Master Your Hypertension With Lifestyle Medicine

Robby Barbaro, MPH

I’m so happy to be here. Thanks for having me.

Laurie Marbas, MD, MBA

Well, I think it’ll be wonderful because you have a unique story and we can just jump right in. And let’s talk about kind of like your past quickly and then how you evolved into managing diabetes. And I know you have a special emphasis also with hypertension and some things that you guys offer. So let’s start there.

Robby Barbaro, MPH

Yeah. I mean I love sharing my story just because of how much it’s inspired me to reach others and share this information. And that really, the connection between insulin resistance and high blood pressure. It’s one of the like central notes of so many things are connected to insulin resistance. And that’s the magic of what we do at Mastering Diabetes. So how do we get started? Well, let’s go back to the beginning. I was diagnosed with type 1 diabetes when I was 12 years old. So that was 24 years ago. It’s a pretty recently I celebrated my 24th anniversary of living with type 1. And, you know, at the time I was following the Standard American Diet. My parents wanted to make sure that we had the best medical care possible. So we were living in St. Cloud, Minnesota, and they said, okay, we’re going to drive to Rochester, we’re going to take you to the Mayo Clinic and we’re going to make sure you have the best medical team. And we would go there was like a whole event. We would stay at a hotel. We would see an endocrinologist, a nutritionist, a psychologist, and this whole team trying to help us out.

And in no conversation did anybody say anything about insulin resistance, nothing. And that is such a missed opportunity. I think even for people diagnosed with type 1 it isn’t caused by insulin resistance, right? So there are different types of diabetes. Type 1 diabetes is an autoimmune condition and so is type 1.5. All right. That’s how much, it’s crazy how many people are getting diagnosed with type 1.5 these days or misdiagnosis type 2 and they have type 1.5. So a side note here, if you’re listening to this show and you are underweight and your blood glucose levels are abnormal, that is the time to work with a qualified medical professional and see what is your c-peptide level. Are there any antibodies present? And really get to the bottom of this. But back to the story here. So type 1 diabetes autoimmune condition, so it’s not caused by insulin resistance, whereas pre-diabetes and type 2 diabetes that is a precursors. You cannot have one of those conditions unless you have exacerbated your insulin resistance. You’ve developed. You’ve really gone quite far on the spectrum of insulin resistance. You have to have it. So even if you’re living with type 1, you just get diagnosed and you go to your regular doctor. It would be nice if they would bring up this topic of, hey, you know what, if you make some lifestyle changes, you can become more insulin sensitive. And the fact that you are now using insulin actually makes it really easy for you to assess your level of insulin sensitivity. It’s kind of like a real benefit, almost a gift that Cyrus and I have with the work that we do is that we have that third variable that you need to have in order to understand your insulin sensitivity.

Anybody listening to this, you can test your blood glucose levels and you can count the amount of carbohydrates you’re consuming, but you don’t know on a meal-by-meal basis. How much insulin is your pancreas secreting to keep your blood glucose at any given level that you’re seeing? You don’t have that data. You can go get a fasting insulin test that’s pretty helpful, but it doesn’t tell the whole story. So people living with insulin-dependent diabetes type 1, type 1.5, and even insulin-dependent type 2, we have this piece of data that tells us instantaneously meal by meal what decisions are making insulin work more efficiently. So I’ve had my c-peptide tested. It’s less than 0.01. So C-Peptide is produced in a 1 to 1 ratio with insulin. So it’s a great indicator of how much insulin is your pancreas secreting. I’m effectively producing none. I’m producing an undetectable amount. So when I eat a meal and my body needs to metabolize some carbohydrates the insulin I inject is the only insulin work. So when I see that I need less insulin for more carbohydrates, I know that those lifestyle decisions that led to that that’s improvements in my insulin sensitivity. And that was the experience that I had and Cyrus had. We had these experiences separately and then we met. We’re like, Wow, like we’re kind of like the same on so many levels like let’s explore working together. 

So I have been following a low-fat plant-based health food diet for 18 years now, and I will consume well over 700 grams of total carbohydrates per day on a consistent basis. That’s gone up even a little bit since I started to train for Ironman races. I did three Ironman races in 2023 and that has improvements on and simply because of the endurance training. But the amount of insulin I need to metabolize that carbohydrate energy, like blows people’s minds, they don’t even think, is that really possible? I will inject a physiologically normal amount of insulin. These days now that I’m using an insulin pump and Omnipod five, I will inject somewhere between like 24 to 28 units of insulin for upwards of 700 grams of carbohydrates per day. A healthy normal pancreas is going to secrete somewhere between 25 and 50 units per day. It’s going to change on your age, your gender, your height, your activity but that’s the ballpark range. And so I’m eating way more carbohydrates than even a low-carb person might eat in a week or even a month, sometimes in one day. And I’m using a physiologically normal amount of insulin. So I’m really experiencing this high level of insulin sensitivity. I’ve been doing this for many years. I’m like, Is there research on this?

So I go and look into the journals and lo and behold, there have been papers published. I’m using a high carbohydrate diet to improve insulin sensitivity as early as 1926 and insulin was discovered in 1921, the first use in humans in 1922. So as soon as we really knew about insulin, there were researchers looking into this and seeing decade after decade the exact same thing with nothing to the contrary. There has not been a single study that was truly low fat, with less than 15% of total calories coming from fat that I have ever seen, where those human beings didn’t see an improvement in insulin sensitivity. I haven’t seen that paper published yet. If somebody has one, I would love to see it. Send it to me. So I have this experience and I’m like, wow, okay. Now the research is showing the same thing and I really have this realization that, wait a minute, we have over 100 million people in the U.S. living with some form of prediabetes or type 2 diabetes. And that condition in the vast majority of cases can be completely reversed if you reverse insulin resistance. And so we started doing this work. Cyrus and I, in 2017, we came together and started Mastering Diabetes and we have been able to help so many people. And what’s been fascinating for, you know, your audience here today is type 2 diabetes pre-diabetes, even those who come to us with uncontrolled type 1, type 1.5, usually, they have some extra weight and usually, they also have high blood pressure. 

The number of people that I speak to that are coming to us on diabetes meds, blood pressure meds, and cholesterol meds is extremely high. It’s the majority. And so people come into the program, they start following this low-fat plant-based whole food diet with a single focus. We try and keep our program really simple and help people do it step by step, because being overwhelmed is one of the biggest problems when it comes to lifestyle change. So it’s okay, we’re going to keep this simple. We’re going to do this step by step, and we’re only going to focus on one thing make lifestyle choices to make insulin work more efficiently, whether that’s the insulin that your pancreas is still secreting, whether that’s seeing some that you’re injecting because you need to inject some whatever it is, let’s just focus on making that work as efficiently as possible and that’s some of the magic that makes us a little bit different from a lot of various programs out there. Is this really singular focus and a willingness and a commitment to believe in people, believe in you listening to this, that you can do it like a lot of times people go to their doctor and they have these conditions and they like, oh, here’s your medication, because they, they might know that lifestyle medicine is the right path, but they just don’t even say anything because they don’t believe the patient will do it. Well, we do and we have there are so many things that you can do, like you can do the basics. And then sometimes you got to go a little further and we’ll help you do that. Whether it’s, you know, recalibrating, you know, how much maybe you need a little bit more fruit. And believe it or not, more fruit and a little bit more raw food and some more greens in a lot of cases can help people take things to the next level. 

It’s so funny. Just today I was reading a post in, we have like this free Facebook group, and some person they were doing well and their C-peptide was like a little bit low. And then they eventually said, you know what, I’m just going to go like full arm and do like 100% off with it and see what happens. And they finally got some extraordinary results. Now, I’m not saying that everybody has to take it that far but we will help you make adjustments along the way to see what you have to do to really reach your goals. And sometimes what do you have to do to make the most of a small amount of insulin production which is sometimes if you’ve had type 2 for so long, your pancreas is so exhausted that you might need to go another level and that’s okay. There are different degrees of commitment to lifestyle change and consistency. And we’re going to help meet you where you’re at. So anyways, we’re doing this for all these years, Dr. Marbas. And we also start running some in-person retreats so people come down. We did some in California, we did some in Costa Rica that people come and fly in. They fly in on Thursday, Thursday, or Friday. The retreat starts on Friday nights. We feed them dinner on Friday night and our meals are super simple. So at these retreats, we would only do buffet style of single ingredients. Okay, so you would just like there’s like a for breakfast you have a big bowl of mangoes, a big bowl of papaya, a big bowl lettuce, a big bowl of spinach, maybe some beans and stuff like that. Some very simple options at each meal. Dinner, we would have, you know, like kosher squash. We would have some quinoa, some beans, and stuff like that. So you have all these individual ingredients. You put a sauce on top if you want.

And people were lowering their blood pressure so fast that they had to reduce their medication. So people are there on Friday, Saturday, and Sunday. We should have breakfast on Monday. Some people Saturday and Sunday, we had a medical doctor on staff for all these retreats and they would need to talk to the medical doctor and reduce their blood pressure medication like that quickly because, at the retreat. This is the perfect example of us like stacking together everything we really know of that can help you improve your insulin sensitivity. The diet is like really, really optimal and clean. We’re having you move your body twice a day. We’re encouraging everybody to go to bed early and get some sleep because you can wake up the next day, and you’re going to learn a lot. You’re going to be active. So we’re stacking all this stuff together. We have community, we have good energy, we have support. Hopefully, you’re getting a less stressful environment because we tried to create that for you. And people are low in their blood pressure like that fast. It’s fascinating. And of course, inside our coaching program, Again, people are not here like eating certain foods or doing some certain thing, you know, specifically for blood pressure. They’re just reversing insulin resistance and it’s the reduction in diabetes meds, classrooms, and blood pressure rise. It’s all coming together. And I mean, Dr. Marbas, we’ve sent a lot of patients to you over the years. And I mean, do you I mean, what do you see in the people who are following the Mastering Diabetes map?

Laurie Marbas, MD, MBA

Absolutely. I think, let’s see the first one must have been 2018 or something. It’s been a significant number of folks and people working with them and they do very well. So they reverse the diabetes or we find that they were diagnosed inappropriately with type 2 and it was actually type one and a half and it’s a very nuanced diagnosis. It’s fascinating you’ll see definitely some characteristics that are across the board. But yes, the insulin resistance is a big thing. I’ve done deep, deep dives on this resistance. Diabetes is my favorite thing to work with. And so, you know, just to kind of highlight what you’re speaking to when you think about insulin resistance and hypertension, there’s a few things that we want to keep in mind. First of all, you’ll see in some resistance there’s a sympathetic nervous system activation, right? So that will raise your blood pressure. We have impaired nitric oxide production, which again is very important for vasodilation. We have sodium retention and fluid imbalance which causes hypertension. We have inflammation. We have the obesity and there are hormones from the particular fat storage not being utilized very well. There are vascular changes. There’s the kidney is sending out messengers to raise the blood pressure. So there are so many things tied around insulin resistance and hypertension that it’s a really important thing to point out. And so, yeah, a low carb, low fat, high carbohydrate whole food plant-based diet is definitely the way to go. But it also speaks to you having another product that I utilize with patients as well, and that’s the Amla product. And we talk a little bit about that and what that is exactly.

Robby Barbaro, MPH

I love to tell the story about this. Okay. So I’m holding the one that I consume every day. This is hibiscus amla green. It’s a tea, right? And so when Cyrus and I first started running our program in 2017 together and we started knowing a lot of people, we would have some people that if things just seem to be a little bit more stubborn, you know, as they could be. They were really compliant. They were doing things and they were getting really good results. But there was just like this final end result of like they kind of get their buggers just a little bit lower, their blood pressure still a little bit high, but cholesterol’s just not budging in the way we wanted to. And so, okay, you know, let’s do some research on this. And we stumbled across a video from Dr. Michael Greger talking about Indian gooseberries. And he was discussing some research on the topic. So, of course, we go and we dig into this research and we’re like, this is really intriguing. So we would then say, hey guys, just do an experiment. Just buy some of this, put it in your smoothies, and see what happens. And lo and behold, people got great results and we were like, wow, this is crazy but the problem is it’s not very palatable, like to just buy it. It doesn’t really taste good. So. Cyrus in his Ph.D. background here is like, I’m going to solve this. He ends up going to some shops in San Francisco like herbalist people. And he starts talking to them and starts thinking about what can we mix this with to make it taste good so people can consume it on a daily basis and get it in their body consistently which is the key factor here is that you’ve got to use it consistently, just like you got to have your diet consistent, you got to have your movement consistent, like just doing one thing in some bursts is not going to help solve any health problems. So like how are we going to do this consistently? 

So the first thing he came up with was, let’s combine it with oolong green tea, which has a whole other range of scientific papers discussing the benefits around that. So that was the first product that was created. It was just amla Indian gooseberries, the powder can with oolong green tea combined, and boom, there you have it. Okay, so we start getting that in the hands of people and they start consuming it regularly just as a tea. And we couldn’t believe the testimonials that were coming in. I mean, it’s crazy. So none of you have heard about this fruit, it’s called the Indian Gooseberry and it is the most antioxidant, rich, whole food on the planet. There’s no whole food that has more antioxidants than Amla Berry’s also known as Indian gooseberries but the problem is the reason you don’t see them at the grocery store, they don’t see them like in a container next to the blueberries and blackberries is because they’re very bitter. They just, you’re not going to enjoy the berry itself. It’s going to be hard to find. You can go look for it at some Indian markets and I encourage you to do that so you can just try it and see. But really the easiest way to get it in your body is through this tea and then we also turned it into a coffee for people who are coffee drinkers. We want to serve people wherever they’re at and whatever they enjoy to get this in their bodies consistently. I don’t drink caffeine so this one is caffeine free. There are also a couple of other options that are caffeine-free, but it’s incredibly powerful. And so I’m just going to read a couple of people who wrote their story to us. 

Somebody says this is Mrs. G. On January 25th, 2024. She says I have been drinking amla green tea hibiscus consistently one or two daily for four months to include restricting my sodium intake. I have been able to stop taking my blood pressure medication and maintain my blood pressure below the numbers. When taking medication, I feel wonderful and I believe consistency is the key. So that’s a great story. And I want to highlight there. Dr. Marbas, the key is so people who are picking this up are also getting recipes from us, they’re getting lifestyle tips, and so it’s a combination of both. Please don’t mistake us in saying, oh, wow, just like put this little just so you know, it is a tiny scoop, right? So I’ll show it to you, I guess just this little scooper, that’s it. Like, don’t think this is some miracle pill, all right? We’re not telling you that this is a miracle. We are not telling you to just drink this tea and all of a sudden your life is going to be fantastic and your blood pressure is going to be fixed. Now, there is research demonstrating the benefits of people who just added a certain amount of Indian gooseberries but we know that to truly get the overall results, you have to combine medicinal plants with a whole-food diet. You have to address the cause. You can’t just try and cover up the problem with some sort of even if it’s a natural pill, even if it’s a natural medicinal plant, that’s not what we do here. You have to address the cause, your cause of high blood pressure. You’re the cause of type 2 diabetes wasn’t a lack of Indian gooseberry. It’s just like it’s not a lack of metformin but this stuff can help this. 

And that’s another thing about what we do at Mastering Diabetes, which I’m super passionate about, is like a lot sometimes, you know, we get like criticism out there, almost all of us of our diets are restrictive or it’s like too much. Look, we are helping people who have a metabolic illness, like you dug yourself into a hole. You’re going to have to take some steps to get out of the hole like you’re in a different position than the 22-year-old that hasn’t been eating well but isn’t on any medications, doesn’t have type 2 diabetes, isn’t 50 pounds overweight, isn’t taking a blood pressure medication or cholesterol medication. It’s like you’re in a different spot. So we serve the people who are ready to dig themselves out of that hole. And what you want to do when it comes to your maintenance program and how you want to adjust that is totally up to you. But let’s talk about that in two or three years, once you’ve really fixed the whole you dig yourself into. So we’re really passionate about what this does. It’s also it’s a habit like when you make it part of your morning, it’s a way to kick start your day off like, okay, you know what, I’m going to make all the decisions. I had my tea, I had my traditional plants for the day because there’s also a bunch of other plants in these. So for example, the Hibiscus version also has ginger, cinnamon, mint leaf, and obviously hibiscus, right? So medicinal plants are powerful. Start your day with some medicinal plants and let that be the setting of the tone. Okay. You’re going to make that better decision at lunch today. And always know it’s step by step. It’s not black and white. It’s not like, oh, my gosh, has to be perfect. Like, get rid of that. Like, get going. Start taking steps in the right direction. You are going to it’s going to become easier over time and know that you will falter. You will make mistakes. Nobody has a straight line to perfect health everything being fixed. It’s going to be up, up and down, up and down. But your trajectory is going to be up and get started.

Laurie Marbas, MD, MBA

I think that’s a great way to segway here. So thank you so much for joining us today. And I hope you found this conversation insightful and engaging. If you’re a summit purchaser, stay right here because we’re about to dive deeper into this very interesting conversation. And if you’re not, click on the button below or to the side to get access to the rest of the conversation. If you’re watching this, thank you for being a valuable member of our community, and let’s continue with Robby from Mastering Diabetes. So I kind of like how you hinted around like it’s not a perfect trajectory. Can you speak to some of the stumbling blocks that you see people maybe come across as they’re trying to engage in these healthier lifestyle choices and then how they actually you know, the ones that are successful overcome them because I think that’s a very powerful statement.

Robby Barbaro, MPH

Absolutely. For sure. Okay. So the first one that comes to mind is that when people first start eating a plant-based whole-food diet, one of the most common mistakes is not eating enough food because the calorie density is so much lower than what you’re used to eating. And so a lot of people have a little bit of fear of eating carbohydrate-rich foods. So having a big bowl of quinoa and beans and potatoes and brown rice and fruit, having a big bowl is scary. So maybe they’ll start with like a smaller bowl, which is okay, but just know that is not going to have enough calories. It’s certainly not going to have the same amount of calories you are consuming prior, especially if you come in trying to emphasize salads like, oh, I’m going to do this healthy diet so I’m definitely going to include more salads, I’m going to eat more carrots, I’m going to eat more lettuce and I’m going to eat more tomatoes and peppers. That’s great. But those foods are super low in calories and they’re quite bulky, which in the beginning could be a problem. So you really got to find a balance like it’s beneficial that you’re lowering your calorie density and you’re eating these filling foods. But there’s a place where there’s like a sweet spot and a sweet spot is somewhere around 400, 500 ish calories per pound. Believe it or not, that’s where starchy vegetables end up landing and that’s where some of the most calorie-dense fruits end up landing. So things like plantains and bananas may support some of those foods. Those could be more satisfying fruits as well. 

But the bottom line is, it is a valuable exercise to use in nutrition, logging software. Our favorite software is Chronometer. There are many others you can use, whichever one you want, and everyone you use consistently. We’re not recommending that you log your food forever because it can be painstaking, annoying, and frustrating, but definitely do it in the beginning as a learning experience. It’s going to illuminate what you’re going to be doing for the next the rest of your life. And it’s a very valuable exercise, so make sure you’re consuming big enough portions of plant-based whole foods and you’re consuming the right foods that are nutrient-dense and calorie-providing. Okay, you have to find that balance and these days it’s pretty simple, right? If you follow the recipes that are provided by pretty much any plant-based expert, you can follow our recipes on our website. They’re free there. We have more on Instagram. We have them on a meal plan. It’s very easy to find recipes these days. You can even ask Chat GPT for recipes if you want to, believe it or not, it does a great job. Okay, so definitely focus on that. That’s one mistake. 

Another mistake I see people doing is they try to do intermittent fasting and the cravings are just like too much, too much. So Amla Green is actually a fantastic way. Somebody consuming a beverage that has a little bit of flavor, and a little bit of nutrients can be a great way to help you successfully do some intermittent fasting. And I would say some people try and maybe go overboard with intermittent fasting. That’s another problem sometimes. So I would say incorporate in a slow, steady, consistent way. Let’s see, what’s another mistake I see people making? I think, you know, I just keep on going back to number one. Dr. Marbas, like the fear, the fear of eating carbohydrates is unbelievable and this goes in like the night you aren’t eating enough fruit, and then they’re not eating enough potatoes. They’re just like, you’ve got to have calorie providing, you know, what we call green light food. We put food into green light, yellow light, and red light. And we list them in that as that got an order right to the first four categories are intentionally the first four because they’re calorie providing it fruits, it’s starchy vegetables, it is legumes, and it’s intact whole grains. You’ve got to have a proper portion of those with greens and non-starchy vegetables at every meal. You know, that’s another mistake. Let me cover that one, Dr. Marbas. So people with blood glucose challenges. Okay, in the beginning when you’re very insulin resistant, okay, you will see spikes. There’s no question you’re you’re not going to solve this problem in one day or two days. You could see improvement and see they’re going in the right direction. But you’re not solving it. You’re not like completely turning this around 180 degrees that fast. 

So you have to learn how to eat your way, eat, and move your way out of insulin resistance in a steady way. And one of the the like you’re going to have bug spikes how you can blunt them and make them you know less frustrating is including greens and non-starchy vegetables at every meal in every meal. I have greens with my breakfast. And that’s how your tastebuds change your tastebuds, absolutely change. And arugula is like one of the best-tasting foods on the planet for me, it’s unbelievable. I have arugula with almost everything. I just love it. I also love spinach. I love romaine lettuce. There are so many great greens, but in our recipes, we will take care of that for you. Kind of to think about it because we’ve already proportioned out how many greens and non-starchy vegetables should be in that serving but nonetheless greens and non-starchy vegetables every meal, especially in the beginning. Then you should also eat at a reasonable pace. Okay. Then again this is a nuance-specific detail for people who are struggling with also blood glucose challenges, which I assume are a lot of people who are coming here to learn about high blood pressure. These things come together. So when you’re insulin resistant, you got to give your body a little grace. You don’t you don’t just start eating that meal as fast as possible. If you’re eating meals right now in 8 minutes, bump it up to 12. Right. Like that little difference is going to make it. If you’re eating out, you think your lunch break is only 15 minutes. Okay, fine. Then you will do what, you probably finish the meal sometimes in six or seven, bumping up to 14. Like any small increment and just the mental shift of the mindset. Okay, I’m going to start chewing my food. I’m going to take it gracefully. I’m going to maybe say some gratitude before this. You know, like really just bringing that attention to your meal is definitely going to help blunt blood glucose spikes there is no question.

And then moving your body after a meal is spectacular for people who have blood glucose challenges. Moving your body any time of day, any amount, especially any amount that’s more than you’ve been doing previously like you’re moving in the right direction is always beneficial. So if you’re like, oh, I can’t do that after a meal, but I can do it before, great, do that. But for people with blood glucose challenges, the best thing you can do is move your body after and it doesn’t need to be intense, just walking. We seen this in the research, we’ve seen in our clients and as a person living with type 1. Again, I have all these fun experiments every single day, every time I eat food, I know that if I’m walking after a meal, I have to adjust that carbohydrate insulin. Rachel, I have to take less insulin or I have to eat a snack every single time is no exception. Like, it’s just like that’s a fun thing about insulin resistance, it’s so objective, it’s so repeatable. It’s unbelievable. So that’s another mistake that I think it’s easy to correct. And hopefully, you love your meals so much that you enjoy spreading them out a little bit more.

Laurie Marbas, MD, MBA

No, I think that’s fantastic. This is going from being mindless to mindful and movement in what you’re eating and your meals. And I think that people also find that they’re more present in other parts of their lives, which is always a wonderful way to live. So I think this is a super way to end our conversation. So thank you so much, Robby, for sharing with us today your story and all the work that you’re doing to help people find health and wellness. We appreciate you.

Robby Barbaro, MPH

Thank you so much. So happy to be here. And I hope everybody listening. You’re really inspired to take action and enjoy all the speakers.

Laurie Marbas, MD, MBA

Thank you.