Your Guide To Diabetes Remission Without Meds

Ashley Bizzell, RD, LDN

Hi, I’m doing well. Dr. Hsu, thank you for hosting me today.

William Hsu, MD

It’s fantastic to have time to go over one of the, I think, most interesting programs that we see in terms of reversing type 2 diabetes. Now. You’re involved with a company called L-Nutra. Tell us a little bit about your background, and then we can go into the program, the company, and the program.

Ashley Bizzell, RD, LDN

Sure. Yes. I’m a dietician, and I have been for almost 20 years, which is hard to believe. I’ve worked in lots of different realms of nutrition initially and then in internal medicine practice and had the opportunity to work with patients with diabetes, glucose monitoring, and other things. Then I transitioned into the hospital, where I spent, I would say, the bulk of my career and a lot of time in the critical care setting. I got the opportunity to work with all different types of patients. But 2020 drove me back home as everybody was changing gears a little bit then. I had children at home, and I took a telehealth job doing more of your back-to-the-basics, just preventative nutrition. I think that’s something I miss about long-term interaction with patients, watching them make progress and meet their goals. When I started with L-Nutra, it seemed like the perfect fit. This great nutrition technology helps people reverse what’s going on, get back into a healthy place, and instill healthy habits so that they can be successful and prevent disease.

William Hsu, MD

Speaking of the pandemic, it seems so long ago now, but while we were in the midst of it, many people may not realize this, but a lot of people gained weight, lost their glucose control, got worse, and many people developed diabetes. This is the epidemic after the pandemic. Now people are beginning to recognize that it’s a major problem. Ashley, it’s fantastic to have you on the show here. Tell us a little bit about the program you mentioned, L-Nutra Health as a program for diabetes. What is the program about?

Ashley Bizzell, RD, LDN

Sure. L-Nutra Health. The main concept of this program with diabetes is that we incorporate the five-day fasting-mimicking diet into your monthly routine. Within those five days, we have very specific precision nutrition to help you reverse or go into remission with diabetes. In those off-weeks in between, we work on improving your diet and setting smart goals together. This five-day fasting-mimicking diet has been shown within six consecutive months of use. Just these five days and six months, it shows reversal and your insulin resistance, up to 60% reversal, two-thirds in your insulin resistance can come off under medication. To sum it all up, there’s about 22 pounds in weight loss and about a 1.4 average A1C reduction, which is impressive. There’s not anything else out there.

William Hsu, MD

You provided lots of information there. Let’s digest it for the listeners here. You talked about diabetes remission. It’s a concept that’s not very well known. Although the title of our summit is Reversing Type 2 Diabetes  Summit. A lot of our listeners may not have heard from their dietician or their physicians about diabetes and whether it can be reversed or go into remission. Can you define what diabetes remission means for our listeners?

Ashley Bizzell, RD, LDN

Sure. Diabetes remission is just being able to improve your insulin resistance. I think today we’re so focused on just taking medication after medication. As soon as that one stops working, we add on others, and it just doesn’t feel like we’re getting better. But with this, we can see improvement in your overall health and reduce those things so that we can prevent a lot of those long-term complications that can occur and prevent having to add on extra medications that have the potential to have negative side effects, too. It’s just an ongoing definition.

William Hsu, MD

You seem to be suggesting that instead of adding more medications, we’re taking off medications.

Ashley Bizzell, RD, LDN

Yes. instilling good eating habits and just overall improving your health, allowing you to feel better, live longer, and be healthier.

William Hsu, MD

I read an article about two years ago. It was written by the American Diabetes Association, the Endocrine Society, and many other international organizations that defined diabetes remission as getting your A1C down to less than six and a half or three months. The most important thing is without the help of medicine. Your doctors, your family physicians, and endocrinologists may be focused on getting glucose under control. But now these international experts are pointing to a new angle, and that is getting you to reduce your medication, even to stop your lifelong reliance on medicine and that’s defined as diabetes remission. It’s an exciting new end.

Ashley Bizzell, RD, LDN

Absolutely.

William Hsu, MD

Since the discovery of insulin over 100 years ago, there have been more than 12 different categories of diabetes medicine. Finally, we’re looking towards a new goal where we could help people get off their medicine, restore their true metabolic health, and tackle the root cause of type 2 diabetes. Ashley, earlier you also mentioned doing diabetes remission. It’s hard to use another medicine to get rid of another medicine. You’re proposing that through L-Nutra Health for the diabetes program, you’re reversing type 2 diabetes with natural means. You mention something called the fasting-mimicking diet. Can you tell us a little bit more about them? What does it come from, and what does it involve?

Ashley Bizzell, RD, LDN

Sure. The five-day fasting-mimicking diet was made or researched. I’ve studied with Dr. Valter Longo and a group at the University of Southern California, and they have come up with this precision nutrition. It’s very simple to follow. There are five days, and each day is specifically geared for you to put you into its fasting state, something that would be hard to do on your own. You get some nutrition each day, and your body is tricked into thinking it’s fasting, but you’re still getting some food, so you eliminate some of the obstacles of dehydration and hunger, headaches, and other things that you might face if you were doing it on your own. It allows you to have five days to ignore that state of easing into fasting and that fat-burning a little bit of ketosis and then into autophagy, where you see some of that cellular cleanup. That’s what autophagy is. It’s self-eating, so our cells can clean and rejuvenate. that you can improve your overall health. There are just five days.

William Hsu, MD

How many people eat in the program, and how often do you repeat this fasting, mimicking the diet?

Ashley Bizzell, RD, LDN

Sure. I mean, we know life happens, but we encourage you to try to do six consecutive cycles. Each month, five days. Then, after that, we look and see where you are. We work with your healthcare provider. We look at labs, and then you can transition into a maintenance phase where, every three months or so, we take another one. Just to see so initially, and there’s been a bit shown with even just three consecutive months, but we do encourage at least six consecutive months to get those benefits. That was shared earlier with that study with the 1.4 A1C reduction.

William Hsu, MD

Are you saying just five days of effort per month will get you the diabetes remission results? This sounds great, although fasting mimicking also sounds challenging. Is it challenging for the members?

Ashley Bizzell, RD, LDN

It can be fasting in an ancient process that’s been around or practiced forever. But it’s intimidating-sounding. I think even when sometimes our members get these practices, it’s a little intimidating. Let’s face it, it can be hard. You have to self-cut yourself, and that’s what our dietitians are here for—to help motivate you and coach you along the way. We spend time giving you some tips and tricks on what to expect and how to get through things. It’s doable. I find that my members share with me. With each cycle, it gets easier and easier the first time it’s new, so everything’s going to be a little bit. You might have a little bit of anxiety around that, but we help coach you through it, and it’s very doable.

William Hsu, MD

It’s not just for drinking water. 

Ashley Bizzell, RD, LDN

Absolutely, not. 

William Hsu, MD

Let’s say in the fasting-mimicking diet, what’s in the product and the package?

Ashley Bizzell, RD, LDN

Yes. It’s all plant-based, gluten-free, dairy-free, and very simple. When you open up, you’ll get a large box, and inside each of your days, everything that you need to eat is within that box. You’ve got soups in there that you add water to. They can be, and they vary. There’s a vegetable. We have Minestrone, there’s a black bean and mushroom, there’s crackers, there’s olives, and we’ve got a little what we call H-bars that have nuts. A lot of our food has a lot of nuts and a lot of healthy fats. That’s part of the makeup of each day and helps you get into that fasting state. But we have to have an L-drink, which is very specific to this fast to help preserve your lean body mass, which is something a lot of weight loss programs out there don’t talk about. You lose this weight, but a lot of times you lose that good metabolic tissue that we need to help support our metabolic health. This L-drink, which the dietitians share with our members, isn’t consumed on the first day, but on days two through five, it helps your body preserve that lean body mass while you’re losing weight during that week. Each day is very specific, and we have little bars. The Coco Crisp bars that all of my members share with me are their favorites. They would love to consume those outside of the fast, but it just makes it very simple to follow each day.

William Hsu, MD

You’re talking about giving nutrition that gives you the benefits of a prolonged fast.

Ashley Bizzell, RD, LDN

You have some autonomy with that, too, with each day. You don’t have to. We give suggestions on how you should consume it, but you can alter that so that it fits your needs and your schedule. We have some members who may already practice the little time-restricted eating, and you can fall within those windows of time to just make it as easy as possible for you.

William Hsu, MD

Some of our listeners are taking medications for their diabetes. In fact, on average, a person with diabetes takes six different medicines. Now, Ashley, since you mentioned that this fasting-mimicking diet does work, who’s going to manage the medications during this period?

Ashley Bizzell, RD, LDN

Sure. We have members that come from different referrals. We have our HEPs, medical doctors assistants, members to us, and we work with their physicians on their medication. If patients seem to be doing well and their labs are improving, we work with them to see if we can come off some of these medications. We also work with the telehealth provider. I love that life and that of their members, too. We have this nice open communication so that we can have this team effort to help improve the member’s health.

William Hsu, MD

I see. Either physicians you can work with with the interest of individual, physicians, or you have your telehealth physicians who could manage the reduction of medications. Is that right?

Ashley Bizzell, RD, LDN

Exactly. Yes, that’s exactly it.

William Hsu, MD

Let’s learn a little more about your particular role as a dietitian. The dietitian coach plays a critical role in this remission journey. Can you explain how you support the members during the first five days of that fasting-imitating diet, that fasting period? What about the rest 25 days? What do the members do? How do you help the members?

Ashley Bizzell, RD, LDN

Yes, that’s a great question. Usually, when we first meet with our members, they have the most questions geared around the FMD, and we talk about that, but when we approach them, we would, anybody, want to get to know them. Tell me a little bit about your background. Tell me about your weight history and your health history. We review their medications, and we talk about things they’ve done—things that have worked for them in the past. We talk about what motivates them, which is an important tool to help them, and those other weeks are to figure out how to motivate them. We provide education during those off-weeks. We try to encourage a Mediterranean diet, and we use a lot of Dr. Longo’s longevity principles to help them achieve results. But we support them with education. We have a web portal that we use to communicate with our members. They have access to us to ask questions, and we can get them quick answers. They can text us emails, and we have a lot of great resources that we can send to them to help provide them with maybe tools that they need, such as personalized meal plans and recipes I’ll have members share with me. I don’t have a lot of time to cook. I don’t even feel like I’m very good at it. Where should I start? We talk about some of the basics and just meet them where they are and help them set goals to get to where they want to go.

We have lots of other tools that we use besides just the web portal. We send our members Dr. Longo’s book, but we also send them a Bluetooth scale so that they can track their progress from month to month to see body composition changes. Many of our members do have CGMs or glucometers, so we can use those as tools to see in the off-weeks or during the F&D testing what’s going on with your blood sugar. Why did that happen? What can we do to improve those numbers? There are great ways that we get to interact with our members so that they’re empowered and feel more in control of their health.

William Hsu, MD

Yes, what I had heard was that there were these high-tech components of the fasting-mimicking diet that were developed at the U.S. University of Southern California. Then there is this high-touch service that you and other dietitians are providing to the member. That sounds like a great combination. You also mentioned the term longevity diet.  The book that Dr. Valter Longo was, what he came up with. Can you tell us a little bit about longevity and nutrition? What is that? What are some of the key principles that you would coach your patients for the rest of the 25 days while they’re not fasting with their family?

Ashley Bizzell, RD, LDN

Sure. Dr. Longo and his book, which is a great book, by the way, for anybody to read and great principles for not just people with diabetes to incorporate in their diet, prefer you and me as well. He talks a lot about time-restricted eating. A lot of times we start with 12 and 12 hours without eating and then 12 hours that we do eat. maybe an 8 to 8 window, 8 a.m to 8 p.m., You choose to eat then and then the other hours you don’t. We can narrow that window down too. Sometimes the 14/10 works best for people as well. However, we advocate for much less processed foods, and whole foods, eventually transitioning. Not everybody’s ready to do this, and that’s okay. We start with small steps, then build. But I’m incorporating more non-starchy vegetables into your diet—less red meat, less chicken, more fatty fish—just more plant-based protein foods. There’s so much protein and other foods that I think a lot of times we forget about, or maybe people don’t realize, but a lot of our beans, lentils, seeds, and a lot of our vegetables contain a lot of protein, too. We just encourage a more balanced diet. But with whole foods, we talk about cooking methods and the importance of hydration and activity.

William Hsu, MD

I think one of the biggest challenges that people have is when they go out. Well, at home, they can get to prepare things when they go out for holidays, weekends, or different special occasions. What are some of the tips that you would provide to your members?

Ashley Bizzell, RD, LDN

We’re in the middle of the holiday season, so there’s a lot of temptation to eat out and eat with family and friends. We encourage members to adopt this mindset when they’re in a restaurant: not to be intimidated. You can still go and eat. I know it can be stressful when you have diabetes. What do I have that’s not going to affect my blood sugar? Surveying the menu. See what’s there. Not being afraid to ask questions, What vegetables do you have? Asking maybe for things on the side, sauces on the side, looking for things that are grilled, roasted, or baked. Those are the types of things we want to have. Think about the plate method. If you’re not familiar with that, that’s where at least half your plate is non-starchy vegetables, and then a quarter of your plate is your protein, and a quarter of that is your starch. Think about when you’re putting together what you’re going to eat, thinking that way, and also just some strategies to help with overeating, maybe getting a to-go box at the beginning and going ahead and putting aside half of what you or it’s on your plate so that you don’t overeat, or maybe sharing an entree with a friend just so that, you just aren’t tempted to have too much.

William Hsu, MD

You introduced many interesting concepts in this interview,? You introduce the concept of remission and how diabetes can be reversed.  That’s number one. Number two, you introduced to us the concept of a need for precision and nutrition that gives you the benefits of a five-day fast. You’ve introduced to us this diabetes remission program that’s intended with physician oversight. RDL facade that supports and then a technology that’s centered around this five-day fast. Well, what a fast and meeting program that you have brought to us. If we have a listener who is struggling or is even aspiring to get off their medicine, what advice do you have for them at this moment?

Ashley Bizzell, RD, LDN

Yes, I would encourage them to reach out to us. We’re here and want to help. Anybody interested? We’ve seen fantastic results from people who are newly diagnosed with pre-diabetes to those who have had maybe Type 2 diabetes for 30 years or so. Everybody’s receiving results. I encourage you to go to our website. www.l-nutrahealth.com and reach out to us. We are happy to answer questions, talk you through it a little bit, and just try it. Why not? If there’s the opportunity to drive your diabetes into remission and to be able to come off of some of your medications, improve your health, and promote longevity, why not reach out and try something? We’re about to enter a new year. It’s a great opportunity to get in control of your health.

William Hsu, MD

Well, thank you. I think for those of you who are just tired of taking so many different medicines and thinking about how to restore your true health with natural means, you might be interested in checking out L-Nutrahealth.com. That’s actually on the screen there. Fantastic, Ashley. Thank you so much for this time, but I think our listeners can benefit a lot from maybe listening to it one more time to the content of this show. Thank you very much.

Ashley Bizzell, RD, LDN

Thank you for your time too, Dr Hsu.