Gain Control: Food’s Power Over Diabetes

Robby Barbaro, MPH

Dr. Fuhrman. It’s a real honor to be here. I’m so glad that you guys are doing this summit, and you’ve been such an inspiration and example. The fact that you guys are out there being very verbose and that you can reverse heart disease—is powerful. Everybody who’s joining you is lucky to be in the presence of these guys and learning this information. I’m happy to be a part of it.

Joel Fuhrman, MD

Thank you. that’s right. You can get your blood pressure back to normal. If you’re a type 2 diabetic, you can become non-diabetic. If you have heart disease, you can reverse it without angioplasty, bypass surgery, or taking dangerous medications. You can recover and get well. We want to have this information available so people can take it, bring it into their lives, and save some lives but also make people happier as they get healthier. Can you start by going over for us the relationship between blood sugar, blood glucose, heart disease, atherosclerosis, cholesterol, and blood pressure? Start going over this relationship between sugar and heart disease.

Robby Barbaro, MPH

Well, to me, it’s a very simple relationship, which is that people don’t understand that the number one cause of death for people living with all forms of diabetes is heart disease. People think I have diabetes. My blood sugar is too high. If that’s the case, that’s why that’s my main problem. It’s like, well, there’s a lot that’s happening here. There’s a lot that’s going on. From what we teach, we help people make lifestyle choices that maximize their insulin sensitivity. The foundation of everything we talk about is mastering diabetes, which is my passion and the information I’m getting out to the world is that when you are living in a state of insulin resistance or glucose intolerance, you are increasing your risk for a longer list of conditions, including heart disease, cancer, fatty liver disease, chronic kidney disease, high blood pressure, high cholesterol, high triglycerides, Alzheimer’s disease, retinopathy, and neuropathy. Insulin resistance is the central theme of how we like to speak about it in mastering diabetes. So our focus is on if you can start making these lifestyle choices to maximize your insulin sensitivity, you’re going to be addressing all of those conditions simultaneously. So, that’s our focus. My passion comes from this and what I experience daily.

Joel Fuhrman, MD

In case some people are listening and they don’t quite understand what insulin resistance means, you just add a couple of extra sentences to the list. Have them understand better what you mean by insulin resistance.

Robby Barbaro, MPH

Insulin resistance is the diminished ability of your body to take glucose out of your bloodstream and into your cells. But that is what insulin resistance is. Insulin’s primary function is to take glucose from the bloodstream and put it into your cells. You need glucose to fuel your cells and become an active, healthy human being. So insulin resistance exists on a spectrum. So that’s why the official definition is diminished ability. So when insulin is not working properly, people start to develop blood glucose problems. What happens is that if insulin’s not able to take glucose out of your bloodstream, your blood sugar starts to get elevated, and that’s when you get diagnosed with pre-diabetes. if that gets worse and you get diagnosed with type 2 diabetes. What most people don’t understand is that you were living with insulin resistance before you got to that prediabetic state. There are some experts. I believe up to 90% of people in the Western world are living with insulin resistance, and in that case, your pancreas is secreting extra insulin to keep your blood glucose in a healthy state. You might go to your doctor, and get an A1C test, and it’s in the non-diabetic range. You think that’s fine. I’m not insulin resistant, I’m not diabetic, and I don’t have a problem here. But if your doctor was as smart as you are, Dr. Fuhrman and your doctor ran a fasting insulin test, you would likely find that your insulin level is high, and it’s that excess insulin that’s shoving glucose into your cells and keeping your blood glucose stable. But you are on the verge of becoming insulin-resistant if you don’t start making lifestyle changes.

Joel Fuhrman, MD

What you’re also saying is that I presume that even before your sugar starts to rise, the higher level of insulin needed by insulin-resistant people is damaging in itself. High levels of insulin accelerate aging and cause damage. The glucose coming up is another cause of damage. But insulin itself is an independent risk factor.

Robby Barbaro, MPH

That is exactly right. It’s very important to get a fasting insulin test. That should be a standard. But again, a doctor knows how to do that. Unfortunately, most of our doctors don’t have the education that you do, and they’re not running this test. But you guys listening to this, you now can be an advocate for your health, and you can either choose a better doctor or you can ask your current doctor to run a fasting insulin test. It’s very important information, and it should also be known that the caveat here when we talk about fasting insulin because there’s a lot of conversation about this topic, is that if you are following a very low-carb diet and you go to your doctor and you still have low fasting insulin, that does not mean your insulin sensitive. Just because you have removed glucose from your diet or you have significantly decreased the amount of glucose you’re consuming and you’re fasting at some point, that’s not 100% accurate. The fasting insulin test becomes valid if you’re consuming a reasonable amount of glucose. This is where a lot of people get confused and why the literature is so confusing about diabetes and insulin resistance because there’s this test called Homa-IR. Homa-IR factors in it’s a complex equation, and when you read the papers that were used to develop Homa-IR and make that an actual valid test, those papers were used in people who were consuming carbohydrate-rich food because the gold standard for testing your level of insulin resistance is a new glycemic clamp test. It’s very expensive. It’s hard to do. You’d have to go to a university laboratory. That’s the gold standard. To make it easier to assess insulin sensitivity in research, they decided to create a test Homa-IR where you’re only factoring in blood glucose and insulin levels. That is an incomplete mechanism for assessing insulin resistance. That’s why there’s so much confusion. You have to understand that you must have a glucose challenge present in your body, or, let’s say, you can do an OGTT, but the glucose challenge has to be connected to your fasting insulin level for that task to be informative.

Joel Fuhrman, MD

What you’re saying is that this is about, and we’re saying that I think all people who are overweight, have heart disease or have diabetes have insulin resistance and are not sensitive to insulin enough. We have to increase insulin sensitivity and decrease insulin resistance. Now go into some methods by which people can increase insulin sensitivity and decrease insulin resistance because that’s the goal.

Robby Barbaro, MPH

That’s exactly right. There are a couple of simple ones. They’ve been demonstrated in research year after year, dating back to the 1920s. Insulin was initially discovered in 1923 and was first used in humans right around that time. Then there’s a paper published in 1926 in the Journal of the American Medical Association, JAMA, by Dr. Sansum. Dr. Sansum started testing a high-carbohydrate diet with his patients, and again, they only started to do this because they just discovered insulin. You couldn’t have a conversation about insulin resistance. We knew what the heck it was. As early as we knew about it, leading researchers in the leading journals were talking about increasing carbohydrate intake and then decreasing fat to a reasonable level to increase insulin sensitivity. This continued decade after decade with Dr. Hemsworth, Dr. Walter Kempner, and Dr. Anderson; it goes on and on and on. The bottom line is that we know we have to get rid of trans fat. That’s obvious. We know we have to reduce the amount of saturated fat that we’re consuming, and we need to increase our consumption of whole foods that contain fiber, vitamins, minerals, antioxidants, and phytochemicals. These are simple dietary principles. But in addition to that, if you want to become more insulin-sensitive, you have to move your body. 

But it doesn’t need to be; you don’t need to be an Olympic figure skater like Dr. Freeman, okay? You don’t have to be a professional CrossFit athlete to simply begin to walk. That is the beginning for a lot of people. When you change your diet, you start moving more, and these simple changes start moving in the right direction, and you start seeing some changes snowball. Eventually, maybe you get ready to go 100%. I know you and I have talked about this, Dr. Fuhrman. Sometimes people have to go in 100%. Sometimes people are okay to just start making slow changes and ease their way into them. I think it’s best to work with a doctor and decide that. If somebody is working with you, they go to your retreat, they have your guidance, and maybe you go 100%. In some cases, their doctor might be like, what, let’s just ease into this. But I think those simple, straightforward changes are needed to get rid of the trans fat. You have to reduce saturated fat, and you have to move your body. You’re going to see a big difference, and you have to eat whole foods that are full of fiber. You’re going to see a big difference.

Joel Fuhrman, MD

What about body fat percent? How does body fat percent relate to insulin resistance and insulin sensitivity? What body fat percent would you consider ideal for a male and a female?

Robby Barbaro, MPH

That’s a great question.

Joel Fuhrman, MD

Am I going to go?

Robby Barbaro, MPH

I think it’s a great conversation. You tell me, when you are with your patients, what do you shoot for?

Joel Fuhrman, MD

Well, you want to know.

Robby Barbaro, MPH

I want you to answer 100%.

Joel Fuhrman, MD

I tell the general public that to be healthy, you have to have a body fat percentage for a female below 25%. Male below 15%. Excellent. However, that’s what I give the public. But I also know that 15% body fat for a male is not optimal. These are just what I think are good because my hope is that at least 70 in a month and my body fat’s 11% natural. I know we could do better than 50%, and mine is measuring super-healthy people. A female could even do better than 25%, but 15 to 24% is a good guideline because when I notice with my measure, their insulin resistance and their inflammatory markers, we know as it goes for a female above 25% to 28, 30%, you see inflammatory markers in institutions go up. When you see a male go from 15% to 18 to 20%, you see these numbers start to go up. We have to get them moving in that direction towards at least those decent numbers.

Robby Barbaro, MPH

I love this. You’re very inspiring. I’m an Iron Man athlete. I’m looking to get better and better. I’m on my journey to try and get closer to 6%. That’s best for athletes, right?

Joel Fuhrman, MD

That’s world-class.

Robby Barbaro, MPH

But we’re talking about general health here, and I think that’s important for people to know. I’m curious, Dr. Fuhrman, what do you use to have people test their body fat percentage?

Joel Fuhrman, MD

Well, I used the InBody machine, and they are less expensive, this is like a $10,000 machine. But nowadays, they make them pretty accurate. If you buy for a few hundred bucks and you don’t get these electric scales that only put in one or 2%, they’re pretty close.

Robby Barbaro, MPH

That’s great. That’s good to know. 

Joel Fuhrman, MD

We want people moving in the right direction. Of course, 100%. Whether the baby is stepping or whether they’re fully doing it, if they’re not seeing the body cycle, they’re not seeing the wake of that, and if they’re not seeing numbers improving, they’ve got to do more. They’ve got to present. They’ve got to get results. They had to fix themselves.

Robby Barbaro, MPH

I love that we had a conversation about this recently when I was interviewing you, and I think it’s a fascinating topic. You have, and it might be worth talking about here for your audience, but you have a lot of experience. Well, it’s been so many years. When it’s right for somebody to go in 100%, just make the changes. What we’ve recommended in our book and what we do in our coaching program is that we help people change one meal at a time. I think there’s a level of self-awareness that each individual has to have about themselves, and there’s a level of trust in your doctor. Sometimes, going to a retreat like yours is much easier.

Joel Fuhrman, MD

And we know that from my experience and what I could say over the years, the change in what I’ve been telling people over the last 30 years is that I have become more white; maybe I’ve become more compassionate, more understanding, and have more wisdom, but I’m not reducing it. But I have more reason to be more strict and aggressive in getting people’s buy-in to 100%. Because too many people I’ve seen who dabble and cheat go on binges, and then when they keep lighting the fire under their desire, the more they go off the diet, the more they want to go off the diet and never get to the point where they fully enjoy this. Who can stay on it? But they keep going back and forth. If anything, my initial books were less strict than my latest books.

Robby Barbaro, MPH

 It is amazing. 

Joel Fuhrman, MD

How about you?

Robby Barbaro, MPH

I agree. I went in 100% in 2006, which is when I learned about this way of eating, which is full of whole foods, and got rid of this garbage. That just blew my mind. I went in 100%, and I’ve never looked back. Cyrus said the same thing, as did my co-founder of the book Mastering Diabetes. So we’ve had that experience. What do you think about the people who see challenging gut symptoms in the beginning? There’s a conversation going on; if you ease into it, your gut can transition a little bit better. What do you think about that, Dr. Fuhrman?

Joel Fuhrman, MD

I think in some cases you have to do something like that, which is advisable. Sometimes I give more things that are gentle on the gut if people can’t handle the fiber, like a lot of beans. I’ll have these in, but that’s not for most people; it’s still rare. Not that common, but it’s not always one size fits all. You have to adjust.

Robby Barbaro, MPH

For how many years have you been practicing medicine?

Joel Fuhrman, MD

Well, I don’t think I need to go to medical school, so I was almost 30 years old. When we started practicing, I only finished my residency in 1988. I’ve been practicing doing this from 1988 to 2023.

Robby Barbaro, MPH

I just want the audience to know, like, so you can ask me the question again in 20 years, Dr. Fuhrman, after I’ve gathered some experience, but you’re on a whole other level.

Joel Fuhrman, MD

Thank you. Appreciate that. So, what do you think now the response of the health care and medical communities is: how can these people be sabotaging people’s health or how are they helping people’s health, and how can they navigate that? Well, how do we get people to use this holistic, natural method, and how do they navigate that with their conventional practitioners?

Robby Barbaro, MPH

I would say the medical community is sabotaging people’s health by not believing in what people can do. So many doctors are saying, I’m not going to tell my patients about lifestyle change right now. They’re not going to do it. That’s ridiculous. What we need is doctors who are living by example, like you, who tell the patient, I believe in you, you can do this, and I’m going to show you how I’m going to give you the resources. That’s how people are getting sabotaged, and just unsupported. My best recommendation for somebody who feels like maybe they’re stuck in the medical system is that you have to find a way to get out. You have to find a way to get yourself surrounded by a medical team that knows and believes in addressing the root causes of your challenges. So that’s what you do. You and Dr. Kahn are resources, and there’s much more on the Internet. We work with an organization. It’s called Love Life Telehealth is a whole organization dedicated to providing doctors who know about the work of people like Dr. Fuhrman, Dr. Kahn, and Dr. Ornish. They studied this world of nutrition, right? We understand nutrition and lifestyle. So you can start having appointments with those doctors now. If you’re like, no, I have to use my insurance; I got to work with my team, then the best thing to do is adjust how you communicate with your doctor. You don’t want to go in there and try to act like you’re smarter than them. 

That’s going to be a very combative relationship. If you respectfully come to your doctor and say, look, these are the goals that I have. Let’s say you’re living with type 2 diabetes. Your doctors put you on metformin, and you come to the doctor and say, “Look, right now you have me on 2000 milligrams of metformin. I would like to reduce that medication. Can you tell me what number you need to see from me for you to be able to reduce my medication?” And your doctor, “Well, that’s what you want, I’m going to need you to by the time you come in for your next visit, I’m going to need you to drop 20 pounds. I’m going to need you to show me that your fasting blood glucose is finally under 100 for us.” We help. We advise people to get their fasting blood glucose under $100 for seven days in a row. then it’s time to start reducing medication with their doctor. See, you have this friendly conversation with your doctor, very respectful, and say, “Look, tell me what objective things I need to achieve for you to reduce my meds.” You go and do that, and you say, “I’ve lost 20 pounds. Look at my fasting blood glucose.  Do you think it’s safe for me to reduce my medication?” There you go. They get back. “Great. Wow. Yes.”. When it comes to blood pressure, you have to be careful. You can be overmedicated in a very short period when you start implementing these lifestyle changes. You can communicate with your doctor about reducing your medication appropriately, but you have to have consistent communication.

Joel Fuhrman, MD

Let me just make one clarifying statement about what you said. Because if the person is switching from an unhealthy diet to an excellent diet and they start losing weight and controlling their numbers, the response they get can be very effective and even radically reduce their blood sugar. In that case, when the blood sugar starts to drop, if we wait for seven days once the blood sugar is back below 100, the person could potentially become hypoglycemic to a dangerous level if they don’t cut back. You’re saying that if they’re eating well and avoiding sugar for some amount of time, they’re running about 100 to 120. That’s fine. But if they made the change and it’s dropping, they’ve got to look at it too much sooner because if one day it’s 100, the next day could be the next 60. They could be if they were on medication; the over-medication could cause a problem. They’ve got to be very alert to that, too.

Robby Barbaro, MPH

That’s an excellent clarification. In this case, it does. It depends on what diabetes medications they’re using. If they’re on like 500 milligrams of metformin, that’s likely not going to cause too much danger. As far as low blood sugar.

Joel Fuhrman, MD

Metformin doesn’t push it down low, it’s the other medication’s fault.

Robby Barbaro, MPH

You’re 100% right. In our book, we clarify that. When we talk about medications, we list them in order of which ones are the most dangerous. As you’re switching your lifestyle, that would be insulin, first and foremost. That’s the one that can cause a problem if you’re not reducing it properly.

Joel Fuhrman, MD

I’m going to say I’m going to tell you a quick, one-minute story. This guy comes in, and he’s very overweight with a big belly, but he’s eating very unhealthy. He’s diabetic and takes 180 units of insulin a day. Type 2 diabetes. Now I know how bad he is eating, and I know how good he’s going to eat now. I’m thinking to myself that this person has become rapidly hypoglycemic. I’m going to stop all of that insulin on day one. When he comes in, I take 80 units of insulin and wipe it out on the first night he comes in. His sugars are running like 260 on 80 insulin on a day to 60. Not the next morning, but the following morning he was combative, confused, and hypoglycemic, and he was eating a combative, confused, and hypoglycemic, and I called 911. I had to hold him down. I had a jump on him, but I got some date paste into his mouth. Before the ambulance came to pick him up, he got better and recovered. I gave him a little food and got it. But I’m just putting it up to how even though I stopped all his insulin—100% of the long-acting insulin—the diet was so effective at dropping the sugar from how badly he was eating. It’s looking at how badly they are eating to see that. There’s a lot of judgment and experience it could take some time, but in this case, we are the story.

Robby Barbaro, MPH

We are sure. Was he taking any other diabetes medications? You stopped all diabetes medications.

Joel Fuhrman, MD

All diabetes medicines.

Robby Barbaro, MPH

That is pretty scary. That is crazy.

Joel Fuhrman, MD

265, two days later, in the evening, they stop it. Two days later, he was hypoglycemic. Still the next morning. But the following morning, a day and a half later, he was hypoglycemic.

Robby Barbaro, MPH

That’s the power of lifestyle change.

Joel Fuhrman, MD

All right. We’ve got to pause here. Thank you for joining us today, everybody. I hope you found our conversation insightful and engaging. But if you’re a summit purchaser, stay right on because we’re about to dove even deeper into this captivating discussion. If you’re not, click on the button below or on the site to get access to further information. If you’re watching this, thanks for being a valuable member of our community. Let’s dive in a little further. We talked a lot. We’ve got a lot of good information now. But what do you think are the two most important findings from the world of nutritional science over the last decade? Pull out the two most critical things you’ve found that people should know about.

Robby Barbaro, MPH

Number one is the importance of fiber. We continue to learn so much about fiber and the microbiome. It is mind-boggling. For those of you listening, you don’t need to necessarily understand all that science is. Much of it is developing and is even the best test to assess the quality of your microbiome, which is evolving and is all new. But the bottom line is that what’s clear is that well over 95% of the population is fiber deficient, not consuming enough fiber. You want to take action. You don’t want to be in that population, and so I think the importance of fiber has been mind-blowing. Number two, I would say this is just a personal experience that I had, which is certainly well documented in the research. But the value of walking, I cannot say enough, by just including more walking in your life. I want to add to that that it’s more than just a benefit for your body and for your physical health. Walking can be transformative for your relationships. This is a great opportunity to spend time with your partner. It’s a great opportunity to spend time with family. You can walk your dog, you can make a phone call, and you can get connected with nature. I just think this is a powerful principle of lifestyle change that we’ve learned more and more about. There’s more research coming out about the benefits of cost control from just walking. I think a lot of people get intimidated by exercising, but everybody walks. You already do a little bit of parking at the grocery store. You walk into the grocery store. Everybody does a little bit of walking, and doing more can be life-changing for you.

Joel Fuhrman, MD

You’re not talking about adding something like a fiber supplement. You’re talking about adding foods with fiber and not eating foods that don’t have fiber, like white flour, sugar, oil, or honey. People don’t realize that you’re diluting the fiber content of your diet, the nutrient content, and the protein content of your diet because you’re getting your fat from oil and not from a nut that has protein in it. For example, one.

Robby Barbaro, MPH

Hundred percent. Eat almonds; don’t have any of the almond oil; eat olives. You don’t need the olive oil. 

Joel Fuhrman, MD

Eat fiber.

Robby Barbaro, MPH

With sesame oil?

Joel Fuhrman, MD

You get the full fiber; you get all the parts.

Robby Barbaro, MPH

Absolutely.

Joel Fuhrman, MD

the last thing I want to ask you. As we wrap this up, what are the two most important take-home messages people can go to and apply to their own lives? You mentioned walking. Do they walk once a day or multiple times a day? What else do they do besides walking? What else do they do? What is some specific information you could give them dietary-wise, to improve the quality of the results they would receive?

Robby Barbaro, MPH

I’ll expand a little bit on walking, then I’ll add two more tips. When it comes to walking, I say to walk as much as you can. I have made a rule for myself, which is that if I’m going to spend time on my phone, whether that’s responding to text or if I’m going to go post on Instagram, I do it while I’m walking. Just imagine if you made that one life change where the time you spend on your phone, whatever that is, you can’t be sitting down. You have to be walking. That’s a big change.

Joel Fuhrman, MD

Take all your calls. Stay connected with your community on the phone while you’re walking.

Robby Barbaro, MPH

You could even go outside; investing in a treadmill could be a good idea like it’s a game changer. Remember, the other two changes I would recommend are: first, take the time to experiment with recipes and foods to find the ones that you love. The only way for this lifestyle to be sustainable is for you to love your food as much as Dr. Fuhrman and I love our food. You have to look forward to these meals. You have to enjoy these recipes. You have to be proud of them. If you’re doing this and you’re like, This doesn’t taste that good, I’m happy with the results. That is not going to last. There are so many recipes to try. There are so many foods to try. There are so many different ways to prepare meals and different textures. You have to spend time. As you try some recipes, you might try ten, and you might hate eight of them but love two of them. That’s a win because what you’re looking to do is you’re going to end up developing a pretty small set of recipes that you’re going to have repeatedly. All human beings eat very similar meals. You need to find a new set of similar meals that you’re going to enjoy over time. 

Number two, I would say, is seeking out community. For long-term success, it’s going to be challenging if you’re the only person in your group who’s doing this, and you can’t convince family members to do it by brute force. The best way to convince people is by being a shining example and making them come to you and ask, “What are you doing? I want to do that too.”But I would not count on your inner circle right now to see the same revelations that you’re having. They’re not going to have them at the same time. You need to seek out communities outside your current inner circle. They’re not going to change at the same rate as you. So this could be going to meetup.com and looking for groups. This could mean getting involved with people digitally. This could involve joining a coaching program. This could involve going to a retreat, connecting with people there, and staying in touch with them. But you have to proactively take steps to develop a community of people who are on the same path as you. You feel like you have support. You have people to share with and grow with because changing your life is not the easiest thing ever. You’re going to be growing into a whole new person, and you’re going to need people to support you.

Joel Fuhrman, MD

Robby, thanks so much for your participation, your wisdom, and your leadership. Thanks for being a part of this, and I think people got a lot out of listening to you today.

Robby Barbaro, MPH

Thank you so much. It was great to talk to you.

Joel Fuhrman, MD

Be well.