Reverse Diabetes & Heart Risk With Fasting

William Hsu, MD

Dr. Kahn, thank you for inviting me. Glad to be on your show.

Joel Kahn, MD, FACC

I can’t believe it’s been since 2019 that you’ve been Chief Medical Officer of L-Nutra. That time has flown by. I remember when you were introduced and you were a big shot, and you’re still a big shot. We like having big shots and the seven because it brings so much scientific authority. Just a little background: you were at Joslin, and you still live in Boston and may have some ties to the Harvard system, perhaps. But what kind of research were you doing on diabetes? What were some of your favorite projects?

William Hsu, MD

Well, a couple of things. One is that we try to understand what the root causes of type 2 diabetes are. From my angle, by looking at people who were not very overweight, believe it or not, there are quite a lot of people that don’t look very overweight but develop type 2 diabetes, and because a lot of times we need medicine when you study the extreme or something different from the norm, you get to cover a lot of the intricate backgrounds and the mechanisms of action. For example, if you look at populations living in Asia and the Pacific, they don’t necessarily look very overweight, but the rates of diabetes are sky-high over there. So even though people can have a near-normal BMI, they kind of have high interest and resistance, which is what’s driving type 2 diabetes. things of that sort. The second area that I was quite interested in was the area of digital health. This was all before the pandemic. How do we provide care in between? The visits were one of my areas of focus.

Joel Kahn, MD, FACC

We can have people go to expensive resorts and make lifestyle changes. But for the majority, we’re going to need to fill the gaps and keep them focused. That’s excellent. Without too much detail,  it’s a big jump to leave the academic world of Joslin enjoying the scientific team at L-Nutra and a very academic group at L-Nutra. But not everybody would have taken the step.  what attracted you to hang your hat with Dr. Longo and Dr. Antoun and the great team that’s now centered out of Plano, Texas?

William Hsu, MD

A lot of my colleagues were asking me that same question in the event my wife was questioning the sanity of my decision. But, in hindsight, it’s been a great journey as a clinician. But four or five years ago, it was very clear to me that the very reason why our patients with diabetes became people with diabetes was because of their inability to adhere to a difficult lifestyle. Every day, eating, exercising—we all knew that it was the right thing to do. But it was so difficult for people. If we were asking people with diabetes to reverse their diabetes by using the same methods—eating well every single day and exercising well—that could work in theory. But practically, it’s still very challenging. It’s almost impossible for a patient now. That’s why many of our patients resort to taking medications and injectables because it’s much easier. The lifestyle was that kind of disillusionment, if you will, that I said we’ve got to look for something else that could give you the benefits of drug-like benefits, but it doesn’t require an everyday adherence, an everyday change in our lifestyle. We are all big proponents of lifestyle changes, but in the back of my mind, I always remember the patients who sit in front of me who struggle to adhere to what we tell them to eat and to exercise. That’s also for us. When I stumbled across the word by Professor Valter Longo, USC, it just opened my eyes to see. How could you have such impactful results with such a short intervention? And that was what led me to L-Nutra. No regrets there.

Joel Kahn, MD, FACC

Well, I would imagine most of the viewers of this reversing heart disease summit are familiar with the idea that there has been a product available called ProLon, created by Dr. Longo and made available through the L-Nutra Corporate System that you opened up. It’s the simplest program in the world for five days. You eat what’s in the box—one box for box three, one box for box five. Since the randomized study was published in 2017 and showed multiple benefits, we won’t go into detail here. This has been a program that over 100,000 people have used, but with L-Nutra, we’re not going to use the word ProLon anymore because L-Nutra has developed a slight variation specifically for type 2 diabetics. You published this study. Tell us a little bit about the Journal of Clinical Endocrinology and Metabolism, July 2022, what you observed in people who did this slightly modified five-day fasting-mimicking program, and why people listening should be excited that they may be able to get off the endless treadmill of more diabetic drugs.

William Hsu, MD

Dr. Kahn, this study you cited was, in fact, revolutionary because the study was done at the University of Heidelberg in Germany, involving two teams of individuals, one taking five days of what we call a fasting-mimicking diet, or the FMD for short. That’s the invention of Dr. Valter Longo. Just five days per month, you repeat, is six months. You’re talking about a 30-day effort, five times 630, compared to another group of individuals that were simply on regular standard therapy with no particular dietary sort of participation. At the end of six months, we saw a couple of amazing results. Number one, the group that was on the FMD, the five-day efforts, lowered their A1C by 1.4. Now, 1.4 might seem like it’s respectable, but it’s not five, not three. But it’s very important. 1.4% just for every percent dropping in. Once you’re talking about a 30% reduction in long-term complications, That alone is almost comparable to some of the best drugs in the world. However, two-thirds of the people who are on this five-day FMD lowered their medications. Some of them even stop taking medicine. So you may not appreciate this so much from the audience right here. But to lower A1C, that’s a third-month, three-month glucose average. It’s a marker for diabetes control with more medicine, which is very commonly seen, but to drive a drop in A1C while at the same time lowering medication. Now that’s impressive because it works through a different mechanism, but in addition, we saw about 22 pounds in weight loss.

Joel Kahn, MD, FACC

Just say that loud one more guideline.

William Hsu, MD

It was 22 pounds of weight loss, and most of it was fat loss with the preservation of lean body mass. That is astounding, because a lot of our listeners may not realize this. When you lose weight, you lose much of your weight in the form of muscle. For example, with a lot of popular drugs like Ozempic and others, when you lose one pound, 30% of that weight is probably muscle weight. But, because of a fasting-mimicking diet, the FMD was through a different mechanism. People lose the way they don’t want. They had the muscle they had. So that was a great study. With 30 days of effort, you had the weight loss, you preserved lean body mass, you lowered your medications, and you lowered your A1C.

Joel Kahn, MD, FACC

That is remarkable. Maybe you start the program with a hemoglobin A1C of 6.8% and of course, it’s just average for the group. Six months later, with 30 days of effort and hopefully eating well, the other days, of course, you’re down from 6.8 to 5.4. That would be a 1.4% drop if my math is right. So you would be in the normal range at that point, maybe on some medication, but you’ve gone from diabetes type two by definition to normal blood sugar control by definition.

William Hsu, MD

It’s interesting because, about a year and a half ago, several US associations like the American Diabetes Association and Cancer Society, got together and said, for a long time we just wanted to sugar to get to a good level, like it was less than seven, but that translates to lifelong disease management, meaning that we just expect our patients to live with this disease with multiple drugs for the rest of their lives. But since this consensus paper was published about two years ago, these organizations got together and said we ought to have a different goal and a different angle. That is, instead of driving just lifelong dependency on medicine, we should begin to define what diabetes remission is. We should put an end to this lifelong dependence on medicine. So from there on, there was this idea that we should try to help patients get rid of their drugs. We should try to help them reduce the burden of medicine. This is what we’re driving for lowering the A1C and, at the same time, getting people off their medicine. That ought to be the new angle. I wonder how many doctors, or how many of you doctors, your listener’s doctors, have told them that they could achieve this. They don’t have to live with diabetes for the rest of their lives. They’re means of achieving diabetes remission.

Joel Kahn, MD, FACC

It’s amazing if everybody just writes this down. The average weight loss was 22 pounds. Nobody’s guaranteeing it. But that was the average. The average reduction in medicine was that two-thirds of the participants could reduce or eliminate diabetic medicines, and the hemoglobin-A1C average drop was 1.4%. Quite remarkable. Then, rather than just sit on academic achievement, you guys developed a little bit of a long-named DRRP, Diabetes Remission and Regression Program. It’s been a real brainstorming session to come up with something like that. But this is available, and I can tell everybody it’s available because, in my clinic, I’ve been able to offer it to type 2 diabetics, and they’ve made a decision to get involved. It’s not clinical research anymore. It’s just a nutritional program that they can participate in. But tell us, for those that are listening, what are the participants that were out of the research phase when to make it available to the public phase? What’s going to happen to them if they say, I want to try that for the next six months?

William Hsu, MD

This program is for people who say, I’m sick and tired of taking all these medicines, and I want to feel normal again. I don’t want to be taking medication for the rest of my life. If you’re someone with type 2 diabetes, enroll in the program. This is what you would expect. You will expect. A dietitian will hold your hand throughout this journey There are six months of monthly FMD, five days of this fasting-mimicking diet for the rest, and 25 days the dietitian will be by your side that will provide nutrition and counseling. We hope that we can help you, even though the five days alone are powerful. But look at the combination of the five days plus the dieticians giving you personalized guidance for the rest of the 25 days. That’s what they make up there. As we talked about in the program, it took about six months to reduce the medications. We give patients the option to extend it to a 12-month program. So that you could even when you were off the medicine, when you’re completely down to just living your life alone, we’re still there to help you. But people have choices, too, to finish the program with the constitution of their doctor and their dietician, the dietician that we provide to start the program any time along the journey. It’s a plant-based, five-day FMD. With dieticians supporting you. It’s a smart scale that will give it to you; it will tell us your anthropometrics, the changes in your body, fat, and muscles. It’s a library of contents. There is an app to support you. There are even ten days of simple meals from our sister company, Nutrition for Longevity, which provides medically tailored meals. That shows you what the 25-day diary should look like. It’s a well-thought-out, full-fledged program for you.

Joel Kahn, MD, FACC

That’s a remarkable wrap-around trying to maximize the chance of people listening and they know type two diabetics, their type two diabetics, everybody knows somebody with the explosion of unfortunately, type two diabetes that we’ve seen in the last couple of decades. Somebody knows somebody who’s going to benefit from this program but has not heard about it. the fact that it comes even with some samples of this wonderful food by this company, longevity for Nutrition for Longevity.

William Hsu, MD

Nutrition for Longevity, yes.

Joel Kahn, MD, FACC

Nutrition for Longevity. That would make more sense. It’s a wonderful company, and I’ve eaten their food. It comes right to your doorstep and gets you started along the right way because, of course, you want to, between the monthly five-day periods, also focus on a healthy whole-food diet, and they teach you how to do that. There’s an app that guides you right on your phone.

William Hsu, MD

That’s right. There’s an app. then there is a book on the longevity diet written by the very inventor of the program, Dr. Valter Longo. It’s thought of every way to support the patients. The key is that you don’t feel alone during this journey because the product does work and so we’re going to need to work with your doctor. In this case, Doctor Kahn, about your patients reduce and de-escalate those medicines along the way. But if you don’t have a doctor who’s working with you on this, we now also have ways to arrange for the medical supervision of a physician who will lower the medication for you if you so choose not to work with them.

Joel Kahn, MD, FACC

That’s new. That’s great because, during the five days that people are using the L-Nutra program, they’re reducing calories. We are very often counseling them to cut back on their long-acting insulin and reduce their oral agents for those five days. It takes a little expertise. The fact that you have some experts who specialize internally is going to make this program even more available and successful for many people. Tell those who are listening that if they want to find out more, where would be the best place to go?

William Hsu, MD

L-Nutra is the mother company, and so if you go to L-Nutra and the word health at the end, that’s where you will find the information that’s l-nutrahealth.com. It’s a little bit of a mouthful, but if you understand that kind of spirit, L-Nutra has always been the mothership of the company. Adding the health differentiates from sort of our consumer offering because this is a health care program; this is a medical program. You can find us at l-nutrahealth.com.

Joel Kahn, MD, FACC

That’s clear. l-nutrahealth.com read about it, and sign up for it. If you’re not a type 2 diabetic, of course, there is ProLon on the five-day fasting-mimicking diet that’s suitable for most people. There are a few exclusionary criteria, even though it’s a food program, but there are a few people who may not be ideal for it. The majority are. Of course, this program is specifically for type two diabetes, not type one. There is ongoing research there, but that’s what we’re talking about. We’ve learned a lot. Just before we go for a quick break, tell us, based on your vast experience, why putting type 2 diabetes into remission, putting type 2 diabetes into a regressive mode, and dropping hemoglobin A1C, what’s that going to do to cardiac risk?

William Hsu, MD

As a doctor, can you always say that diabetes is a vascular disease? All the complications of diabetes end up being vascular. That’s why you said at the beginning of the program that these two disease states are the hips. That’s why we have a term called cardio-metabolic. When you lower the A1C, when you treat the root cause of type 2 diabetes, when you reverse type 2 diabetes, you’re very much reversing these risk factors for heart disease. You’re reversing these risk factors for these vascular conditions. For example, the vascular conditions in the eyes are called retinopathy, the nerves are called neuropathy, and the kidneys are called nephropathy. These are all vascular; these are blood vessel diseases due to constantly having this high level of blood glucose. You do yourself a favor by reducing the disease burden and even the side effects of medicine through this program. Lowering the A1C, lowering the medications, and treating the root cause of type 2 diabetes is the best thing that you can do for yourself to support healthy longevity and reduce all these complications.

Joel Kahn, MD, FACC

That’s what we want people to get excited about. Natural approaches to reversing chronic disease and regaining your health are not necessarily dependent on more pills and new pills. We’re all grateful for the new medications and the existing ones. But imagine a world where you just eat your way into better health, and I’m excited. Dr. Hsu, hang with us for a little bit. We’re going to say thank you for this great overview of this program. Come back in a few minutes for our premium members. We’ll just talk a little bit more. Hang on there. Everybody, please stay tuned. In your premium membership, we still have Dr. William Hsu with us, the chief medical officer of L-Nutra. We had a great discussion about a program you probably didn’t know much about before his interview. Talk a little bit. insulin resistance. What do you think happened over the six months with these people? They’re all eating the L-Nutra program for five days, or 12% of the time. I’m not sure my math is right. What do you think’s causing some of these significant, beneficial impacts? You can go as scientific as you want.

William Hsu, MD

This is a good question because how could five days of nutrition intervention change so much? The answer lies in the fact that this is a very systemic sort of intervention. This has a very, what we call an upstream effect, as well as a very systemic impact. Let me give you one example because it’s hard to understand. If you exercise, that’s one lifestyle-based intervention. How is it possible that it strengthens the muscles, lowers the fat, increases the strength of your heart, expands the lung capacity, and is even good for your mental health? Think about that one intervention. The second is about another powerful lifestyle intervention. Sleep when you don’t sleep; every system, organ, and organ system fails. I remember that during the days of our residency and training, we worked hundreds of hours a week. Our brains weren’t working, and our muscle coordination was much lower. Everything was in a shamble. Fasting for five days. does mean the same thing. It’s very systemic because the stress of fasting affects every cell in the body. The cells have to survive. The heart cells, the brain cells, the muscle cells, the fat cells—everything goes through these and cleans up these changes. That’s why, specifically, when you look at what happens to mainstream resistance in the study that I quoted earlier, we had a 60% reduction in resistance just by five days of fasting-mimicking six-month cycles. So not only does it address a lot of the basic fundamental pathophysiology of type 2 diabetes, like illness and resistance, but it also has this systemic impact almost working in the liver, for example, on the muscle, on the fat, and even potentially in the beta cells. That’s the very cells that make insulin themselves. It has this overarching impact on systemic health. It truly is one of the major changes that bring about major changes to the body, much like exercise and sleep. It’s a very powerful lifestyle intervention.

Joel Kahn, MD, FACC

Can you separate weight loss from any source at 22 pounds over six months with, god forbid, a carnivore diet or a high-fat animal-based ketogenic guy? I don’t want anybody to do that. I’m asking a scientific question of a leading scientist in the world of diabetes. Do you think it would have resulted in the same 60% improvement in insulin resistance, or not necessarily?

William Hsu, MD

Not necessarily. Well, for a couple of reasons. One, you would have to be on six months of everyday adherence to that ketogenic diet. That is very different. Six times thirty, there’s 180 days of commitment versus five days per month. Every perspective is different. Number two, this is a plant-based approach. Think about how there’s no animal origin in the composition, FMD is a very different composition. I’ll be asking the cardiologist about its impact on cardiovascular and heart health. Number three: the mechanism of action is very different. While the ketogenic diet, a carnivore type of diet, relies on ketones to generate the benefits in the case of a fasting-mimicking diet, the ketone is a beneficial side product, a byproduct of the fasting process. It’s not what changes the cells inside out. What changes the cells inside out is the process called autophagy. That’s the basis of the 2016 Nobel Prize signs. When the cells don’t see enough nutrients for a long time, they begin to digest parts of the cells that are seeking a new source of energy to depend on for the next couple of days until the food becomes available again. This is what every living organism does: seize nature. When nature, from time to time, gives us periods where there’s no food, the cells have to survive. It’s like cutting your arm to survive a crisis; the cells go into this existential crisis mode. Doing these prolonged fasts causes the cells to shrink during that period, hoping to survive, get by, and get rid of the more dysfunctional components of the cellular organelles. But when time becomes plentiful again and food becomes available again, the cells grow back. Now, when they grow back, that’s when they have replaced a lot of the worn-out paths with new ones. Just think about the disadvantages of nature. when it has the hands down to when ahead and when money is handed down to us as a threat to our existence. The cells adapted by converting that disadvantage into an advantage by making new cell parts and undergoing cellular rejuvenation. This is the miracle of life; without this kind of mechanism, living organisms can never have a sense of survival over hundreds of millions of years of existence. This is the miracle of life, and we are banking on that because of this process. One of the scientists who described this won the Nobel Prize in 2016. Here, with the fasting-mimicking FMD, we’re just leveraging what nature has already designed. But in a controlled way, we mimic the fasting. You don’t go through the suffering and pain of five days. We’re only fast at giving you nutrition. What doesn’t trigger the body is knowledge of these nutrients in the body. You get the benefits of a five-day fast in the story. It is just an amazing story.

Joel Kahn, MD, FACC

It is. We haven’t even mentioned the fact that it is a plant-based program. It has years of research behind it. We know that it’s likely very good for the cardiovascular system. We don’t have to worry about the negative impacts of a daily ketogenic or carnivore diet, on negatively impacting the cardiovascular system, and with all the others, just before we leave, just tease us with some of the ongoing research projects within the L-Nutra umbrella. There’s an Alzheimer’s study we’re kind of waiting for. That’s one of them.

William Hsu, MD

Well, we published that early in the year in the animal model with pilot human data, and more recently we just did our most recent paper show. Again, this is not a claim of promotion of the product because it has to be in the context of the program. But Dr. Kahn,  most recently there was a paper that looked at triple-negative breast cancer and how the addition of FMD to the standard of care chemotherapy almost doubled overall survival into almost 30 plus months versus 17 months.  The overall study was just amazing. We look to expand upon that because fasting is not only good for metabolism but potentially has a place in our fight against our mortal enemy, which is cancer. You have more to come. But we never stop doing research at L-Nutra.

Joel Kahn, MD, FACC

Incredible and exciting, and the future’s so bright. Thank you for taking the time. Everybody learned a lot. Everybody can go over to l-nutrahealth.com and learn more about the diabetes regression program. Sign up. The patients for my clinic who have signed up have done exceedingly well. They’re about halfway through their year, and they’re looking forward to the rest of the year. We’re just so grateful. Companies like you and leaders like you are doing this. Thanks again.

William Hsu, MD

Thank you, Dr. Kahn, for having me.