMAP diets, whole 30 diets, things like that. I honestly my take is I’m just giving you a personal opinion on that and not really as much of a research base because there’s a ton of research on low carb as a con or research on FODMAP Whole Foods or whole 30 diets stuff like restrictive diets, autoimmune diets. My take is that ultimately everyone probably could benefit from doing some form of elimination and finding out what actually suits them well, on a regular basis. You know, a coalition may hear that their head might explode and say, Well, yeah, are you really recommending that every patient eliminate things from their diet? That’s unrealistic. I’m not talking about what’s realistic or not. I’m just saying from optimized health perspective. Would it be good if everyone like started from ground zero actually find out what their body actually does well with overtime, so in essence, the only way to do that in today’s society is to restrict and build from that restriction now to find out what your body responds well to. So from that perspective, I’m actually I’m actually trying that right now. And so I actually tried something called a whole 30 diet on which I’m doing low carb but what whole 30 means I don’t entirely know my wife’s want to do it to be honest with you just kind of doing it with her. But in essence, you’re removing any artificial sweeteners and any non whole foods from the diet and I will say that I have found that there’s a few things I limited that I was experiencing maybe not ideal symptoms or I’m being chronically hungry because I added too much stevia into some something that I consume. So I was I had enhanced palatability. And I dealt with that hunger more than I needed to for the rest of the day. So you know, I played around with this person a little bit. I’m a little bit less familiar on the literature as a whole and how it relates to this specific type other than a low carb diet is a form of an elimination diet in some ways. So
Bill Clearfield 1:29:11
what about food sensitivity tests? Are you familiar with any of them at all with water, you know, and they’ll tell you you’re sensitive to cashews but not almonds or
1:29:23
you know, yeah, I am familiar with them. I am familiar with them. I cannot speak to their utilization or not in this topic to be honest with you, do they or do they not have used I don’t even know. I but I’m sure there are people who do know more about the topic than me.
Bill Clearfield 1:29:40
Okay. Question about semaglutide is a fairly pretty popular even in the non diabetic world because there’s a it’s a potent weight loss substance. And the question is, is that is that you’re able to use semaglutide with diabetes type one.
1:30:02
And you know, it’s a good question. I’m sure people have off label use it there is one study and type one diabetes, to my knowledge on semaglutide use. I expect every population that has overweight issues to probably be touching that drug because of its immense efficacy shown in the journal medicine paper. So the ability to suppress appetite seems incredibly powerful for many of the issues we deal with in our obesogenic society, you know, with the hyper palatable foods and explore etc. So, I suspect we’ll see a lot more research in particular other diseases beyond just type two diabetes and obesity were originally was shown so
Bill Clearfield 1:30:42
I seem to remember somewhere that the incretins you know, that’s one of them. You’re not supposed to use them with insulin though is that
1:30:52
I while to this I do know there are plenty of physicians who are giving the whole house the shotgun approach of getting patients whatever it takes to get the patients to improve. That might take Well, in my experience, I didn’t seem to hold back some physicians from doing any multitude of therapies to improve outcomes, but I can’t really speak at that from a clinical perspective on what a clinician might be or not doing on that so
Bill Clearfield 1:31:20
can take one develop in adulthood?
1:31:24
Yes, in fact, the data from that 2020 2020 to September paper says that the mean age of diagnosis is now in the 30s for type one diabetes. This was once a pediatric disease, a childhood disease that was expected to only be happening in childhood. But we now can appreciate that actually, a large number of adults are being diagnosed and it’s probably for two reasons. One is probably legit, like or increase of diagnosis for reasons that are probably environmental that we don’t fully understand yet. But the second reason is almost certainly because of a increased awareness that a lot of type twos were actually type ones. And now we have advanced tools to actually be able to capture that. Things like antibody testing and other tools that allow us to refine that is in type two is type one, it’s just much slower progressing ie called lotta late adult, did the exact definition of late auto immune diabetes. Either way, Lada is the term used La da for adult induced late onset adult type one diabetes. Could
Bill Clearfield 1:32:23
you elaborate just a little bit on the antibodies and
1:32:27
yet, not all type one diabetic have formed a type one diabetes actually have positive antibody testing. But if you do have positive antibody testing, usually it’s more than one. Your risk for developing disease goes up infinitely. And all this is looking as auto antibodies for detection of autoimmunity against beta cells. And ultimately, if you have one, your risk is much higher. You have to and Joe may know a bit more about this than I do. He’s done a lot of talks on this. But ultimately if you have a multitude of these antibodies present, your increased risk for this disease can almost be upwards of 99% for getting diagnosed. So this just comes down to the auto immunity factor of this right so once you find out your body is auto having auto reactivity to your beta cells, you know you’re on a likely spiral to get diagnosed, but not all type ones have auto antibodies and they still have type one. So it isn’t universal, but it is what is that percentage of distribution between auto antibody positive and
1:33:35
positive antibodies with type one. What’s the percentage?
1:33:41
I actually don’t know that number. That’s a good question.
1:33:43
Okay. Well, I have a thing here that I want to talk about. Dr. William Allow me. But I mean, your presentation was great. I like the low carb, Is it zero carb? Or you have some carb there and you’re dying? Yeah. So
1:34:03
most people would recommend on this dietary strategy that the carbohydrate should be coming from fibrous green. carbohydrates in the form of like spinach, broccoli has, etc. To get in four or five phytonutrients nutrients and fiber in the diet. Obviously, fiber is an important component of health in gut health, as well. And there’s a number of phyto nutrients within vegetables in general that are important that you don’t want to Well at least I would not want to universally avoid. There are some people who do diets that are completely absent of all carbohydrates, but that’s not what most people would even recommend. That’s more on the that is a much more controversial topic, I guess is a nice way to say it.
1:34:42
It’s just hard to get 00 carbohydrate from your diet. Because especially if you want to eat vegetables, there is some carbohydrate in it and you need the nutrition and the vitamins and polyphenols in it. Now, the thing is that I want to add I think you are diabetic type one. Yeah. And recently me and my group and I think Dr. William were discussing oxytocin and it has an anti diabetic effect a very powerful anti diabetic effect to the point I have some doctors reporting that the patient was on. They have 400 glucose and they ended up in 280 with with oxytocin and I want more data, just one patient is not enough and before they have been done intranasal oxytocin, but I think those it’s not right. I think now we can go up to 100 international unit and it’s just an estate of just going 40 Especially with patients who have conditions like yourself with diabetic type one, so as a patient, or as a doctor, can you help us in getting reports with our data out of using intranasal oxytocin up to 100 international unit, because it does help to stimulate insulin from the beta cells if there is anything left and also increase the sensitivity of insulin plus it helps to induce fat shrinking or lipo lysis plus regeneration of the muscles. So and a chance to change the body composition with that kind of high concentration of oxytocin. Maybe this something with your diet and possibly this will knock down even your insulin dosage into half and maybe zero, I don’t know. And also it will help also the puffy eye that you have there in your onto your eyes. If you use intranasal oxytocin, because it does have some neuro vascular modulation effect as well. And it has an anti aging effects and so it has that collagen building and helps the skin rejuvenation. So is it something we may consider and I’ll connect you with compounding pharmacy and try it for three months and then report us your insulin dosage and your wellness in general and how you feel about using it and send that would help us to get more data to prove oxytocin intranasal along with your diet. It’s a powerful tool to manage patients with diabetes type one.
1:37:10
Alright, so a lot of things that unpack there. I don’t know if these bags are going away. Those are totally genetic. But they may if oxytocin cures that holy shit, you got something way more powerful than a body composition issue for many people. So that might be something interesting. I actually studied oxytocin international when I was at the Department of Defense grant from the oxygen office. of Naval Research. We actually were studying international use of oxytocin for thermal regulation capacity, one of the world experts on that as Natalie Adler at a University of Florida, and I’ve actually since walked away from that project, but it’s still being ongoing right now. If you got access to that, wouldn’t mind trying it now the the thing that I’m familiar with oxytocin intranasally, as it wasn’t as potent as if you actually look at the blood kinetics of intranasal oxytocin, it’s questionable it meaning like the ability to actually readily elevate oxytocin to meaningful levels with a singular doses,
1:38:08
singular dose, and we’re also enhancing it with photodynamic therapy as well. So there’s a lot of other things we add. So instead of just using 40, international unit, you go up to 100 international unit, plus if you have still barrier of getting it through the blood brain barrier or through the blood, then you can use intranasal photodynamic therapy, which helps to increase the blood brain barrier plus it does help to increase the blood flow and absorption of oxytocin because it’s only nine amino acids not a big deal for oxytocin not to pass through and getting into the blood and and then we are also advocating doing subcutaneous oxytocin as well. So this is something um, you know, we can also help you to supply with that as well. But this start with an intranasal oxytocin, see what what happened. And then, if you see some good results or enhancement or improvement then we may consider also adding oxytocin, subcutaneous, you can have both the peripheral effect of oxytocin plus the central one,
1:39:06
I be interested in for sure and I from especially because I am familiar with this topic, I have not diabetes specific it was more for thermo regulatory perspective and because of that, I am familiar with the international use. Have you ever connected with Natalie Abner or any other people working
1:39:23
with all those people we are interested and anybody who was interested in advancing it, anybody who’s already working on it. We want to learn from all those doctors and get them here with Dr. William Bill. presenting to us that will be fine. I’ll be presenting here as well. So I opened the 22 up I just compare the whole pack here even more illustration and everything is coming out recently. That’s the reason you know, we don’t hear much of oxytocin because the publication’s is 2017 and 1819 2021 and 22. But me in the compounding pharmacy, we’re trying to enhance the absorption of intranasal, using photodynamic therapy. So that’s one way of getting better results. Yeah. So but invite anybody that you think here and I’ll be presenting it on the 22 and with Dr. Billy William, okay. But if you have those doctors, you can invite them on 22 here, that will be great. Is that okay? Dr. William?
Bill Clearfield 1:40:18
Fine. It was me. More than merrier you know, I always ask bring one person. So another question, are you familiar with the glyco Mark blood test? And if so, have you seen any falsely low levels and people on keto on the Keto plans?
1:40:38
I’m curious what the glyco Mark refers. I’m not familiar with that. Is it a glucagon test? Is it a C peptide test? I’m
Bill Clearfield 1:40:45
not really sure Dr. Horvitz asked Are you still with us?
1:40:51
Yeah, I’m here. What does that refer to?
1:40:55
Steve like, like a mark is tests I get it through LabCorp. Supposedly, it looks for glucose excursions above 180. And if you’re glyco mark, they have levels below 10. They say you’re in for diabetic control above 10. You’re in good diabetic control. But I bring this up only because I’ve been seeing in diabetics who are uncontrolled it’s absolutely below 10. But I’m also seeing people who have been keto for quite a while but it’s below 10 And I’ve asked like a mark a couple of times as to why are they Cygnus as well and they’re not. So it’s GL y CEO Mark ma RK?
1:41:36
I’ll check that out. I am unfamiliar. It’d be interesting to know why there are certainly a whole host of metabolic shifts that happen on this diet. So if there’s any type of metabolically oriented biomarker, then I could see there be interaction.
1:41:49
Yeah, I was just wondering whether possibly ketones interact with it in some way. But thanks,
1:41:57
Andrew, I know that the ad is dip their foot in the low carb dipole. Do you think they’re serious about it? I think they’re patronizing.
1:42:07
I think that they’re, I think most institutional biozones Not even just ADA per se, but like anyone in general, I think any institution bodies hesitant to make any serious claims about something that doesn’t have essentially, bucket loads of long term RCT data. The problem with that, though, is where who’s funding that? You know, because my understanding is that that is not necessarily on funding those trials, even though it is the most popular topic, maybe their lives would be awesome. But the problem is that what is expected to make recommendations has to be funded and it’s not being funded. So I do think there is hesitance. I think the historical precedents around this diet has led people to win you know, the first principle first do no harm. So if you have any prior data, historically, this has been deemed negative like, actually my disease is the one that has brought about a negative talent towards ketones. Even though the emergence of evidence over the last 10 years or so the ketones are actually a remarkably good health tools. It’s the acid component of the ketone body that was actually negative and type one diabetes and leading to early complications and potentially death and patients. So we’re obviously revisiting all of this science and really appreciating it. But the people who make the guidelines are those who have been around the longest and the most senior, and they also might be the people who have maybe the strongest sense of their competence on these topics, but the evidence has completely shifted over the last five years. So I don’t know I don’t speak too much to why or why not? Honestly because I think that who knows, you know, but I do. I do think one thing I think is probably almost certain is that institutional bodies try to be careful about what they put out there because there’s huge consequences and benefits or whatever they say, and they will only eat whatever they say. That’s for sure. So it’s definitely not in the mainstream. And I think anything out of the mainstream is going to be something that people are going to be really hesitant to back or give anything behind. But the truth is, you don’t have a choice. It needs to be addressed because patients are doing it and the absence of recommendation is no recommendation. And patients are going to do whatever the hell they want and the absence of that. So there needs to be some formalized recommendations, full stop for what patients should do on this journey. Because right now, we do have 17 studies, and we know patients that are doing it and horts so the absence of guidelines right now is actually hurting patients in my opinion and should be addressed
Bill Clearfield 1:44:46
Can you speak to a follow up can you speak to mineral loss as replacement when it creating an acidosis the literature that it’s darker good kind of watery, I never pronounce her name right. Many of the side effects are related to mineral loss such as weakness, cramps, what’s your experience?
1:45:03
Yeah, so that’s that’s definitely true. It has been well cited McSweeny 2018 2016. Actually, they’ve been some studies from Jeff Bullock, who’s been doing low carb diets for almost 20 years now. Those are familiar with his name. This topic is one that so a lot of the adverse side effects so people can get something called keto flu, okay to get a headache to get fatigue, they get lethargic. A lot of that has been about size as the individual who noted that question from mineral loss, particularly sodium, because when you go on a low carbohydrate diet and actually one of the things many patients with hypertension experiences, lowering blood pressure, and the reason for that is because you’re depleting a lot of not pleading, but like flushing out a lot of sodium, insulin, bring sodium and water in to the body. And so the absence of those carbohydrates is going to deplete a lot of that inherent sodium in the diet, which is why blood pressure lowers a lot of times you have to be careful about hypertensive meds on patients who are on them when you go on this diet. And we actually know that ketone bodies themselves can have an antihypertensive effect on the vasculature. So to which we don’t fully know yet but there’s work out of a group McCarthy, I think he’s at USC University of Southern California, looking at these topics, so but yes, what people often recommend is to supplement with sodium, a good bit actually like a gram per meal. Which sounds like you know that make the A ha, croak saying something like that. But the truth is, that’s what’s been recommended, and it’s been done in the sight of literature to combat some of these symptoms.
Bill Clearfield 1:46:39
Okay, any before you hit on this that, you know, there’s lots of theories of diets out there that I’ve listed here by someone fruitarian diet or vegan diet, any other experiences with any of those, if you have those and then failed or
1:46:57
so I’ve actually done like a lot, so I never really tried to fool. I’ve done a vegetarian diet very short period and is actually low. carb. So I’ve actually done a Low Carb Vegetarian Diet. I have a friend who is a orthopedic surgeon who has type one diabetes she has a mom as well who was actually a full fledge vegetarian because she has autoimmune issues that still beyond type one diabetes and so she’s actually successful doing that approach. She actually has talks online if anyone’s interested in seeing that her name’s Carrie Douglas. And so other forms of these diets I’ve done like flexible dieting. Man, there’s a lot of diets I’ve tried to be honest with you. I’ve done vegetarian but it was low. carb, so something called like a key pico Atkins. I’ve done intermittent fasting. In fact, a lot of times I do that just not because I’m not trying to quote intermittently fast. I just happen to do that I don’t eat when I’m hungry. And I eat when I need to, which is usually after I workout or right before bed. And that’s pretty much it now, right before better like Yeah, and so I’ve done a number of these diets, but I haven’t done a few of them like I haven’t done like a carnivore diet. I haven’t done a FODMAP diet. I haven’t done a few of these but I’ve tried whole 30 I’ve tried flexible dieting. I’ve tried many of these approaches. And I honestly Truthfully, when it comes to type one diabetes and the management of type one diabetes, what we’re essentially talking about here is matching the food kinetics of glucose to the current medications of insulin and the kinetics of insulin. So how quickly it is glucose cause insulin elevation to go up and how quickly can insulin bring it down? And unfortunately, the most the most rapid insulins we have today don’t match the rapidly absorbed elevation and glucose from carbohydrates. That’s where the disconnect happens is because best form kinetics we have in drugs don’t match the rapid absorption and elevation of blood glucose in carbohydrates. So in short, you’re chasing your tail all the time. And that’s why it never matches but if you remove that form of the the carbohydrates from the diet, and you start using slower acting insulins like regular insulin, or delayed boluses to match protein, one the mistakes are much smaller, the doses are much smaller, and you have a much more reliable chance of actually hitting the mark which is often the case why? Because you can see in those tracings I showed you, it isn’t a flat line. I’ve experienced flat lines, but it’s not a flat line, you’re still dealing with the same problems at a lower amplitude, and a much more manageable situation. You don’t just like magically disappear with a disease. So I don’t know if that answers the question, but
Bill Clearfield 1:49:38
what about anti islet cell antibody insulin antibodies and GA D 65? In antibodies
1:49:46
so I’m a little less familiar with this specifics. I guess I would have to ask you, what are they what are they asking about? So is there a role for those are they important auto antibodies to the pancreas and other tissues are commonly looked at for diagnosis. There’s something called TrialNet T one D TrialNet. There’s looking at antibodies and siblings. I think it’s in siblings, children I might be speaking here, but it’s looked at it’s being studied right now and autoimmunity pathology. There’s also a child called the the environmental determinants of diabetes in youth. They’re all considering antibodies as a key metric and their onset criteria. Okay.
Bill Clearfield 1:50:33
One question is do you have a protocol for diagnostic diagnostic protocol,
1:50:40
diagnostic protocol for type one diabetes, or you mean like intervention of doing a low carbohydrate diet in the context of a diagnosis of type one diabetes?
Bill Clearfield 1:50:49
The question is, do you have a hormone protocol or lab tests for diabetes so I, I think, you know, for your type one, okay,
1:50:57
so what Yeah, so I don’t have a test what the standard guidelines are, when someone gets diagnosed, what happens is they test their finger blood stick and they’re above 200 at an unknown period of time, and they have no relationship to the food and that seems to be a surefire indicator. Okay, you got a problem. Like if it even if you have like, straight up Coke, you might get there if you’re lucky, but usually you’re not getting like 200 You’re still gonna come crashing right back down. If you have normal metabolic response to glucose. If you’re sitting at 200, it’s not coming back down, you got a problem. And you might have type one diabetes. So that’s an easy one to do. You can also look at your HPA want to see we know HPA will see starts creeping up as you start losing beta cell function. Usually most type one diabetics are diagnosed with an HPA won’t see well above well within a diabetic range, and these HPA won’t see that metrics are two to three month average. So we know that HPA won’t see as a diagnostic metric is a indicator of early onset diabetes. So HPMC glycemic metrics are kind of your ways of detecting and getting diagnosed with type one of these most of the time
1:52:09
Hey, Doc, if I may. After volunteer with Doc for six and a half years, Dr. Clearfield and watching what he does with hormones. He stabilizes a whole bunch of stuff, a whole bunch of diseases, and I’m now learning everything via hormones. So have you done research based on not sugars or blood sugars, but hormones and stabilizing the sugars and the blood sugars via hormones?
1:52:39
So, so I guess the best way to say this is the the fundamental drug used to manage this disease is a hormone. It’s insulin, So insulin is king and metabolism. It is the king regulator. In my opinion, I can definitely make the case for this. If anyone must play devil’s advocate here, but Insulin is the most potent, in my opinion, one of the most potent if not the most potent metabolic regulator. And that’s what you have to take. I mean, that’s what I have two forms of insulin right here that I take on a regular basis. So this disease is functionally managed by hormones, or a hormone in the form of insulin. Now, your question makes them a little bit beyond like what other hormones are being considered regulated? Beyond that, well, I can tell you most people manage their disease in the absence of just through insulin, syringes and insulin, blood glucose meters are usually the people who are going beyond that and looking at more advanced hormonal profiles for people who aren’t the typical type one diabetic, there are people who are trying to take a step further in their health care, or their advanced care. And so those are not as common, but every type one diabetic, if they’re planning to live, is going to require insulin unless they’re able. In rare cases, a lot of patients can go on a very low carbohydrate diet, in some case reports and I have heard the number of patients reaching out to me anecdotally, they can go on a low carbohydrate diet, post diagnosis in adulthood because it’s tends to be much more progressive and adults like slower progression, and delay the full fledge like insulin requiring the need for insulin requirements for years, but I don’t know that really gets your question but ultimately to say like every patients on it I have hormone right now to manage the disease and ultimately, refined management other hormones it seems like a a important consideration for general health it might be important beyond just type one diabetes, you know, in general.
Bill Clearfield 1:54:40
That’s all the questions in the chat. Okay. Any any final thoughts? For us? I just say I
1:54:47
appreciate the opportunity. I mean, that one of the biggest goals to get out and speak on this topic anyone has any follow up questions, please just speak up, is just get out and share a story from a disease that is by its nature, probably one of the most unique in my opinion, in metabolism. The absence of insulin ultimately makes you the king can have your own metabolic regulation. I think insights from this give insights to many other diseases. And how one might be able to optimize and manage overall health. So with that, I just appreciate the opportunity to speak to you guys and kind of speak on a topic near and dear to my heart. So
Bill Clearfield 1:55:20
anybody else have any any questions? So comments? You’re getting a lot of kudos in the in the on the chat and great talk and thank you for being with us. And we really appreciate we really appreciate it that you spent this time with us. We hope you’ll come back. We won’t bother you too often, but maybe once or twice a year. Kind of keep this going. Anybody somebody else have something to say. Next week we have Dr. Our own Dr. Su Lakhta. Dustin Souillac is going to give us an update on he’s, he’s our cannabis guy and one and he’s going to give us an update on what’s new in 2022 for cannabis. So that’s next week. So if you weren’t welcome to join us and we’ll be seeing you will be same time same station 5pm Pacific 8pm. Eastern, and it’s always the same link also. So everybody who gets that will again, bring one friend so we can expand our, our, our group. So, Dr. Gu thank you so much. This was very informative, and you know, anything that we can do to help you with your your research and your you know, your your your work. Well we’re you know, we have a whole network of the folks that are a little bit outside of the box. So
1:56:46
so that’s why I appreciate that. Have you Do you know anyone who wants to address two of the big needs as far as like actually getting a trial off the ground to kind of solidify this and then also clinical guidelines that want to support tonight that you pass on? My way. I’ve been when we have basically a protocol already set up. We already have guidelines mapped out with a team, but obviously nothing happens without a little bit of support. The best way to play
Bill Clearfield 1:57:11
Dr. Burgess, where are you?
1:57:15
I’m on the edge of my seat listening to every word, especially if you’re interested in research. So I’ll be in contact with both of you guys, and we’ll talk about what might be done with that. This is exciting, important stuff affecting millions of people. So we’re totally on your side. Dr. Cook, Nick.
1:57:33
I appreciate it, sir. Thank you.
Bill Clearfield 1:57:36
Here’s our that’s our research guy. He’s our he’s our research expert here. Dr. Velocity I don’t think he’s like the you
1:57:44
know, so this is some serious beards. They’re impressed. Yeah,
Bill Clearfield 1:57:47
absolutely, you know, on the on the on the outlier here,
1:57:52
so I’m gonna try to get that present like that’s, that’s that looks like father’s time like I have no shot at getting a bail on.
1:57:58
GED bioidentical hormone therapy. I’ll just be honest.
1:58:02
Okay, there you go. Yeah. I was bald.
1:58:09
Here, the research beer. That’s amazing. That’s awesome. Well, guys, I appreciate it. It’s honor to be here. Thank you so much.
Bill Clearfield 1:58:15
I know it’s late back East. So we’ll let you go. Thank you so much, and we really appreciate it and hopefully we’ll be in touch again. Okay. Good night, everybody. I’ll have this. We put everything on our website by the way. We record it if it’s okay with you. Yeah, that’s good. Yeah. aos rd.org/webinars. All of our programs are on there. I spell it right. Yes, voter right. No slash. It’s a dot.org not a not a slash. Org. So we’re on we’re on. All of our programs are on there. And we have quite a database as we have two years worth of work.
1:58:56
Awesome. Amazing for you guys. And
Bill Clearfield 1:58:59
also coming up. We’re still talking to Noma about maybe doing a brief one or two day program in South Lake Tahoe. In the middle of January, that ski season as of your skiers. You know, it’s a it’s a good place to go and give you some some more information on that as things go along.
1:59:21
So that last that I think Medical Association,
Bill Clearfield 1:59:24
yeah. So with that, we’ll say goodnight. And if anybody has any other questions, comments, and we’ll get this out up on our website as soon as we can. And again, Dr. Andrew, thank you so much. We really appreciate it, John. Enjoy your night guys. How’s it going? I