The Role Of Insulin Resistance In Inflammation And Cancer

Cyrus Khambatta, PhD

Thank you, Isaac. So good to be with you. I appreciate the kind introduction.

Isaac Eliaz, MD, MS, LAc

Tell us a little bit more about your journey because you integrate a lot of know-how and a lot of enthusiasm that comes from your heart and is well expressed as I know you, but I also know your journey. You have your own experience to validate your way.

Cyrus Khambatta, PhD

Yes. It is funny because a lot of people ask me how I decided to get interested in diabetes in the first place, and my answer most of the time is that it is a completely backward route to get here because when I was growing up and as I did throughout my adolescence and college, I did not even know what diabetes was. I kid you not, I had heard the term. I maybe knew a couple of people who were diabetic, but I had made the association in my brain that diabetes was what happens to old people who eat cake. That was all I knew about it. So when I got to college, I was 22 years old. I was going to Stanford University; I was a senior, and I was just trying to graduate and move on with my life. I started to feel very low energy and extremely dehydrated, and I was cramping significantly when I would go to sleep. For about a 2- to 3-day period, I just could not get anything done. I was a very unproductive human being. I could not study properly. I was drinking upwards of a gallon to two gallons of water per day, and I was urinating very frequently every 30 minutes or so like clockwork. 

When I went to the health center, I picked up the phone and called my sister, who is a Doctor of Osteopathy and Family Practice Medicine, and I explained my symptomology to her. She said, “Stop everything you are doing now. Go straight to the health center. Check yourself in, because you are explaining the symptomology of type 1 diabetes.” I remember talking to her at the time. I was, “What are you talking about, I am a 22-year-old guy. I am an athlete. I am of normal weight. I eat a healthy diet. I cannot possibly be living with diabetes?” She said, “I do not have time to explain, different from the diabetes that you are thinking about. Just go to the health center.” I walk over to the health center and check myself in, a nurse greets me, and she ends up taking me to a room, checking my blood glucose, coming back a few minutes later, and I am passed out. I wake up; I do not even know where I am. I am, okay, in a doctor’s office. How did I get here? What am I doing here? She looks at me. She goes, “How did you get here?” I said, “I walked from my dorm”, and she said, “I am going to take you to the emergency room. Now, your blood glucose is 660. It is six times higher than it is supposed to be. You are in an emergency state referred to as DKA, which is diabetic ketoacidosis. We’ve got to get you to the hospital ASAP.”

Long story short, it took me to a hospital there. In the hospital, I got diagnosed with three autoimmune conditions—not just one, but three. I was diagnosed with type 1 diabetes, which is beta cell failure, pancreatic beta cell failure, and an inability to make a sufficient amount of insulin, which was causing my blood glucose to go extremely high. Then, number two, they also pieced together a medical mystery that involved two other autoimmune conditions, one of them being Hashimoto’s hypothyroidism, which partially explained why I was so low on energy. The third one was Alopecia Universalis, which is just a code for hair loss. I used to have hair, I used to have eyebrows, I used to have eyelashes, and I used to have facial hair, but I lost all of my hair. All of that happened at the age of 22. It was all very quick. You can imagine that at that time I walked away from the hospital, and I was very afraid of what was going to happen to me because I did not know what had caused these three autoimmune conditions in the first place. I did not know if I was at risk of developing more, and I did not know what I was supposed to do about the ones that I already had.

The doctors at that time said, Listen, the only thing that we can do for Hashimoto’s hypothyroidism is give you levothyroxine or synthroid, and you can just take that, and we will find the dose for you over time, and that should help you get more thyroid hormone in circulation, and that should solve that problem. But when it comes to eating, we cannot do anything for alopecia, but we can teach you to eat a low-carb diet because carbohydrates are not bad for you. If you eat carbohydrates, your blood glucose will go up, and your insulin use will go up. then that is going to cause more difficulty. Instead, we are going to teach you how to eat a low-carbohydrate diet, which will keep your blood glucose low and your insulin levels slow. I replied, “Great, sounds like a plan.” I tried to follow their recommendations, eating turkey, burgers, fish, cheese, milk, eggs, yogurt, and peanut butter, and trying to avoid fruits, pasta, grains, and cereals. Again, the promises that are keeping my glucose low in my insulin are slow. 

But the exact opposite happened. My glucose went up significantly, and it was to the point where my blood glucose meter felt it was a random number generator. Any moment of any day, I could check my blood glucose, and I could be as low as 50, which is hypoglycemic, or I could be as high as 400, and I just could not piece it together. I finally switched over to eating a plant-based diet because I got introduced to the idea of eating a plant-based diet in 2003, which was not even talked about very much at that point. I started eating a plant-based diet that was truly low in dietary fat, not lowered in dietary carbohydrates, because the gentleman who had introduced me to this concept, whose name is Dr. Douglas Graham, had gone on to write a book called The 80/10/10 Diet.

He explained to me that there is a very strong connection between the total amount of fat that you consume in your diet and your insulin requirements. I did not believe him at the time, but I followed his methodology, and I said, Listen, I will do whatever you say. So I switched over to eating a very low-fat, plant-based, whole-food diet. In the process of doing so, my insulin use fell by 40%. My blood glucose increased very quickly, and I was able to return to playing a significant amount of sports and feeling a million bucks. Long story short, fast forward now; that was 2003. I then went to graduate school. I got a PhD in Nutritional Biochemistry because I was so excited about what happened inside of me. I wanted to be able to explain my own body, and I wanted to see if I could extrapolate it to other people. What I learned in the process is that there is a large connection between the quality of the food that you consume and your insulin requirements. There is a large connection between eating a plant-based diet in particular and using that as a tool to significantly improve your blood glucose values and reverse—not just manage but reverse—the underlying condition that causes blood glucose variability in type 1 and type 2 diabetes and prediabetes. Here we are, 20 years later. It has been an incredible journey. I am very thankful to be able to help as many people as we have.

Isaac Eliaz, MD, MS, LAc

It is very inspiring, and it brings up so many topics, which I will touch on later. But just as a hint for the audience, there is this concept that a ketogenic diet is now a solution for life, including cancer, and it is problematic, and I will touch on it again. But I want to hear more about the whole mechanism because, as you are very familiar with, it has a period in biochemistry and nutrition, and I love cellular and metabolic metabolism and how it translates specifically for cancer. One of the big secrets for a plant-based diet, and you see the same thing with restorative colitis and the same thing with Crohn’s when you have a lot of fiber, naturally glucose absorption is slowed down a grade, and when glucose absorption is slowed down, then insulin does not spike. Very different. It is fundamentally different from a disrupted metabolism. 

If you look at metabolic syndrome, the classical thing before anything is elevated lipids; it is what drives the condition. This misnomer about using fats all the time. The ketogenic diet has a place in cancer, to be very specific. I warned about it already in 2010 overusing it. But what I tell people is that if it were our diet, the body wouldn’t make it. There’s an alternate emergency diet. The body’s too smart not to use something, which is all the time. With this in mind, there is so much connection between diabetes and going through a dehydration process for people to understand ketoacidosis, which is specifically for type 1, not type 2. There can be tons of glucose in the blood, but the cell is starving. Because the osmolarity increases, the density of the blood goes up, and all of the fluids move into the extracellular space. The cells get dry and shrink, and you lose a lot of potassium in the process. They tend to electrolyze. I know from what 

I remember from my residency managing this patient in family practice residency that it was an emergency. It is remarkable that 24 hours later when they get properly hydrated, they are back to life. Now, in your case, it is extremely unusual that you had three autoimmune conditions present immediately. It is a multiple endocrine failure, and it is worthwhile discussion for us even after the interview. But as you talked about, what you are hinting at is what insulin resistance does from the point of view of turning the fire on and causing inflammation. Maybe you can share with us a little bit about the connection between insulin resistance and inflammation, and then we can move on to how it drives cancer, which is such a fundamental concept.

Cyrus Khambatta, PhD

Absolutely. Yes. It is because I love talking with you. After all, you understand biochemistry, I think, at a much deeper level than I think a lot of people do, which is great. We can have these conversations, and we can become super nerds about what is happening from a biological mechanism perspective. Going back to what you were saying specifically about the consumption of fiber-rich foods, I cannot emphasize this enough. In the world of ketogenic diets and the world of low-carbohydrate diets in general, they always equate anything that contains carbohydrate energy with sugar. It is a huge misnomer for a multitude of reasons. But the general rhetoric says anytime you eat anything that is carbohydrate-rich, it does not matter if it is a fruit, a potato, a bowl of quinoa, or a bowl of black beans, which are all considered whole carbohydrates. That is either naturally occurring or minimally processed versus if you are eating cookies, crackers, chips, pasta, breads, sodas, sugar-sweetened beverages, all these refined carbohydrates that had to go through a manufacturing process for them to become edible. Okay. They take both classes, the whole and the refined carbohydrate-rich material, and they lump them into this umbrella term called carbs. 

Then they say, regardless of how much or what type of carbs you are eating, you are going to eat those foods. It is going to cause a number-one blood sugar spike and an insulin spike. Then that is going to cause you, and then that is going to convert the carbohydrate to fat, and then you are going to become fatter as a result of that then that is going to drive the diabetic process. There are so many things wrong with that in the first place. The first concept is that the differentiation between a whole carbohydrate-rich food and a refined carbohydrate-rich food is essential. It is absolutely important to understand that whole carbohydrate grain foods contain nine classes of nutrients: carbohydrate, fat, and protein. All three of them are present in all whole foods. In addition to that, there are vitamins, minerals, fiber, water, antioxidants, and phytochemicals—nine classes of nutrients. You have the three macronutrients—carbohydrate, fat, and protein—plus six other micronutrients: vitamins, minerals, fiber, water, antioxidants, and phytochemicals. All of them are present, and they are wrapped up into a three-dimensional matrix. 

When you are consuming the whole food, the whole food travels down the esophagus, and it gets down inside your stomach. There is an acid bath inside your stomach—a linear rise of these molecules. that finally gets inside your small intestine, where there are enzymes, digestive enzymes secreted by your liver, your pancreas, and your small intestines, that act upon these foods and start to break large molecules into smaller molecules, and then eventually monomeric units to absorb those molecules through the walls of your blood and then transport them to tissues. The presence of fiber is critical for this process because, as you said, it slows down the digestive process, which means that it slows down the glucose, the resultant of glucose excursion or the blood glucose concentration that happens after a meal, which then slows down the amount of insulin that has to be secreted by your pancreas to match the amount of glucose that is coming inside of your blood. It gives you a normal glycemic response and a normal insulin response, but it does not drive the diabetic process. 

But if you are already starting from an insulin resistance state, the insulin resistance state we were talking about earlier is not characterized by the consumption of too many carbs. It’s characterized by the consumption of excess lipids. The lipid gets stored inside your liver and inside your muscles, in particular in excess. That causes a system-wide defect inside both of those tissues. That makes it so that insulin has a difficult time communicating with both of those tissues. If there are already insulin signaling defects that are present inside the liver and the muscle, then any time you eat a carbohydrate-rich food, whether it is whole or refined,

Isaac Eliaz, MD, MS, LAc

You are going to react.

Cyrus Khambatta, PhD

It triggers high glucose and high insulin.

Isaac Eliaz, MD, MS, LAc

I want to take my second.

Cyrus Khambatta, PhD

Yes.

Isaac Eliaz, MD, MS, LAc

Because you have the other side. They can understand your patient. Yes. You have presented multiple critical concepts for cancer patients who are getting lost, including integrative medicine, which is so protocol-driven and fancy treatment. There is a very basic movement here. When you eat a high-lipid diet, your insulin receptor density goes down in the cells, which means they think about it all together then they get spread by the fat, which means you are not going to absorb glucose in a normal way. What happens when we use glucose to produce energy in a very efficient way? Through the mitochondria, we get 36 ATP through its molecules of energy for one glucose. When you block the insulin receptor, which is what you are describing, AMPK or adenosine monophosphate kinase gets blocked, the cell gets a signal that it cannot produce energy properly, which means it goes into starvation and cannot take in deep, energetic breath. This shifts the cell you do in a hypoxic state, and it moves into aerobic glycolysis. It produces energy through glycolysis in the presence of oxygen. This is the driver of cancer. 

When we do a ketogenic diet, we are saying that instead of fixing the metabolism, let us just bypass it and give people other nutrients. Now, of course, every meat, every fat from the animal kingdom, is very high in pesticides, and even fats from plants, if there are too many. Also can be high in pesticides because most pesticides are fat-soluble; they are lipid-solid. The idea of the fiber is that it regulates but there is another very important component. Fiber is the oxygen of the microbiome. That microbiome is our friend in our journey to heal from cancer. I cannot emphasize that enough. Our relationship with the microbiome will determine our outcome. For example, if you take one of the most commonly used chemotherapy drugs, Doxorubicin Adriamycin, and you give the patient antibiotics, it is the day of administration. It will not work because we disrupted the microbiome. The microbiome is our friend, and our partner will have the wisdom. It’s mind-blowing. to activate chemotherapy, to work better for us, and without fiber, if you just give it fats, it is a lost case because the fat will exchange it with phosphatidylcholine, which is part of the biofilm, and it will turn into a mess. We have to recognize it. 

For cancer patients, sometimes when you go to the chemo room and you get chemotherapy, the nurse, to pick up your energy will give you a concentrated orange juice. It has zero fiber and pure sugar. It is canceling the effect of all of our S-based chemotherapy and reactive species, oxygen species, like Doxorubicin because now we are shifting the metabolism. What Cyrus is talking about is differentiating between the concept of carbohydrates, which have been in nature for millions of years, and the concept of refined sugars. It has been in use for about a little bit over 100 years. All of the diet cokes and diet soft drinks that have been developed arrived later damaging from the point of view of auto mechanisms. Thank you for clarifying. Perhaps you can talk a little bit more about the role of inflammation in all of this.

Cyrus Khambatta, PhD

Yes, for sure. What I think is essential to understand here when it comes to inflammation, which drives the progression of cancer, is that insulin resistance is a very influential player in this process. There is a strong body of research that demonstrates that there is a very clear connection between insulin resistance and cancers of many types, including but not limited to liver cancer, endometrial cancer, pancreatic cancer, kidney cancer, bladder cancer, colon rectal cancer, esophageal cancer, and breast cancer. The list goes on. 

Many of the biological mechanisms have been explored, but researchers to this point, admittedly, do not have the full picture of exactly what the connection is between insulin resistance and cancer risk. But they have measured many things in the laboratory, and they do know exactly what happens in a clinical setting. As a result, there is active research going on to elucidate what this biological mechanism is in more detail because all of it centers around inflammation. What about early?

Isaac Eliaz, MD, MS, LAc

But one of the interesting things that we checked earlier is that in cancer patients, IGF-1 is a factor. For the audience and their doctors, you have to evaluate it very wisely. For a healthy person, on some level, it is a measure of our growth factors or of our ability to be resilient. For people who have deep fatigue, where those adrenal hormones are low, IGF can go down. But if you see a cancer patient, they will know they have low energy and are not feeling well. Let us say the IGF is between 80 and 210 and the patient is 60 years old. They are supposed to have IGF one, 100, normally 110, and they show up with 150, 160, and say, “Oh, it is good. It’s not good.” There is a pathway driving them through glucose, and then too much glucose is too much insulin resistance. IGF-1 is often a bridge between insulin resistance and cancer. From a good point of view, at least in my experience.

Cyrus Khambatta, PhD

Yes.  I am glad you brought up IGF-1, because IGF-1 is synthesized in the liver, and two tissues take the brunt of the damage when it comes to insulin resistance: the liver and the muscle tissue. When I am referring to your muscle tissue, I am referring to the skeletal muscle that exists inside of your arms, your shoulders, your chest, your abdomen, your buttocks, your quadriceps—you name it—the largest tissue in your body. Your liver and your muscles have the highest expression of insulin receptors of any tissues in your body. As a result of that, they are the most glucose-dependent tissues in your body. 

There are three tissues. Number one is your brain; number two is your liver; and number three is your muscle. These are the tissues that are biologically designed to absorb glucose from your blood when necessary and to use that as a fuel for immediate oxidation or to store glycogen for later use. Your brain is the only one that cannot store glycogen, but your liver and muscles can. Now, when your liver and your muscles become insulin resistant, which usually happens simultaneously as a result of consuming a high-fat diet, your liver in particular undergoes a whole collection of dysfunctional mechanisms downstream of that. One of the things that happens is that your insulin, I am sorry, and your liver, increases IGF-1 production. This is a huge problem because, effectively, what your liver is doing is making your liver have a difficult time communicating with insulin, which drives more insulin production by your pancreas. Your pancreas increases the amount of insulin that is being produced. The insight that insulin increases concentrations in your blood continues to knock on the door of your liver and say, “Hey, there is glucose in the blood. Do you want to take it up?” 

Your liver is partially blind to that insulin because, as you alluded to before, the number of insulin receptors has decreased. Your liver or liver cells, or hepatocytes, are effectively operating in a high glucose environment and a high insulin environment. As a result of that, they are partially blind to both of those signals in the blood. One of the things that the liver cells do is manufacture insulin, and this process is called HGP or hepatic glucose production. They manufacture insulin, and they put it into the blood specifically so that your brain has an adequate supply of glucose at all times. When your liver is partially blind to the amount of glucose and insulin in the blood, it then starts to oversecrete glucose into the blood, which contributes to an even higher blood glucose value. 

Again, your liver is in a dysregulated state, and it cannot fully pay attention to what is happening inside the blood because it is partially blind. It can also oversecrete IGF-1. When it begins to do that, you have a very powerful growth signal that promotes cell replication and tumor progression that is now available in the blood to every single tissue. The combination of having high IGF-1 status plus high insulin, which is high hyperinsulinemia, is a very dangerous game to play because insulin is the most potent anabolic hormone in your body. End of story. It’s more potent than the IGF-1. It is more potent than testosterone, thyroid hormone, and growth hormone. Nothing else is more powerful than insulin and its driving growth processes, which are cell replication and glucose uptake. When insulin levels are high and then IGF-1 levels are also elevated, the combination can be disastrous and can drive tumor progression.

Isaac Eliaz, MD, MS, LAc

Yes, so well said. Thank you. It is a great discussion. Tell us how you can reverse insulin resistance from your experience, from your knowledge, and from what you have done with thousands and thousands of people.

Cyrus Khambatta, PhD

It is dangerously simple. A lot of people are skeptical when they start to learn it. Just how powerful this process can be. But we talked about the fact that insulin resistance, the primary driver of it, is caused by excess lipid accumulation inside your liver and muscle. Where does that lipid come from? Well, it comes from your mouth. When you are eating a diet that tends to be high in fat, whether it is a ketogenic diet, whether it is a low-fat diet, or whether it happens to be an animal food-heavy diet, triglyceride that comes from your diet ends up inside of your blood, ends up inside of your liver, gets repackaged by the post office that your liver is putting in a little protein particle, sticks it back in the blood, and then they’re back in circulation to go to your liver and muscle or to go to all tissues. 

Long story short, when your lipid intake and your fat intake are very high from your food, then that drives the insulin resistance process. If you are trying to reverse insulin resistance, the most effective thing that you can do is do several things. Number one: lower your total fat intake. Let us just say, for the sake of argument, that you are eating the standard American diet. The standard American diet is usually somewhere on the order of about 42 to 42 to 16; with 42% carbohydrate, 42% fat, and 16% protein. You can wiggle it a little bit. You can say it is 40, 40, or 20, somewhere on that spectrum. The 40% of your diet comes from fat is quite large, and that is going to drive the insulin resistance process. 

What we recommend is taking that 40% of your diet and minimizing it so that it is closer to about 15% of your diet. Somewhere between 10 and 15%, which, if you want to talk in terms of grams, we are talking about somewhere between 25 and 30 grams per day. If you can take a large fat intake, call it 60, 70, or 80 grams of fat per day, and you can reduce it to somewhere between 25 and 35, or 30 grams per day. That is going to have the single most powerful effect at effectively waking up the insulin receptors that are living inside of your liver, inside of your muscle, that is going to get those insulin receptors that are handcuffed because of a high lipid environment to be coming in handcuffed and becoming more responsive to insulin. When insulin does appear in your blood, In addition to that, eating a diet that contains a significant amount of plant material is very powerful. Number one, because it contains a significant amount of fiber. Fiber slows the glucose absorption process in your small intestine. Fiber is also a fuel for 38 trillion bacteria inside your large intestine. As you alluded to earlier, those bacteria can manufacture cellulose. 

Cellulose is the one enzyme that human beings cannot manufacture. Cellulose cuts the cellulose into individual glucose units. They absorb those glucose units, they proliferate, and they manufacture these magical things called short-chain fatty acids, or molecules that can signal to every single tissue in your body. They do magical things to many different tissues to reduce the inflammatory process in many tissues. Eating more plants, a.k.a., more fiber, and lowering your fat intake is the most powerful thing that you can do from a dietary perspective. In addition to that, we also recommend that people move their bodies for a minimum of 30 minutes per day because movement is another way to mechanically stimulate your muscle tissue to ask for more glucose from the blood and to open up the doors for glucose to enter tissues, which drives what is called non-insulin-dependent glucose uptake, which allows glucose to get inside tissues and lowers your blood glucose concentration. In addition to that, we also factor in a third puzzle piece, which is intermittent fasting, and there are thousands of studies at this point.

Isaac Eliaz, MD, MS, LAc

I was just going to ask you. Thank you for bringing it up, please. What is your position on intermittent fasting? From my perspective, there can be different opinions on diets for cancer. But the one universal thing is intermittent fasting. If you can please, from a point of view of diabetes because it is misunderstood sometimes that if you need to get carbohydrates all the time you can do no intermittent fasting. Maybe you can elaborate on this, and then you can share with me what your favorite way of doing it is. Then I can share a few details with the audience, specifically about the conventional treatments.

Cyrus Khambatta, PhD

If we take a trip back to the years 2007 to 2012, when I was getting my Ph.D. at UC Berkeley, I was studying in the laboratory of a gentleman named Dr. Mark Hellerstein, who is one of the world’s foremost experts on carbohydrate metabolism. One of the areas of study that was happening inside the laboratory at that time was: how do calorie restriction and various forms of intermittent fasting affect downstream conditions, including diabetes and cancer? We were using stable isotope tracers to understand the pathogenic mechanisms in a very high level of detail. One of the things we found over and over again is just what you are saying: no matter how you slice it, no matter what combination, no matter what the timing is, no matter what it is, when you perform intermittent fasting, cellular turnover rates significantly decrease, which slows down the cancer progression rate. It can be a phenomenally powerful tool for slowing down the progression of cancer and reducing cancer risk if it has not already formed. 

When it comes specifically to diabetes, intermittent fasting is a very powerful technique because the way I think about intermittent fasting is that it is an opportunity for you to give your liver and muscles time to go internal. When you limit the fuel supply that comes in from your mouth and the amount of glucose, amino acids, and fatty acids that come in from your mouth. Effectively, what that does is keep the concentration of glucose, amino acids, and fatty acids in a relatively low basal state inside your blood for an extended period. What that forces your liver and muscles to do is not rely as much on nutrients from the blood as they normally would. Instead of relying on those nutrients for uptake so they can use them for fuel, what they do is go internal. They say, Huh, do I have anything inside of the cellular environment that I can oxidize for energy? If you are in your liver and you say, Okay, what do I have here that I can oxidize for energy? 

The answer is two things: Number one is glycogen, which is a stored form of glucose, and number two is triglyceride, which is a stored form of fat. Liver cells end up degrading glycogen molecules and using them as ATP, burning them for ATP. They also do the same thing to triglyceride molecules, which they turn into fatty acids, and then the fatty acids get sent to the mitochondrial network, where they turn into ATP. Throughout a 16- to 24-hour intermittent fast, you see a significant reduction in glycogen concentration and a significant reduction in triglyceride concentration intracellularly. That is a good thing because these cells are effectively able to reduce the amount of fuel that they have on board, which means that the next time you go eat, they are that much more receptive to being able to take up glucose from the blood and being able to take fatty acids from the blood.

That relieves a lot of the internal stress that they have been experiencing for a long time. When these, specifically when the triglyceride molecule becomes too large internally, your muscle tissue does the same thing as a very similar biology. It relies on glycogen; it relies on triglycerides. When you give your muscle 16 to 24 hours of fasting, those two fuel sources can get smaller and smaller and smaller, and your muscle tissue effectively becomes hungrier. What that means then is that when you perform an extended duration fast, which is somewhere greater than 16 hours, my preference is to do a daily 16/8 hour fast, which is 16 hours of fasting and 8 hours of eating. 

If you do that daily, what you do is effectively put your liver and muscles into a stage by which they are effectively nutrient-deprived for a good portion of time. They end up doing a lot of this housekeeping, keeping the glycogen content low and the fatty acid content low. They become supercharged for nutrients when they do appear. then in those 8 hours when you are eating nutrients, they’re able to take that fuel in, store it when necessary, and burn it when necessary. It keeps it. It leads to a significantly improved efficiency of fuel oxidation. That is a good thing because it keeps your chronic disease risk nice and low. It allows you to maintain your normal weight and allows you to lose weight if you are overweight. It keeps your lipid concentration inside your blood at a low level as well. All of that is a good thing because all of those are known to be associated with increasing longevity.

Isaac Eliaz, MD, MS, LAc

Yes, it is a great description, and I want a little bit to highlight it. For cancer patients, specifically. Cancer cells divide faster and divide all the time. Normal cells divide in our bodies based on stimulation from the outside. When you are doing intermittent fasting and you are going to autophagy, this is the state of inner reflection and inner cleansing. You are slowing down the division of cells. For example, if you are getting radiation therapy or chemotherapy, you are getting natural protection from normal tissue. Because cancer is highly glucose-dependent, the more aggressive the cancer becomes, the more glucose-dependent it becomes, and the more starved it becomes. That is why, especially if you are getting chemotherapy for the first two half-lives, the drug goes down by 50% the second time and intermittent fasting is critical. 

One of the tricks to do, and I may do a mini-talk about it if I have time in the summit, is to look at the half-life of the chemo drugs. If it is a drug, it is a long half-life. It lasts for a long time carboplatin and we have more time. But if it is a drug called gemcitabine, it has a 45-minute half-life. You want to come into the state of getting chemo in a deprived state, and the one place where a ketogenic diet can have a role is in these first 24 to 48 hours, where there is no glucose, then because the cells starved, they will take in very strongly the chemotherapy. But the most important thing is the intermittent fasting. It allows your system to rest.

The other data that I want to shine on is what Cyrus says: when you have a high-fiber diet and a very low-refined sugar diet with fewer lipids, the amount of glycogen storage is smaller, which means that you are going to deplete faster and you can get into this state where this cell has to start using different energies. The cancer cells keep thriving while the normal cells get shut down. You create this differentiation where treatment becomes more targeted and has fewer side effects. This is remarkably important. It is simple, as you say. It is scary and simple. It is sometimes hard to keep. I think that is another part, Cyrus, and I wonder what you say about it. One thing that drives people to eat sugar and get energy is that most people are chronically dehydrated.

Cyrus Khambatta, PhD

Great point.

Isaac Eliaz, MD, MS, LAc

When you are dehydrated, you consume calories. For cancer patients, whatever the blood fluid is, what creates communication in the body? When we are dehydrated, our tissues become inflamed. There is a way to calculate how much water you need, but a habit of drinking two glasses of water before every meal Two glasses of water when you wake up and twice a day more drinking—two glasses of water in and before bedtime—will allow you to stay hydrated. You will naturally have a desire to eat, and your imbalanced appetite will naturally go down. 

This supports a high-fiber diet. It gives in to aid and makes it simple. These are the things that are free and available, and these things that look simple can make the whole difference in the outcome of a sophisticated integrative cancer treatment with the most fancy new creative stuff or integrating complementary methods with conventional oncology. This very principle that you covered, plus hydration, I think is critical. I want to thank you for sharing your experience and for putting it in such simple language while not skipping the biochemistry we love about talking to you. So how can people find out more about you and your exceptional work?

Cyrus Khambatta, PhD

Yes. Thank you for asking. The easiest way to do it is to go to our website, which is masteringdiabetes.org. If you go there, we have information in all shapes and sizes. We have a blog with scientific information and case studies. We have a podcast, we have a YouTube channel, we have social media on Instagram, on TikTok, you name it. It’s all about mastering diabetes—national diabetes, master diabetes. We also put out a book, which was published in 2020 and became a New York Times bestseller. If you are interested in learning more specifically about insulin resistance and how you can get out of the insulin resistance trap, then I highly recommend picking up a copy of that book and reading as much as you can.

Isaac Eliaz, MD, MS, LAc

I second this recommendation, and I want to thank you for sharing your wisdom, your experience, and your amazing work at this summit. Thank you for coming.

Cyrus Khambatta, PhD

Yes, thank you for inviting me. I appreciate being here, and hopefully, the information was helpful. Thank you.

Isaac Eliaz, MD, MS, LAc

Thank you.