WW - Diabetes

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John Salak: Diabetes is everywhere. Too few people realize its [00:00:36] reach, let alone worry about it. Think about it. How many other diseases impact more than 100 million people because they already have it, or because, in this case, they've been labeled pre diabetic? And yet the potential dangers swirling around type 1 and type 2 diabetes seem to get marginal attention at best.

Yes, it's absolutely amazing, but maybe we shouldn't be surprised, because the extremely dangerous impact of diabetes can take time, really years, to do its dirty work. This can include... Heart disease, [00:01:12] strokes, kidney problems, loss of vision, miscarriages, nerve damage, and more. It's not like a lot of other diseases.

You can't see it or feel it initially, so that means there are perhaps thousands, if not millions of people running around who have it or are on track to get it and they don't realize it. As a society, another reason we don't pay enough attention to it is because culturally, too many people assume diabetes.

is a disease that is focused on the old, the overweight, and the out of shape. Yes, diabetes too [00:01:48] often finds a home in these individuals, but it is tracking younger all the time, in large part because we have shifted our diets in recent years to include more processed foods and foods high in sugar. All the while becoming increasingly sedentary.

This is all extremely dangerous. We need to spend more time thinking about diabetes, positioning ourselves to avoid it, treating it effectively if it is contracted. And working to get rid of it if it is possible. The good news is that it is possible to do all of these things [00:02:24] provided we gain some knowledge and start making the right efforts.

Our upcoming guest is ready to lay out a lot of information, insights, and answers on how we can better battle this disease. He's also ready to signal what he thinks shortcoming in the medical profession in helping people. Toss off the most common form of diabetes. Type 2 diabetes. Listen up and learn.

Welcome to our interview at what the health. We're dealing with the subject of diabetes. We're welcoming Dr. Jason Fung, who is the author of The Diabetes Code, which he, and [00:03:00] in addition to that book, which came out a few years ago, he's just generated a workbook that goes along with it.

But needless to say, Dr. Fung is well versed in the issues around diabetes, the seriousness of the problem, and what we may be seeing in terms of trends. So we'd like to welcome Dr. Fung to What the Health. Dr. Fung, welcome.

Jason Fung: Hi, good morning.

John Salak: Good morning. Dr. Fung you're working out of Toronto, correct?

Jason Fung: Correct.

John Salak: Correct.

And we just discussed it's getting really cold up there. Do you have snow yet?

Jason Fung: Not yet.

John Salak: All right. And not to make this a light subject because diabetes is not [00:03:36] necessarily a light subject and it's rampant.

And I know you're working out of Canada, but obviously I have better statistics on what's happening in the States, but it's parallel to what we're seeing, I assume, in all developed countries. We see millions of people dealing with diabetes and prediabetes. Do these numbers alone tell how serious the problem is or are they overstating it or understating it? How serious is this problem?

Jason Fung: I think it's probably the most important sort of health issue that we face because diabetes is not only very prevalent, but it's also increasing [00:04:12] in prevalence. So it's getting worse over time, and it has been for a couple of decades. And the trends are going in the wrong direction. So the problem is that the diabetes contributes to a lot of other diseases, such as heart disease, and strokes, and kidney disease, and blindness, and cancer.

So even if it doesn't get captured, it contributes in a heavy way to these other diseases, sort of like smoking, for example. Nobody dies of smoking. You die of lung cancer, you die of heart disease or die of other things. So sometimes it gets a little bit [00:04:48] underappreciated the importance of it because it contributes to those other diseases, and it's probably the most important reversible risk factor at this point.

John Salak: There's certainly been a lot written about diabetes. People are aware of it. They either told they are pre diabetic or they know someone who has diabetes or a relative or something like that. Are people sufficiently aware of the problems, the threat that diabetes presents?

Jason Fung: There is some awareness of it, but I think it sort of pales in comparison to some of the attention paid [00:05:24] to other diseases, for example, COVID, of course, has been very important subject, but it's sort of completely dominated the discussion about health.

To the point that nobody cared about diabetes to some extent even though it was well known as a risk factor, for disease and so on, and yet people still didn't really pay attention to it. And I think that's part of the thing is it's a little bit under appreciated, just how important this disease is, how it touches sort of everything else.

So there is awareness, but it's sort of one of these things that we really [00:06:00] have to bring to the forefront to say, like, we really need to focus on this a little bit more.

John Salak: why do you think that is? I mean, again, everyone knows about diabetes or is aware of the word that it's not a good thing. Why do you think that is? Is it because it's not an injury? It's not something you can cut out. With a knife or a scalpel? Does it not seem as threatening as cancer, even though it can lead to cancer or heart disease or something else?

Jason Fung: Yeah, I think it's because that's exactly right. It's just that it's not completely the, story, like if you die of COVID, you say, oh, dies of COVID, whereas it gets buried a little bit. [00:06:36] And it's in the background and it's not something that happens immediately. So if you have diabetes, it's not like you have problems immediately.

It just, it takes sometimes decades to really find that effect. So because it's sort of a slower moving sort of. disease. Perhaps people don't feel the urgency in treating it. To the point that it's gotten, to be such a huge problem and growing. And yet there's still not a lot of attention.

John Salak: The medical community, doctors, when you go for your annual checkup. The ability [00:07:12] to identify someone with diabetes or pre diabetes is risen significantly. Is that correct? ? Is it likely they're walking around with diabetes and they're unaware of it?

Jason Fung: Very many people are. And the thing is that if you don't check for it. It's not as easy as say a blood pressure and of course blood pressure is similar. It takes many decades for high blood pressure to manifest its effects, but it did still take sort of decades before we really got people. paying attention to the problem of high blood pressure, and I imagine it's going to be the same for diabetes, like you have to [00:07:48] get tested for it, but it's not even as easy because blood pressure is not invasive, whereas this you really have to do blood tests to really find out what your sugars are like.

John Salak: The most common forms of diabetes 1 and 2? Is that correct? Okay. What are the differences and what are the potential impacts of either? Or are they similar?

Jason Fung: They are sort of different diseases, so diabetes simply refers to the fact that the blood glucose is high, and they're really opposite diseases in type 1 diabetes you have a lack of insulin, in type 2 diabetes you really have an excess of [00:08:24] insulin, so those diseases are really quite opposite one another, even though they give you the same high blood glucose.

glucose. So to treat them is totally different. So for type one diabetes, of course, if your insulin levels are very low, then you give insulin and that helps bring it up. In type two diabetes, if your insulin levels are very high, then you should really bring them down in order to help normalize them. So they are sort of almost polar opposites, although they have the same effect of high blood glucose, and that's why people call it both diabetes.

But they're very different in terms of [00:09:00] what's happening underneath. For example, in type 1 diabetes, if you don't treat it, people lose weight to the point that they'll die if you don't give them insulin. Whereas in type 2, people are very overweight in general. So, they live sort of on opposite spectrums

But same have the same sort of high blood glucose and that's why they're called the same sort of like if you have a fever while it could be a infection or it could be a drug reaction But they both give you fever.

You don't call them the same disease in this case it's more confusing because we take that symptom of high blood glucose And say, well, everything with a high blood glucose is now called diabetes. But [00:09:36] there's two different causes of it. Right? They're separate. You have to think of them separately.

John Salak: Is one more dangerous than the other?

Jason Fung: They're dangerous in different ways. So most of what we talk about is type 2 because that's the most common. 90 ish percent of diabetes is type two diabetes.

John Salak: Are there other forms of diabetes as well? Lesser known forms.

Jason Fung: Yeah, there are other forms. So there's just gestational diabetes and there's also things such as secondary diabetes due to pancreatic disease, chronic pancreatitis or pancreatic [00:10:12] cancers, for example. So those are different, but very unusual. Gestational, of course, is only in pregnancy and secondary diabetes is.

Really less than 2 percent of all diabetes.

John Salak: So, that's why we don't hear about them as much or you're just not going to come across them. Why do we see the rise in diabetes? And you mentioned earlier that the trends are increasing. Why is this occurring? Is it something in our control or is it something that's genetic or a combination?

Jason Fung: yeah it's something within our control and I think that's the main thing to [00:10:48] understand is that it's really a dietary lifestyle disease and therefore it's important to treat the disease. diet and lifestyle. There's a lot of talk about genetics of the disease, but genetics, of course of the world population hasn't changed in the last 30 years.

So it's hard to say that there's been a change in the genes of people that has changed. what they do. However, there's been a very big change in diets and lifestyles mostly diets of people because lifestyle always changes. You go from the 1500s, for example, where [00:11:24] there's horses and stuff to automobiles, that's a huge change.

But even that change in lifestyle didn't change the prevalence of diabetes much. What changed a lot was the diet in terms of highly processed foods and more availability of foods and that kind. So it's mostly a, an environmental change that seems to have caused it, largely lifestyle and diet.

John Salak: We often associated diabetes with someone who might be older terribly out of shape, maybe overweight and that certainly is a profile for someone who might have diabetes, but there are trends that diabetes is [00:12:00] tracking younger.

Is that an accurate assessment of what we used to think of someone who had diabetes? And do we see it tracking to a younger demographic.

Jason Fung:

Absolutely. It's trending to a younger audience, in fact. Children, pediatric clinics, for example, that used to have a lot of type one diabetes now are seeing a lot more type two diabetes. So we're seeing it in Children. We're seeing it in young adults, and it really reflects the increasing obesity epidemic.

So we know that the average body mass index, average weight of people has gone up significantly and type 2 diabetes goes sort of [00:12:36] along with the body weight as well.

John Salak: And is it that we used to see it in older people or identify it more in older people who may have been out of shape? Because as you said, it takes a long while to realize there's a problem or it was, is there some other reason?

Jason Fung: It does take a while to make that diagnosis because most people get like an annual physical, when you're younger, you don't get your blood drawn quite as frequently. So therefore you're not going to pick it up because there's nothing that you can do. There's nothing you're going to feel.

There's nothing you're going to actually be able to determine what your blood [00:13:12] glucose is without checking the blood. So that's why it's harder to pick up. Whereas I say with the blood pressure, you can go to any pharmacy, put your arm in and get your blood pressure taken now. I mean, obviously that's taken many decades to get to the point where people are so aware of this, but.

It's harder to make that diagnosis. So a lot of times people will go without knowing it for years.

John Salak: We see the scope of this problem, and it's growing, as you know. What do we see in terms of a reactive response to diabetes in terms of treatment, versus a proactive response to, okay, [00:13:48] preventing or lessening the risk of gaining diabetes, or retracting. What are we seeing on both sides of that? And is it effectively being dealt with?

Jason Fung: It's not very effectively being dealt with. I mean, for years, people did consider type 2 diabetes sort of a chronic and progressive disease. That's what the American Diabetes Association said. And basically said, well, if you get it, you'll have it for life and just take your medications.

Which is sort of, a very difficult thing. fetus attitude and one that in the diabetes code in 2018, I said, well. It's a reversible disease. Everybody already knows that.[00:14:24] Because if you have somebody who has type two diabetes and then they lose weight. Almost always that diabetes gets better or even goes away completely.

So everybody knows it's a reversible disease, but you need to lose weight. But that's not something the American Diabetes Association admitted until 2021, like just two years ago. Even though people for the last 15, 20 years already knew it was reversible. Mostly related to trying to lose weight.

And of course, weight loss up until recently didn't have very effective drug treatments. So therefore we are all focused on drug treatments. Whereas we really should have been focused on sort of lifestyle treatments, dietary [00:15:00] treatments, to get that weight down and then their diabetes would get better.

So for years because the official position was that this is chronic and progressive, nobody focused on it. So luckily that's sort of changed now and you know, hopefully people will start to focus on it a bit more.

John Salak: Why do you think that was, that even though that awareness was there in the medical profession. Why was it, not thought of in a different way that this is a treatable disease?

Jason Fung: Honestly, I don't know. I mean, I thought it was ridiculous. It's the way that physicians are taught. That's the way I was taught.

But it was obviously not true. [00:15:36] Every doctor, every nurse, every patient knew it. And yet, in all the official publications, they said, oh, it's a chronic treatment.

If you ever listen to any lectures, they talk about medications. I think it's because they were so unsuccessful in getting people to lose weight that they sort of assumed they, again, took this very defeatist attitude that, hey, if we tell people to lose weight, they won't.

So why even try? Which is a very poor attitude. That was why, I mean, I talked about this in 2013. I had put out some YouTube videos. I said, this is one of the biggest lies of type 2 [00:16:12] diabetes. Like, why are we just lying to people? Everybody knows it's a lie. So why are we keep telling it to people? We tell it to the doctors, we tell it to the dieticians.

Why would we say this? You simply weren't focused on the right thing. You're focused on

Medications when you should have been focused on getting people to lose weight.

And again, another issue, same thing, is like, why would doctors have no interest in weight loss until just recently when there's a drug, like, are doctors only interested in medication, in, in giving drugs? I think that to some extent, the medical profession. Starts to believe that their role is to [00:16:48] find the right drug, to prescribe.

I don't see that as the role of a doctor. I see that as how do you get people healthier, whether it's drugs or something else such as diets. You have to give the right treatment, whereas doctors are only interested in drugs. So weight loss, for example, it's not a specialty. Until recently, there was no obesity medicine specialist.

There are now, but there was no training in it. It's not part of the curriculum. Yet. Excessive weight plays a role in almost every disease we deal with. Heart disease, strokes, cancers, everything. [00:17:24] So why would you abandon this entire field of treatment? And not teach anybody about it.

For them it was all about drugs.

And the drugs didn't cure it. So they said, therefore it's incurable. Well, it's a dietary disease. You need a dietary treatment. You can't give drugs for a dietary disease. It's like celiac disease. It's a dietary disease. You can't just give drugs. Like, that's not gonna cure it. You change the diet, and it does.

Same with diabetes. I think what had happened was that doctors just saw it as a drug problem and not a dietary [00:18:00] problem and therefore gave drugs. And when it didn't... Help. They said, well, this is a chronic disease. It's an excuse for themselves because instead of saying that, hey, we've got the wrong treatment.

They're saying that we have the right treatment. We're doing the best we can. It's just a bad disease. But that's not true. And now they've had to face the fact that, for years.

You've been wrong. For example, in the American Diabetes Association, there's a new emphasis that we should focus on weight. I'm like, geez,

Been obvious for like 25 years at least that weight played a role in [00:18:36] diabetes. Like you're just now in 2020, I think it was 2022 or 2023, you just changed the guidelines now to say that we should focus on weight.

Like, this is the top diabetes specialist all over America and you didn't think that weight was important until last year?

John Salak: We were recently speaking with another doctor who was in the weight control area, he said, one of the challenges for doctors is in the last 20 years when we see the medical industry, medical insurance coming, doctors only spend a limited amount of time with patients.

a general [00:19:12] practitioner. It's something like 16 or 18 minutes when you go for your checkup. It's not about bashing the doctor, but the doctor goes through a checklist because that's all they can basically do. They see you're overweight. So here is a lose. It's not a sophisticated approach to losing weight.

It's more like you're 18 pounds overweight. It would seem like they were saying this was just process. Rather than a thought. And it's also reactionary rather than proactive approach to health, too.

Jason Fung: Perhaps. I actually think it's just because. Doctors just don't know anything about weight loss and that's why they don't do it like if you're not taught about it [00:19:48] I mean honestly people you go through medical school, all you learn is about calories in, calories out. And it's like, boy, that's the least successful strategy ever.

Like everybody's tried it, like 99 percent of the American population has tried that. And it works for like 2 percent of it. It's spectacularly unsuccessful. You tell somebody, Oh, count your calories, cut your calories. They lose weight for a few months, then they gained it all back. So clearly it's not a good strategy.

So pretty soon they stop telling people because they're just like, they know it's useless advice. [00:20:24] So it's not that there's too little time.

I don't buy that. I think that's an excuse. It's the same as, if you have time to take somebody's blood pressure, there's time to talk to somebody about it. Or you can give them handouts. You can give them books, you can point them to other resources. But I think the entire, sort of, weight loss area they haven't focused on it, they don't understand it they're not taught about it, and they don't see it as their area that they need to worry about. Therefore It never becomes part of it, even though it's such an important part of health.

John Salak: And we're talking about now in reaction to someone who already has diabetes versus [00:21:00] the wider challenge how do we eat a healthier diet? Before it creates problems

John Salak: for strokes, heart disease, or anything else. That's a different challenge. It's sort of a proactive health challenge versus a reactive health challenge.

Is that a fair assessment?

Jason Fung: There's a lot of different sort of pieces because of, obviously what we eat is tied into lots of different things. And it's a very complicated area. The issue is that people try to boil it down to a very simple thing. Simple thing and he can't so they try to make it so simple that it's incorrect.[00:21:36]

That is, they boil everything down to calories. He can't. So if you were to say that a hundred calories of cookies are the same as a hundred calories of broccoli, you'd be wrong. There's nothing alike about those two. So when you eat the cookies, your body responds in a certain way, produces certain hormones when you eat cookies versus when you eat salmon or eggs or broccoli.

They will respond completely differently. So if your hormonal response is completely different, your body is going to respond completely differently. So yes, there's same number of calories. What your body does with those calories is [00:22:12] completely different. So, what's happened is that people have sort of taken this very simple sort of idea and tried to simplify it, but simplified it to the point that it's wrong.

So that's why I think this sort of more deeper understanding of what happens to the body is important to understand.

John Salak: We talk about weight issues in terms of diabetes, and one of the things that struck me, I just got a note from a friend who's 65, and he just went in for double bypass surgery. He's thin and lean and I didn't realize until his wife told me [00:22:48] he has diabetes. So it's diet, but it may not just be weight in and of itself.

Is that correct?

Jason Fung: It's mostly the excessive like the fatty liver and the excessive accumulation. So you can see people, for example, especially Asians who on average are much. Lighter. So their body mass index is lower and they will still develop diabetes.

In fact, the average Asian in China, I think a few years ago when they developed diabetes had a body mass index of 24. 3, which is actually in the normal weight range. And over 25 is overweight. So normal weight was 20 to 25. So [00:23:24] they actually had normal weight, but they still develop type 2 diabetes.

So it's more than about the weight. And again, we boil it down, but it's not just that it's really the excessive body fat, but it's not even that it's actually the type of fat. If it's the visceral fat, that you carry around the abdomen is much more likely to cause problems.

John Salak: You were talking about, what we saw in terms of the Asian population. Are there any demographic differences that people should be aware of? Ethnic or demographic differences in terms of treating this? Would we treat or respond to men or women differently? Young or old differently?[00:24:00] Are there ethnic groups that would apply different treatments or approaches? But are there other factors that are involved in this or not at all?

Jason Fung: The treatments are going to be the same. I mean, it comes down to the same thing. Your body has too much glucose, so you really want to, you change the diet so that they burn off some of the glucose. So low carbohydrate diets is one way to do it, exercise is one way to do it intermittent fasting is another way to do it.

And it would be the same for men and for women. I mean, there's various you know, people may tolerate it better or worse, but there's nothing sort of genetic about it. It's [00:24:36] across all genetic categories. It's across all races, that kind of thing.

John Salak: I appreciate all your time and insights on this and I know you're incredibly busy because you're working in the hospital right now. I don't want to tie you up too much longer. What are the most important takeaways you'd like someone to walk away from this discussion?

Jason Fung: I think the most important thing is to say that type 2 diabetes is a reversible disease, but you have to really look at the diet, so you can't expect to just take drugs and reverse this disease. But if you use things like intermittent fasting, low carbohydrate diets, they have more success in [00:25:12] doing it compared to others.

But it is a reversible disease. That's the one thing that people really have to understand. So therefore we should be trying to reverse it because if you don't, you're going to be at risk of heart disease, cancer, blindness kidney disease and so on.

John Salak: Some really horrible consequences.

Jason Fung: Yeah.

John Salak: All right. Dr. Fung, thank you very much. We recommend everybody read the Diabetes Code, your book, which came out a few years ago, and more recently, the workbook. Dr.

Fung, thank you very much for your time, your insights.

Jason Fung: Thank you very much.

John Salak: Before we move on, we want to again encourage our listeners to take advantage of the [00:25:48] hundreds of exclusive discounts WellWell offers on a range of health and wellness products and services. These cover everything from fitness and athletic equipment to dietary supplements, personal care products, organic foods and beverages, and more.

Signing up is easy and free. Just visit us at WellWellUSA. com, go to Milton's Discounts in the top menu bar, and the sign up form will appear. Signing up will just take seconds, but the benefits can last for years. Some closing thoughts on diabetes. It is almost everywhere, and the problem is growing. [00:26:24] But, remember, there are ways to more effectively battle back.

First off... As with almost everything else, people need to take better care of themselves, which includes embracing healthier, more balanced diets, and becoming more active. This goes for everyone, not just mature adults, but children, teenagers, and middle aged individuals. Holding too much weight and doing too little exercise is like opening the door to diabetes and inviting it in.

Knowledge is also critical, both in terms of prevention and treatment. It is also essential. As [00:27:00] Dr. Fung pointed out, not to give in to diabetes if you contract it. Type 2 diabetes can be eliminated through diet and weight loss, an approach that only recently came into vogue. It is also essential to make sure you're tested regularly so that if diabetes takes hold, The challenge can be tackled early before there is any sizable harm.

At a minimum, it is critical to get informed, eat right, and become active. That's it for this episode of What the Health. I'd like to thank Dr. Fung for his [00:27:36] time and insights. Anyone looking for information on diabetes should start by getting his book, The Diabetes Code. It is available on Amazon. Okay, again, thanks for listening, and we hope that you'll join us on another episode of What the Health.

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