On this Q&A plant-based doctors answer questions and discuss the many ways lifestyle medicine can improve and even reverse diabetes.
Learn more about Cyrus Khambatta, Robby Barbaro, and Mastering Diabetes at https://www.masteringdiabetes.org/
Questions Answered
- (01:14) – Introducing Robby Barbaro
- (08:38) – Introducing Cyrus Khambatta
- (15:33) – About: “Mastering Diabetes”
- (18:42) – What is CGM?
- (28:49) – Is there anything you would have done different in your teens or your 20s as far as food or lifestyle?
- (37:10) – “Low-Fat”, Why & How?
- (37:43) – What is your intermittent fasting protocol?
- (42:30) – Can you discuss oil as a fat versus coconut oil versus the oil and nuts?
- (45:45) – Have your antibodies ever changed over the years?
- (51:57) – What are antibody tests?
Complete Transcript
Dr. Laurie Marbas
(00:03)
And we are so honored to have, besides the wonderful Dr. Miller and Dr. Klaper, Cyrus and Robby from Mastering Diabetes. How are you guys?
Dr. Chris Miller
(00:10)
Excited.
Robby Barbaro, MPH
(00:11)
Doing well.
Cyrus Khambatta, PHD
(00:12)
It's always good to be with you guys, so thanks for the invitation.
Dr. Laurie Marbas
(00:14)
Yeah, it seems like I see you quite often these days.
Cyrus Khambatta, PHD
(00:17)
I know. It's like a highlight of my week, every time.
Dr. Laurie Marbas
(00:21)
All right. Awesome. Would either of you like to share? I'm pretty sure a lot of you already know who Cyrus and Robby are. If you could just tell us a little bit about you guys and your program and everything that we could learn from you is amazing.
Cyrus Khambatta, PHD
(00:33)
For sure, for sure. Robby, go for it.
Robby Barbaro, MPH
(00:35)
Yeah.
Cyrus Khambatta, PHD
(00:36)
Robby.
Robby Barbaro, MPH
(00:38)
So, to talk about our program, not our stories, right?
Dr. Laurie Marbas
(00:43)
Your stories or programs, whatever you like. I think the story is important, right?
Robby Barbaro, MPH
(00:48)
Okay, sure.
Dr. Chris Miller
(00:49)
Not everybody's familiar with you guys. I know some people in the audience right now who don't know who you are, so-
Dr. Michael Klaper
(00:54)
Okay.
Cyrus Khambatta, PHD
(00:54)
Okay.
Robby Barbaro, MPH
(00:54)
Okay. All right, so I'll tell my story real quick.
Cyrus Khambatta, PHD
(00:57)
Whoa, whoa, whoa, whoa. You're saying there's people in the room that don't know who Robby is?
Dr. Chris Miller
(00:59)
Not yet. They will. They're on their way.
Cyrus Khambatta, PHD
(01:03)
That's a big deal.
Dr. Chris Miller
(01:03)
They're here today. They'll know soon.
Robby Barbaro, MPH
(01:04)
That's too funny.
Dr. Laurie Marbas
(01:08)
I think we all have ADD.
Robby Barbaro, MPH
(01:11)
Cyrus, we have a lot of work to do.
Cyrus Khambatta, PHD
(01:13)
Seriously, what are we doing?
Robby Barbaro, MPH
(01:14)
Let's go. So, I was diagnosed with type 1 diabetes on January 26th of 2000. So, I'm living with type 1 for over 20 years now, and I actually was quite familiar with the condition because my older brother was diagnosed nine years prior, and I basically self-diagnosed myself. I said, “Mom, you know what? I'm going to the bathroom all the time. I'm thirsty all the time. I think I have diabetes just like Steve.” She said, “No, no. Don't be silly. You don't have diabetes.” I said, “Okay.” A little bit of time passes by, she's out of town, calls to check in, and I say, “Mom, I couldn't sleep last night. I was cramping.” She said, “Okay, go upstairs. Use your brother's blood glucose meter and test yourself,” and I did, and I was well over 400, and my brother said right then and there, “Yep, you have type 1 diabetes. Pack your bag. You're going to be in the hospital for a few nights.”
Robby Barbaro, MPH
(02:04)
So, I went to the general doctor. They ran some tests, and then I went to the hospital. My parents flew in the next night, and my dad just said, “You know what? It's just an inconvenience. Don't worry. You can still achieve all your dreams in life, and that's the way my parents addressed type 1 diabetes for both my brother and myself, and they wanted to make sure we had the best medical care.” So, we went to the Mayo Clinic in Rochester, Minnesota. I had an entire team that had an endocrinologist. I had a nutritionist. I had a psychologist, and they tried to make sure we had the best care, and looking back, there was not a single moment where anybody on that team talked to me about reversing insulin resistance, maximizing insulin sensitivity, making lifestyle choices now that could improve my long-term chronic disease risk as a person living with diabetes. It was never part of the conversation.
Robby Barbaro, MPH
(02:57)
So, I just went on my merry way and started following the standard American diet, and at that point, they're teaching us the food pyramid. My mom is being very diligent trying to follow this as, “Okay. Hey, Robby. You and Steve, you both have to have your one serving of fruit every night.” My serving of fruit with dinner was a can of mandarin oranges with high fructose corn syrup in there, and that was my fruit, and I looked forward to it. Anytime I had strawberries, we put powdered sugar on top. That was just the way fruit was consumed. I ended up developing really bad acne, cystic acne as a high school student. I had plantar fasciitis, which was really frustrating as a competitive tennis player. I had allergies year-round. I took Nasonex and Claritin-D and would still get sick every year.
Robby Barbaro, MPH
(03:43)
I had warts on my feet, so just some frustrating standard American symptoms, and really, what got me into this whole thing was the mindset that I am going to do whatever it takes to regenerate beta cells. I was a high school student. I was going to Barnes & Noble and to get spark notes and there was a book that fell off the shelf. It's called Kevin Trudeau's Natural Cures “They” Don't Want You to Know About, okay? I'm not recommending that book. This guy ended up going to jail. There was some fraud going on here, like just not recommending it, but I guarantee people listening to this show have heard of this guy because he was on infomercials. The guy sold millions of books, and it just planted a seed in my mind that you know what? If I start living healthfully, and Dr. Klaper can appreciate this.
Robby Barbaro, MPH
(04:36)
I mean, this got me into the world of natural hygiene. We started learning about Herbert Shelton. We have this whole mindset of like, “You can heal anything,” and it's a beautiful thing. I love it. There's a lot of beauty in that, and it got me going. So, I can't say that I figured out how to lower my antibodies and regenerate beta cells because that's what we need to do to naturally heal an autoimmune version of diabetes. I haven't figured that out yet, but it sent me down this path, and I have learned so much, and I transformed my life, and what happened when I started dabbling in new lifestyle choices, I tried a Weston A. Price diet. I tried a plant-based ketogenic diet, which back then wasn't called that, but that's what it was.
Robby Barbaro, MPH
(05:20)
It was a Gabriel Cousens phase-one raw food. You get your calories from oil, nuts, and seeds. You have lots of greens, very small amount of non-starchy vegetables because you would then exceed your carbohydrate limit for the day if you did that. So, I followed that program for a while, and it wasn't until I found low-fat plant-based whole food nutrition that my diabetes control turned around and actually started to feel like a million bucks. So, long story short, I started eating a lot of fruits, a lot of vegetables. My insulin sensitivity skyrockets. So, the amount of insulin I need for the glucose I'm consuming changed it by 900%. So, a 900% improvement in insulin sensitivity from a plant-based ketogenic diet to a low-fat plant-based whole food diet, and all of a sudden, my skin starts to clear up.
Robby Barbaro, MPH
(06:16)
I no longer have plantar fasciitis. I no longer have any seasonal allergies. I don't take any allergy medications. I eat well over 700 grams of total carbohydrate per day, and I inject a physiologically normal amount of insulin, roughly 30 units of insulin on average, 30 units of total insulin per day. That includes basil. That includes bolus. My A1C is 5.3%. My time in range on my CGM is upwards of 90%. I'm in between 90, 92%. That's where I'm at right now in my CGM. So, when you look at the AGP Report, the people who believe, “Oh, you can't have a flat line on a high carbohydrate diet,” and I beg to differ and so do our testimonials because it's not just me. It's not just Cyrus. We have endless testimonials.
Robby Barbaro, MPH
(07:06)
Go look on our Instagram page. Go look on our website. Other people are getting these exact same results, injecting a physiological normal amount of insulin, eating large amounts of whole carbohydrate and showing on their CGM that they have excellent blood glucose control and an excellent A1Cs as well. So, now, here we are today, 2020, trying to get this information out to as many people as possible and legitimately trying to send as many humans as possible to Plant Based TeleHealth because your guys's work and the team, like we don't practice medicine. We're not doctors. There's such a bigger picture going on with what we're doing at Mastering Diabetes. It's helping people reverse insulin resistance and how that relates to a laundry list of chronic conditions, which we are not experts in, but you guys are, and you help our members on a daily basis, and it means the world.
Robby Barbaro, MPH
(07:54)
So, I hope your company just blows up, and we have another call with your entire team of 100 doctors at some point down the road because we need you guys, and you're just a huge, huge support for everything we're doing.
Dr. Laurie Marbas
(08:05)
Oh, Robby, that is beyond exciting, and thank you very much, and we'll take it. We're bringing on our first doc probably in January. We've already Dr. Jeff Pierce, and then we're working on our second one after that, so we're super excited. We are growing. It's like, “Yay.”
Robby Barbaro, MPH
(08:21)
That's awesome.
Dr. Laurie Marbas
(08:21)
Yeah, so Cyrus, tell us your story, and you guys can decide how you'd like to share how you guys came together to join forces and create the Mastering Diabetes.
Cyrus Khambatta, PHD
(08:30)
For sure. I don't have diabetes. I've actually never even heard of diabetes. [crosstalk 00:08:33] when to start.
Dr. Laurie Marbas
(08:33)
Okay. Turn it.
Cyrus Khambatta, PHD
(08:38)
Okay, so I was diagnosed with type 1 diabetes in 2002. So, this was 18 years ago. I was a senior at Stanford University. I was just trying to graduate and move on with my life, and I noticed similar symptoms to what Robby described. I was pretty tired. I couldn't concentrate very well. I was extremely thirsty, and I mean, when I say extremely thirsty, I was drinking between a gallon and two gallons of water per day, and it seemed like every single time liquid touched my lips, I got thirstier. So, like take a drink of water. I put it down, and I was like, “Three, two, one. Yeah, I'm thirstier,” and then I would drink some more, and this cycle just kept on repeating, and because I was taking on such a large volume of fluids, I ended up urinating frequently, 17, 18, 20 times a day, like clockwork every 30 minutes, and as a result of that, I was flushing electrolytes.
Cyrus Khambatta, PHD
(09:26)
So, as a result of that, when I would go to sleep at night, I would cramp up. Sometimes, you get those cramps, and you sleep, and all of a sudden, your calf cramps up, and you wake up, and you're like, “Oh.” You try and relieve. You're trying to manipulate your body so you can relieve that tension. Well, imagine if your calf on your right leg cramped up, and then you tried to move your body, and then your hamstring on your left leg cramped up, and then your butt on both sides cramped up, and then your calf on the other side cramped up, and then your abs cramped up. I mean, there were literally nights where I would lie there in what felt like full body rigor mortis because I was so electrolyte depleted I believe that my muscles were basically in a very unhappy state.
Cyrus Khambatta, PHD
(10:06)
So, I check myself in to the health clinic on campus, and they measure my blood glucose there, and the nurse walks. She takes my blood glucose. She walks into a different room. She puts it into a blood glucose meter. She comes back. She looks to me. She goes, “How did you get here?” I was like, “I just walked,” and she was like, “I need to get you to the hospital right now,” and I was like, “What is going on? I don't understand.” She said, “Your blood glucose is in the 600s. We have to get you to the hospital ASAP.” So, they took me to the ER, and they admitted me for one night, and there, they gave me IV saline and IV insulin, and they basically brought my blood glucose down over the course of a 24-hour period.
Cyrus Khambatta, PHD
(10:47)
When I got discharged from the hospital, I ended up walking away with two different types of insulin, a basal insulin, a bolus insulin, syringes, a blood glucose meter, test strips, a carbohydrate counting guide, and a bracelet that said, “Hey, I'm a life alert patient. If you find me pass out on the sidewalk, please call 911,” right? So, you can imagine at 22 years old, you're a happy-go-lucky kid. You're just doing the college thing, and then all of a sudden, you become a chronic disease patient overnight, and my whole world changed in front of me. So, long story short, I ended up doing the low-carbohydrate thing because that's what my doctors had told me to do.
Cyrus Khambatta, PHD
(11:25)
“Cyrus, in order to control your blood glucose, the only way you're going to be able to do it effectively is to lower your carbohydrate intake,” and I said, “That sounds reasonable.” I mean, from the surface, it sounds reasonable, right? So, they said, “Try and limit your intake of fruits and potatoes and pastas and breads and cereals, and eat more chicken and turkey burgers. Eat more lean meats and have dairy products and peanut butter and milk,” and I said, “Okay, sounds like a plan. I'll go do that.” So, I did that for about a year, and let's put it this way. I was pretty low-energy when I checked myself into the hospital.
Cyrus Khambatta, PHD
(12:04)
About nine months into this process, I was so low-energy that there were certain days I would wake up, and I was like, “Oh my God. I'd rather be asleep right now because being asleep is easier,” right? So, it got to a point where I had no energy. My blood glucose was a disaster. I mean, my blood glucose was supposed to become more controllable, and it did the opposite. My glucose got higher. My average glucose was rising. My insulin use was rising, and I was like, “This is just not working. I don't understand what's wrong.” So, I ended up transitioning to a plant-based diet, and just like Robby, within a very short period of time, in my situation, one week, I was able to cut my insulin use by 40% in seven days, but I didn't do that by limiting my carbohydrate intake. I did that by eating 600 to 700 grams of carbohydrate per day from mainly fruits and vegetables.
Cyrus Khambatta, PHD
(12:53)
So, I was eating enough fruits and vegetables to feed a small army on a daily basis. My insulin use was going down. My blood glucose was more controllable. I was more hydrated. I was sleeping better, and I had more energy. So, at that point, I was like, “Wait a second. Maybe this is the right path.” So, I put myself back to graduate school. I went and got a PhD in nutritional biochemistry because I wanted to be able to talk science. I didn't want to just communicate my end of one experiment. I really wanted to understand what's happening inside of my brain and my thyroid gland and my pancreas and my liver and my kidney. Am I a genetic freak? Because if I'm a genetic freak, fine, but I want to understand it.
Cyrus Khambatta, PHD
(13:31)
In this process, I came across almost 100 years' worth of evidence-based research that clearly demonstrates how the world of diabetes, the medical world, the scientific world understands exactly how to create diabetes and how to reverse diabetes. This has been obvious since the 1920s except that information exists inside of this thing called that we refer to as “the literature,” and the public does something completely different, right? So, the medical literature clearly describes that by manipulating your carbohydrate intake to your advantage and manipulating your fat intake to your advantage and by transitioning to a more plant-focused diet, you can dramatically reduce.
Cyrus Khambatta, PHD
(14:08)
I'm not saying a small amount. Dramatic reduction in insulin requirements, but yet what people do in the outside world is they eat high-fat diets that are either ketogenic diets or paleo diets or Atkins diets. They're doing the exact opposite. So, at this point, when Robby and I met each other back in 2010, we decided that we wanted to try and take over the diabetes world together and try and educate people about how they could also make a transition to a plant-based diet living with all forms of diabetes and get not only similar results to what we got, but even better, and here we are today in 2020 having impacted a lot of people, and as far as I'm concerned, we're just getting started.
Dr. Laurie Marbas
(14:49)
Yes, absolutely, and you also have a book out?
Cyrus Khambatta, PHD
(14:52)
That is correct.
Robby Barbaro, MPH
(14:54)
We do.
Dr. Laurie Marbas
(14:55)
Excellent.
Cyrus Khambatta, PHD
(14:55)
This bad boy.
Dr. Laurie Marbas
(14:56)
And where can they get it?
Cyrus Khambatta, PHD
(14:57)
You can buy this book. You can go to Amazon, probably the easiest place to get it. This thing came out in February of 2020, and we were actually pretty excited that this thing became a New York Times Bestseller within the first week of being out, and we, Robby and I, don't care about the ego boost from that at all. We only care about that because it means that people are hungry for this information. Pun intended, right? People want this information. It's changing a lot of lives, and there's a lot of interest in getting more of a plant-based focus in the diabetes world, and we're excited to be part of that whole revolution.
Dr. Laurie Marbas
(15:33)
Can you explain the Mastering Diabetes approach, what you offer, and where people can go to find you?
Cyrus Khambatta, PHD
(15:39)
For sure. We created the Mastering Diabetes method. So, the Mastering Diabetes method basically contains four parts. The first one is low-fat, plant-based whole food nutrition. The second part is daily movement. The third part is intermittent fasting, and the fourth part is documentation of important aspects of your health that you can then use to make decisions based off of, okay? So, by implementing low-fat plant-based whole food nutrition, daily movement, intermittent fasting, and documentation, we have been able to demonstrate not only in ourselves but also in thousands of people that each one of these aspects of your life with diabetes makes a massive impact on your insulin sensitivity, each one of them by themselves.
Cyrus Khambatta, PHD
(16:29)
In other words, if you just integrated the low-fat plant-based whole food diet but did nothing else, your health would improve. You'd become more insulin-sensitive. If you just intermittent fasted by itself and did nothing else, you'd become more insulin-sensitive, so on and so forth. So, what we've developed is basically a coaching program, and the coaching program makes it so that people living with all forms of diabetes whether it's type 1, type 1.5, pre-diabetes, type 2 diabetes or gestational diabetes can join our coaching program and be led by any number of expert coaches who either have personal experience reversing diabetes and insulin resistance or have clinical experience in doing that, and we provide a step-by-step program that takes people from, “I don't know anything about plant-based nutrition,” to getting their feet wet to really understanding every small change they can make over the course of time to transform their habits.
Cyrus Khambatta, PHD
(17:32)
We're sticklers for changing your habits, and we want you to change from the inside out. So, rather than you saying, “Okay, guys. I did the plant-based thing for 21 days, and I lost a little bit of weight, but I'm going to go back to eating meat. It didn't work.” Our answer is, “No, no, no. You can't change your habits in 21 days. Don't kid yourself,” right? This is going to take three to six months or more for you to change your mindset, for you to change your daily practices, and once you make small changes over the course of time, you can completely transform your entire mindset, your daily practices, and your entire physiology, and as a result of that, you can get dramatically improved blood glucose control, and in most situations, living with type 2 diabetes, pre-diabetes, and gestational diabetes, completely reverse it. Completely reverse it altogether, which I know you guys see all the time with patients who have diabetes coming to you, correct?
Dr. Laurie Marbas
(18:29)
Oh, yes. More than a few. So, that's the fun part about medicine is actually saying, “Oh, look, you don't have to come see me anymore. Good job.”
Cyrus Khambatta, PHD
(18:37)
Yeah, I know. It's almost like if you've done your job well, then clients don't need you anymore.
Dr. Laurie Marbas
(18:42)
Exactly, exactly. 100%. So, can you explain, maybe Robby, what a CGM is? Because you mentioned that and we have a question, “What is CGM?”
Robby Barbaro, MPH
(18:52)
For sure, and I just like to say, I'd love for us to go out of business and have nobody to help and then just go be a farmer. That'd be the best thing ever. So-
Cyrus Khambatta, PHD
(19:00)
Ooh. As long as you get some cats, I'm happy.
Robby Barbaro, MPH
(19:02)
Yeah. I saw a “meow,” in the background a little earlier, Cyrus. Okay, so a CGM is a continuous glucose monitor, and they've been around for many years now, 10-plus years for sure, but now they're becoming much more popular and more affordable, and what they do is they measure interstitial fluid, and then these scientists have come up with a formula for figuring out, okay, when they measure the interstitial fluid can relay… This is what your blood glucose is, and they're quite accurate. These devices are accurate. They are 15 minutes delayed. So, the number you see on your CGM is actually what your blood glucose was about 15 minutes ago. So, you have to think about that when you're making decisions, but these devices, they'll speak directly to your phone via Bluetooth. They can speak to a receiver.
Robby Barbaro, MPH
(19:52)
If you get a FreeStyle Libre, you have to scan yourself. If you get a Dexcom G6, there's no scanning. It just talks directly to your phone, which can then talk to your Apple Watch, if you have one of those. That's what I use, and it's really helpful. It's basically telling you your blood glucose every five minutes. I think the FreeStyle Libre 2 is now reporting every minute, I believe.
Dr. Laurie Marbas
(20:14)
Yes, it's every 60 seconds.
Robby Barbaro, MPH
(20:16)
Every 60 seconds, you get a new reading. It's unbelievable.
Dr. Laurie Marbas
(20:19)
But it doesn't work on the phone app right now. You have to have a reader, and then I can't see the date when I'm taking it.
Robby Barbaro, MPH
(20:24)
Right, which is I don't understand what's going on over there. I think they're just saving money or they're making the device smaller, but for whatever reason, it also doesn't proactively speak like… It does. The FreeStyle Libre 2 does, but it doesn't give you the number. It tells you, “You need to scan.” So, that's progress. They made progress.
Dr. Laurie Marbas
(20:46)
It is cheaper though. It is the cheaper one.
Robby Barbaro, MPH
(20:47)
It is cheaper, and it does last longer. I think it's 14 days that that-
Dr. Laurie Marbas
(20:50)
14 days.
Robby Barbaro, MPH
(20:50)
… sensor will last whereas the Dexcom will last for 10, and there's other companies. There's Eversense. You can get an implant in you that will last for a little bit. So, there's other options, but I think… I mean, I know you guys are big fans of this technology. We are too because you can see the trend, and you can see what's happening after a meal. You can see what's happening while you're sleeping, and these insights really help you make really good decisions when it comes to using medications, or a lot of people also become empowered or motivated when they see the trend. “Okay, wait a minute. When I go off the program, and I eat what I know I'm not supposed to eat,” they see it. Like you see that, “Oh, wow. It went to 200. It went to 250,” like, “Oh, man. I shouldn't do that.”
Robby Barbaro, MPH
(21:34)
Whereas if you were just pricking, you might wait two hours after a poor decision, and you're 150 or something. It's not as bad, but you really see what's happening in between, and I know Cyrus published some research with Dr. Gibson out of Shreveport, Louisiana about the benefits of using CGMs in his practice. So, we're big fans of these devices.
Dr. Laurie Marbas
(21:59)
Absolutely.
Dr. Chris Miller
(21:59)
Are we? It's so helpful for us because we're lucky we get to work with people one-on-one. So, we get to tweak it as it's live when it's happening with them. We see them, and we can adjust what time they're eating, and it is so interesting, the four points to your program, because it is so much more than diet I've found too. They may be eating all the right foods, but if they're eating at the wrong time or they're not moving or they're just starting the program, and they're still insulin-sensitive. They haven't fully arrived there, so it's still individualized as far as helping people get to the point, and one thing I want to ask you guys about is transitioning from, say, a standard American diet for someone who's diabetic into your plan, I think it's so interesting how you broke it up into doing one meal at a time and becoming experts at it, and can you go into that a little because I know that's helped a lot of my patients trying to go all in and just being flustered to then breaking it down into the steps and getting actually really good results after that.
Cyrus Khambatta, PHD
(23:01)
For sure. I'm actually glad that you brought this up, Chris, because there's a lot of people who consume either standard American diet or a low carbohydrate diet, and they understand the fundamental principle, which is this. If you guys remember absolutely nothing from this entire conversation, just remember this one thing. When you consume a high fat diet, insulin signaling becomes impaired. That's it right there. You can literally write that down. You can tattoo it on your arm, whatever you want. When you eat a high fat diet, insulin signaling becomes impaired, and it's a very well-described biological phenomenon in the scientific literature, again, but the general public just doesn't really fully understand this, and the idea is that when you're consuming a diet, that contains a significant amount of dietary fat.
Cyrus Khambatta, PHD
(23:48)
Especially if it's saturated fat, the saturated fat ends up overaccumulating inside of your liver and muscle, and the simplest way to get insulin to become less effective is to put saturated fat where it doesn't belong. So, if you put saturated fat inside of your liver, and if you put it inside of your muscle, and it's accumulating in quantities larger than those two tissues are designed for, those tissues basically initiate a self-defense mechanism, and the self-defense mechanism is to try and limit more energy from coming in because they're basically saturated with energy. So, the simplest way for any cell in your entire body to limit how much energy comes in is to decrease its ability to respond to insulin because insulin is the master anabolic hormone in your body.
Cyrus Khambatta, PHD
(24:39)
In other words, it is the hormone that has more anabolic characteristics than any other hormone in your body. It promotes more fuel, storage, and more cellular growth than any other hormone period, end of story. So, if you're a cell inside of a liver, you're a cell inside of your muscle, and you've been saturated with too much saturated fat, and you're trying to block more things from coming in, more fat, more amino acids and more glucose, the simplest thing you can do is basically tell insulin to just go away. So, they create this thing called insulin resistance, which is a self-defense mechanism. When insulin comes and basically says, “Hey, knock, knock. There's glucose in the blood. Do you want to take it up?” These cells respond by saying, “No, no, no. I'm not paying attention to you right now. I don't have room. I don't have space. I'm full of energy. I don't really need you.”
Cyrus Khambatta, PHD
(25:23)
As a result of that, glucose and insulin get trapped inside of your blood. So, this is classic insulin resistance, right? So, imagine if you have been eating a low carbohydrate diet or a standard American diet, both of which are high in saturated fat, you've developed this insulin resistance state inside of your liver and inside of your muscle, and then in that situation, you say to yourself, “Oh, I like the idea of switching to a plant-based diet. I'm going to go do that.” So, if you were to make that transition quickly, and you were to say, “I'm going to listen to Robby and Cyrus, or I'm going to watch Forks Over Knives, or I'm going to watch The Game Changers, and now I'm really motivated to want to put in a lot of plant material,” and you start to eat a lot of carbohydrate-rich foods like fruits or potatoes or legumes or whole grains.
Cyrus Khambatta, PHD
(26:10)
Guess what's going to happen? Your glucose is going to go up, right? So, you're in an insulin resistance state to begin with, and then in that insulin resistance state, you start to eat a significant amount of carbohydrate-rich food. So, now you're basically adding carbohydrate into the insulin resistance equation, and when you do that, the glucose from those carbohydrates gets trapped inside of your blood because insulin keeps on knocking on the door, “Hey, liver, muscle, open the door, open the door, open the door. I got glucose. Take it in,” and both of those tissues are saying, “No, no, no, no, no.” So, in order to get to a point where you can eat large quantities of carbohydrate-rich food, which is what we recommend, you have to allow some time to pass for your liver and for your muscle to become less insulin resistant, and the way that you do that is by slowly transitioning towards more carbohydrate-rich food.
Cyrus Khambatta, PHD
(27:04)
So, what we recommend for people who have been eating a standard American diet or a low carbohydrate diet is to make changes one meal at a time, and that's a very strategic decision because if you make a change and you increase your carbohydrate quantity only at breakfast, but not at lunch and dinner, right? If you eat more plant material at breakfast but not necessarily at lunch and dinner, and you get used to that over the course of about a week or so, then you can limit this unwanted glucose excursions, and then over the course of the second week as your breakfast is already set, you now do the same thing with lunch, and then you do the same thing with dinner, and over the course of a few week period, you gain significant amounts of insulin sensitivity to the point where you can start to eat large amounts of carbohydrate-rich food at all meals, and your blood glucose is going to be way more stable at that point.
Cyrus Khambatta, PHD
(27:55)
So, tip toeing is really the key to this process, not only from a habit change perspective, but also from a physiological perspective in order to prevent your blood glucose from doing things that you don't necessarily want.
Dr. Laurie Marbas
(28:07)
Awesome. That's a wonderful explanation of how to transition slowly and so you can improve your insulin sensitivity. Dr. K, did you have any questions?
Dr. Michael Klaper
(28:15)
I sure do. It's really great to have you guys here, and when I was growing up in the '50s, '60s, I remember the car commercials to get people to trust the damn cars. Ask the guy who owns one. Ask the guy who ones.
Cyrus Khambatta, PHD
(28:30)
Yeah, so true.
Dr. Michael Klaper
(28:32)
You guys, you own it. You've got the experience, and it's a beautifully written book. It's so nice to have some people talking some real science here and yet make it accessible and approachable, and it's just a great service. It's nice to be able to refer people to your book-
Cyrus Khambatta, PHD
(28:47)
Thank you.
Dr. Michael Klaper
(28:49)
… and your classes. I'm curious. Knowing what you know now, looking back through the retrospective scope when you were 15, say, and there's diabetes in your family, or just some angel from the future whispered in your ear, “Diabetes is waiting for you up there.” Is there anything you would have done different in your teens or your 20s as far as food or lifestyle? And people who say have type 2 diabetes in their future, is there anything you would tell them now to maybe prevent this condition?
Cyrus Khambatta, PHD
(29:21)
Yeah, it's funny. I think about that question all the time. Robby, were you about to say something?
Robby Barbaro, MPH
(29:24)
No, go ahead.
Cyrus Khambatta, PHD
(29:25)
Oh, okay. Dr. Klaper, first of all, for you to say that the book is well written and that it's a good resource, that means a lot because you are a true legend in the world of plant-based nutrition, and we really appreciate your kind words. So, thank you for saying that. I think about this question a lot like, “Oh, if I knew that I was going to develop type 1 diabetes in my 20s, and I found that out when I was in my teens, what would I do differently?” I can answer that question from multiple different perspectives, but one other thing that I want to add to this equation is that I've been an athlete my whole life. I've been playing soccer ever since I was four years old. I've been weight training ever since I was 16 years old, and if there's a sport, I love playing it. Hiking, biking, swimming, running, soccer, baseball from a young age, you name it. I love moving my body.
Cyrus Khambatta, PHD
(30:21)
I did recognize when I was in high school that I kept on complaining and getting frustrated that I felt like no matter how hard I tried, no matter how hard I trained, no matter how much I ran, I would hit a wall. I would hit this performance wall whereby I couldn't seem to go any further, and I couldn't gain any more speed. I couldn't gain any more flexibility. I couldn't gain any more endurance, and it was frustrating to me because I constantly kept on thinking, “Well, why are those other athletes getting stronger, faster, bigger, and how come I'm not? I don't understand what's happening.” I chalked it up to just being like, “You know what? Maybe that's just something genetic inside of me, and I've achieved my athletic maximum, and that's it.”
Cyrus Khambatta, PHD
(31:06)
Fast forward six years, I get diagnosed with type 1 diabetes. I change my diet, and one of the first things I recognized once I had changed my diet is that this sealing of my athletic capacity just… I just blew through it, just blew through it to the point where I was like, “Oh, wow. I'm in unchartered territory now. I've never been here. I've never had endurance this good before. I've never been able to breathe this calmly before during exercise. I've never been able to work out this much and with this much volume, and I've never been able to recover this quickly. This feels different,” right? So, diabetes aside… I mean, that has nothing to do with diabetes. All I knew was that I had changed my diet, and I started to eat a low-fat, plant-based whole food diet, and as a result of that, my athleticism is in a completely different realm today than it was back in high school, okay?
Cyrus Khambatta, PHD
(32:01)
So, if I had to go backwards in time, what I would do for that very reason because soccer was such a big deal to me back then that I would change my diet to eating as much plant material as possible, but most importantly I would be doing it with the idea of being a carbohydrate-eating machine, right? You can eat a plant-based diet and get the bulk of your calories from avocados and nuts and seeds and olive oil and coconuts, and there's a lot of people who do that, right? Or you can be a plant-based eater, and you can get the bulk of your calorie from fruits and from starchy vegetables and legumes and whole grains. Knowing what I know now, I would do the latter, and I would eat low-fat plant-based whole food from fruits, vegetables, legumes, and whole grains because it would have enabled me at a younger age to become so much of a better athlete and as a result of that, my quality of life would have improved.
Cyrus Khambatta, PHD
(32:55)
I would have complained less about this theoretical ceiling that I was hitting, and who knows? Maybe it could have reduced my risk for developing diabetes in the future. It's speculative, but there's a possibility.
Dr. Michael Klaper
(33:10)
You think your dairy consumption or gluten consumption, anything like that had anything to do with it and would you have altered that?
Cyrus Khambatta, PHD
(33:18)
100%. There's no question. I mean, all throughout high school, I would drink upwards of a quart of milk per day, especially chocolate milk, with that Nestlé chocolate syrup, thick inside of the milk, and then ice cream and cheese. They appeared in my diet on a daily basis. There's no question about it. So, you're correct in bringing up the point that there's a strong connection between people who consume dairy products and the risk for the development of type 1 diabetes. There's no question about it, and there's also a growing body of evidence that shows that there's potentially a gluten type 1 diabetes connection, and that could be exacerbated by dysbiosis inside of your microbiome.
Cyrus Khambatta, PHD
(33:59)
So, would I have reduced my gluten intake and/or my dairy intake? Absolutely. I'll tell you this. If it would have enabled me to become a better soccer player, I would have done anything. I would have done anything, no questions asked.
Robby Barbaro, MPH
(34:13)
I mean, personally, I would have made these same changes that Cyrus was talking about we teach now literally just out of the principle of pride. When I learned how much money was being spent by these companies to trick us, I read David Kessler's book, The End of Overeating, the former commissioner of the FDA exposing… not exposing, but just sharing the facts about what we know about the money and research put in to truly get people addicted to these foods, and they know it's not healthy for us, and it's just like, “Screw you. There's no way I'm going to spend any money on your thing. I mean, you're trying to mess with my brain.” So, just eat more natural whole foods unprocessed just out of the element of just pride.
Dr. Laurie Marbas
(35:00)
Oh my goodness. That's good. Well, then, and also, you worry parents. So, if you have little ones, take this to heart and really start working on your kiddo's diet. It's really important for their long-term health. We have a few other questions. When you describe a low-fat plant-based diet, how low-fat and why low-fat? Maybe they didn't quite catch that, I think.
Cyrus Khambatta, PHD
(35:24)
Okay, so how low-fat? A lot of people label us as being no-fat, and they say, “Oh, well, I'm trying to get to zero fat,” and the answer is don't try it. It's not possible. I wouldn't recommend it. What we recommend is to eat somewhere between 10 and 15% of your total calories as dietary fat, okay? So, how would you know that? Well, there's many apps that you can download and use on your phone. It's either called Cronometer or MyFitnessPal or any number of other food logging apps. Download a food logging app. List every single thing that you're eating on a daily basis and be very descriptive about what it is and in which quantity. At the end of a 24-hour period, the app will give you a summary, and it'll say, “Hey, Dr. Klaper, this is what you ate. Hey, Laurie, this is what you ate. Hey, Chris, this is what you ate,” and then you're able to see a summary of all that food.
Cyrus Khambatta, PHD
(36:21)
The most important metric to pay attention to is what's called your carbohydrate-to-fat-to-protein ratio or your macronutrient ratio. What we recommend is to consume approximately 70% of your diet as carbohydrate and then the remainder be split between protein and fat. So, that would be 70-15-15, or you can go upwards of 80-10-10. Somewhere in that range. It doesn't really matter, but if you were to eat the bulk of your calories as carbohydrate and somewhere between 10 and 15% fat. Then that is what the research has shown to be a way to dramatically improve your insulin sensitivity and control your blood glucose with precision.
Dr. Laurie Marbas
(37:07)
Excellent.
Cyrus Khambatta, PHD
(37:08)
What was the second question, Laurie?
Dr. Laurie Marbas
(37:10)
Well, they were asking why low fat and how low fat, so I think-
Cyrus Khambatta, PHD
(37:15)
Fair enough. Yeah, the last thing I would say is why low fat because dietary fat impairs insulin signaling right in the story.
Dr. Laurie Marbas
(37:27)
Exactly. It's going to be tattooed across my chest.
Dr. Chris Miller
(37:28)
It's going to be on all of our chests.
Dr. Laurie Marbas
(37:31)
So, instead of it's the food by Dr. Klaper, it's going to be you guys, dietary fat impairs insulin production.
Cyrus Khambatta, PHD
(37:37)
That's exactly right. Make a shirt out of it.
Dr. Laurie Marbas
(37:43)
So, that's good. There's another question here. Do you fast every day for 12 hours or one a full day a week? Can you describe your intermittent fasting protocol or regimen?
Cyrus Khambatta, PHD
(37:51)
Sure. Okay, so there's a literally thousands of ways that you can do an intermittent fast. There's many different time and day combinations. To keep things simple, we recommend one of two different approaches. If you're new to intermittent fasting, what I would recommend doing is a once per week 24-hour intermittent fast. So, that would mean that you basically… Let's say you decided to do a Saturday intermittent fast. What that would mean is you would start on Friday evening after dinner. You would eat your dinner on Friday, and you would stop eating at that point. You would set a stopwatch, and you would say go, and then you would while you're sleeping, don't eat any food. For breakfast on Saturday, don't eat anything, just drink some water, drink some water for lunch, and then eat your dinner again on Saturday.
Cyrus Khambatta, PHD
(38:36)
So, basically, from Friday dinner to Saturday dinner, we're looking at approximately a 24-hour window, okay? That's a simple way for you to get used to the idea of not putting food in your body for about a 24-hour period, and we find that people who do this for the first time are like, “Wow. I got hungry,” by the time the 16-hour marker hit, by the time the 18-hour marker hit, right? So, if you want to just tiptoe into intermittent fasting, try that once per week and do that for three, four, five weeks, and then report back. The second strategy that we recommend is for people who want to be a little bit more consistent in their fasting habits, and to do that, we recommend consuming or fasting for about 16 hours a day.
Cyrus Khambatta, PHD
(39:21)
What that would mean is that you're performing what's called a 16-8 intermittent fast. 16 hours of fasting, eight hours of eating. So, starting at dinner again, let's say you started dinner on Friday night, you would fast basically all throughout your sleeping window and then just start eating food on Saturday at noon for lunch. So, that enables you to eat lunch and dinner, and then you contain your eating within that eight-hour window, and then again, you would start fasting that same evening until the next day. There's many differences between the two, but the 16-8 is meant to be done on a daily basis, and it may seem a little strange at first because you have to eliminate one meal a day, and it can be a little bit challenging to do that, but you can get used to it relatively quickly.
Cyrus Khambatta, PHD
(40:06)
Within a week or so, it's going to feel like second nature, and there's a lot of people who claim that when they do that, they actually feel better. They have more energy. They have more mental clarity. Their digestive system is just not doing as much work, and they feel like they're not preoccupied with the thought of having to eat food and want food and get food, and it enables them to simplify their life just a little bit more.
Dr. Laurie Marbas
(40:31)
Excellent, and our next question… There's some really good questions coming up here. We appreciate you guys answering them. Sandra's asking, she goes, “I just want to get this right. For someone who has the worst sad diet you can think of, and they are type 2 diabetic, you would recommend starting with one meal a day, and how fast should someone like that progress to two meals and three?”
Cyrus Khambatta, PHD
(40:57)
Okay, so my suggestion would be this. There's no script for going from one meal to the second meal to the third meal. Ideally, you would do one meal for a week. So, let's say you changed your breakfast, and then you did that for about a seven-day period, and then you would move on to lunch for the next seven days. Then you'd move on to dinner for the next seven days. So, that would be 21 days plus or minus a few days in order to transition your entire diet, but let's say for the sake of argument that somebody who's eating a standard American diet changed their breakfast and found that seven days into it, they just still weren't comfortable with it, and maybe they didn't exactly know how much to be eating, and they felt hungry afterwards.
Cyrus Khambatta, PHD
(41:45)
So, they didn't know how to prepare the meal properly and how to take it to work or how to do it in their commute. So, there's a logistical side of things as well. What I would recommend doing is change one meal until you feel very confident in that meal. You got to know what to eat. You got to know how much to eat. You got to feel the benefits of that meal. You got to understand the logistics around that meal, and then once you have that down, move on to the next meal. If that takes you a month to figure out one meal, I don't care. That's fine with me. Do that for a month and then move on to the next meal once you feel like you've really mastered that meal, and then if it takes you three full months to transition your diet, I got no problem with it. It's not a race.
Dr. Laurie Marbas
(42:30)
Perfect. Excellent, and this is actually a pretty interesting question too. You finished one. There's another one rolling up here. So, Terry asked, “Can you discuss oil as a fat versus coconut oil versus the oil and nuts? A lot of plant-based diet cookbooks have many recipes that use cashew cream. I'm concerned about the fat content as Forks Over Knives. So, no fat. Getting confused as to what fat is okay.”
Cyrus Khambatta, PHD
(42:54)
You know what? Can I defer this question to Dr. Klaper? I feel like Dr. Klaper is-
Dr. Laurie Marbas
(42:58)
Yeah.
Cyrus Khambatta, PHD
(42:59)
… very good at describing the differences between different types of fatty acids and different foods that contain fat. Can I put you on the spot here, Dr. Klaper?
Dr. Laurie Marbas
(43:08)
Dr. K, you need to unmute.
Dr. Michael Klaper
(43:15)
Okay. Well, in general, the heavier the saturated fats, the more problematic they're going to be, and so the coconut true fats are going to be more problematic than a little bit of flaxseed oil that's in the ground flax, and a lot has to do with the state of the fat whether it's an oil or still in the food. When you bite into a piece of coconut or a walnut, the micro droplets of coconut oil or walnut oil are firmly attached to the fiber of the walnut and the coconut, and you chew it up, and it takes time. It takes hours for the amylases to get in and start digesting the carbohydrate fiber and then the lipases to emulsify the fat, and as a result, the amount of fat in the diet goes up very modestly, assuming you're not just eating handfuls of nuts, et cetera, and it's cleared out of the bloodstream pretty quickly.
Dr. Michael Klaper
(44:09)
But when you eat liquid oil, when you eat a tablespoon of coconut oil or any of these oils, that fat leaks into your bloodstream, and it enters your tissues really quickly, and along the way, it enters your arteries, et cetera. It's able to get into the liver cells and muscle cells much more quickly. It is much more likely to cause insulin resistance. So, in general, as I said in the beginning, fats are not evil. We need a little bit of fat every day. Your hormones are made of fat. Your skin oil's made of fat. You need a little bit, but make sure they're the lighter fats that are still in their natural whole plant form there. So, that's where some ground flaxseeds, hemp seeds, chia seeds on your oatmeal makes sense. A small handful of walnuts, either eaten whole or ground up into a salad dressing.
Dr. Michael Klaper
(45:02)
But as long as you keep your fats in these kind of forms, they're light, plant-based, and attached to the whole plant form. You probably won't get in any trouble. It's the oils and the large amounts and sitting in front of the TV with a bag full of nuts and shoveling them in. That's where you're going to get yourself in trouble. So, hold your fast in the whole plant form as much as possible, and you should stay on the good side of your insulin balance there.
Cyrus Khambatta, PHD
(45:28)
Perfectly said.
Dr. Laurie Marbas
(45:29)
Yep. I think, yeah, you're exactly right. Dr. K has got it down.
Dr. Michael Klaper
(45:35)
Passed the exam. Phew.
Dr. Laurie Marbas
(45:36)
Yes. You did good, man. Did good. Just a few more minutes here is… Chris, Did you have any other further questions?
Dr. Chris Miller
(45:45)
I had so many questions about these guys, but I was wondering if your antibodies ever changed over the years when now that you feel so good and you guys are thriving.
Robby Barbaro, MPH
(45:52)
That's a good question. I mean, I'm about to actually get mine retested because I'm curious to see what's happened, and I'm so glad we're having this conversation because… You guys are helping us, and we're helping bring it more to the table. It's just not talked about enough. Especially for type 1.5, type 1, people don't get a complete panel. I think every single person that who's even has a question of being a type 1 or type 1.5 should have all five diabetes antibodies. That should be the standard of care. They should all be tested right up front. Let's understand where are they starting, and let's start to monitor this over time and see what we can learn for people who make lifestyle change.
Robby Barbaro, MPH
(46:33)
So, I have zero antibody readings for the first 16 years of living with type 1 diabetes until I decided to test my own, and I think I went and I got three done through my doctor. I had to convince him to put it in the system. I had to find the numbers for him because it's very hard for doctors to even find these tests in their system. So, I had to find the exact numbers from Quest, “Hey, put this in the system,” and luckily my insurance did cover it as a preventative measure. So, I didn't have to pay a ton of money out of the pocket, so that was nice, but it was three antibiotics that were tested. I was negative for GAD. I was negative. I think it was for IAA that I was negative, and I think it was IA2 that I was positive, and my C-peptide was less than 0.1. So, basically undetectable.
Robby Barbaro, MPH
(47:24)
Now, requestatest.com has a… You can order four antibodies to be tested. So, I'm actually going to do that. I'm just going to be curious to see what happened because there's one I haven't had tested, and I want to see if the other one changed or not. So, that's my antibody story.
Dr. Laurie Marbas
(47:43)
I will say that I've been testing patients that, like more of the type 1 and it has, and we're seeing a drop pretty much, probably anywhere from 30 to 60% of their antibodies, and their C-peptides will bounce up to at that same time. So, that's fun to see.
Robby Barbaro, MPH
(47:56)
That's incredible.
Dr. Chris Miller
(47:57)
So, up and down, an autoimmune disease, but I don't know as well with type 1 diabetes. So, we'll see what's happening with it.
Dr. Laurie Marbas
(48:05)
Yeah, at least the type one and a half. So, type one's… I mean, will be one thing, but the type one and a half, now, that's the curious factor here. It's like, “Well, how much repair can we do and how long will it last?” It'll be curious to watch these folks as they go along, but they're doing great.”
Dr. Chris Miller
(48:22)
Can someone mention what type one and a half is for people who don't know? Because it's a newish term I know, and you guys define it so well in your book.
Robby Barbaro, MPH
(48:29)
Yeah, I'll let Cyrus answer that question, but I just want to say, Dr. Marbas, I am super, super passionate about this topic because I believe in infinite possibilities, okay? If you ask people in medicine 60 years ago, “Is X, Y, and Z possible?” They would say, “No, it's not.” We will evolve. We will learn. We don't know everything right now. Period, end of story, and us having a conversation, but what can we do to diminish the antibodies is first and foremost. Then we can have a conversation about regenerating beta cells, but I don't care if you generate new beta cells. You still have antibodies. So, this is important. This is I think-
Dr. Chris Miller
(49:08)
I just was writing an article about it, but there's always a reason we're making antibodies, right? Autoimmune disease. There's inflammation. There's something triggering you for your… The immune system only goes into hyperdrive to make antibodies because it thinks it's being threatened. Whether it's a virus, whether it's an external factor, there's something, and then through molecular mimicry or epitope spreading, these techniques or these processes, where if your body starts to think its own body is the foreign invader. So, the immune system is on hyperdrive. It continues to make these antibodies, and now the antibodies aren't turned to an external factor like a virus or bacteria, but it's turned toward yourself, and hence, an autoimmune disease is born, but there's always a reason, and I'm seeing in patient after patient, including my own story, and that's that when people… whatever that trigger is, when that quiets down, when the reason your body no longer feels like it's under threat, and that comes from healing the gut and improving the microbiome and whatever that trigger, if it's an ongoing latent virus or something in the blood, something… thinking even stress can be doing it, right?
Dr. Chris Miller
(50:15)
So, whatever that trigger is, your body constantly is making antibodies. When we figure this out with all these different autoimmune patients that we're seeing, the antibodies start to go down. The inflammation goes down. The antibodies go down. So, type 1 or type 1.5, later on, said autoimmune diabetes should have a similar type response, and you guys would be such good examples. So, I'd be very curious to see with your own antibodies what's happening that you're no longer attacking yourself. You may not be generating enough insulin yet that you still need insulin. So, that's your next part to figure out, but at least, hopefully, the attack stops on yourself. So, two parts to it.
Robby Barbaro, MPH
(50:55)
For sure.
Cyrus Khambatta, PHD
(50:56)
Yeah. Actually, I just had an epiphany as you were describing that because I was thinking to myself, “Well, if there was a lowered antibody response, then that would mean that I would be producing more insulin,” right? That my C-peptide level would go up, but not necessarily because if you have diminished your beta cell population to being effectively zero, then it doesn't really matter what you do. Those beta cells just are non-existent, and therefore, they're not going to be making more insulin. So, you could still have a heightened antibody response at some point in the disease process and then change your lifestyle so that the antibody response is now lower, and if the beta cells don't exist, that's okay, but at least the antibody response has actually gone down dramatically. That's a very good point.
Dr. Laurie Marbas
(51:37)
Yep, that would be a very good point, and then it'd be interesting to see someone who goes from a ketogenic type diet, what their antibodies are to someone who goes to a plant-based diet. That, I'll be curious because I did have a patient. As the thyroid antibodies were over 800, she was doing ketogenic, we put her on a plant-based diet. Six months later, she had zero thyroid antibodies, which is fascinating.
Cyrus Khambatta, PHD
(51:56)
Oh, wow.
Dr. Laurie Marbas
(51:57)
Yeah, so pretty crazy stuff there. Could you maybe describe what the antibody tests are and they're asking why they're important, but explain that a little bit further?
Robby Barbaro, MPH
(52:09)
Yeah. Cyrus, why don't you loop that into answering the type 1.5 question too?
Cyrus Khambatta, PHD
(52:12)
Okay, all right. So, type 1 and 1.5 are slightly different than each other, but they're both worth talking about. Both of them are autoimmune conditions, and they're both autoimmune forms of diabetes as opposed to pre-diabetes type 2 and gestational, which are non-autoimmune. So, type 1 diabetes generally affects people under the age of 30, and it is considered a fast-progressing, strong autoimmune reaction, and what that means is that people who test positive for type 1 diabetes generally go from being able to secrete a sufficient amount of insulin to being fully insulin dependent somewhere between 12 and 18 months, which is considered a fast progression to full insulin dependence, and people with type 1 diabetes, not always, but sometimes test positive for two for multiple antibodies, and the presence of multiple antibodies is what necessitates this quick transition to full insulin dependence.
Cyrus Khambatta, PHD
(53:07)
People with type 1.5 diabetes are slightly different. They generally present with an autoimmune version of diabetes later in life, greater than the age of 30. In addition to that, they also have a slower progressing autoimmune reaction, and what allows them to have a slower progressing autoimmune reaction is that the strength of the antibody, the strength of the immune reaction is lower. So, people with type 1 diabetes, generally speaking, but not always test positive for only one antibody. So, you can think of type 1.5 diabetes as basically being adult onset slow progressing type 1 diabetes. That's a simple way to think about it, right? People with type 1.5 diabetes often get to full insulin dependence over the course of many, many years.
Cyrus Khambatta, PHD
(53:58)
So, again, with type 1 diabetes, it can happen in 12 to 18 months, but in type 1.5 diabetes, it can take two years. It can take five years. It can take 10 years, and you know what? Sometimes, it may never even happen.
Dr. Michael Klaper
(54:10)
Can I just add a clarification and a hopeful note?
Cyrus Khambatta, PHD
(54:13)
Please.
Dr. Michael Klaper
(54:14)
One is that, for people, we're talking about these antibiotics. We're talking about the antibodies against your own pancreas tissue. These are antibodies against your own eyelid cells that are making insulin and fragments of those eyelid cells that get exposed to the immune cells, which they should never be, but your T cells are making antibiotics against the enzymes and the machinery of your own beta cells. That's what the antibodies are against. It's the old pancreas issue, and Robby was speaking almost wistfully about regenerating beta cells, and that's been a long holy grail for years and years. It's turning out however as Cyrus appropriately brought in intermittent fasting, one thing we're noticing is the body fasts. When you're in ketosis, your stem cells and all your tissues hunker down.
Dr. Michael Klaper
(55:07)
When the fast is over, they wake up, and in a more powerful regenerative form, including the beta cells. We're getting little flickers of indication that intermittent fasting may actually help your beta cells regenerate, and what a hopeful thing that is. So, there's all sorts of other reasons why intermittent fasting is good for you, for your tissues, but if you've got type 1, it also might be doing good things to wake up a couple of dormant beta cells in your pancreas there and a bit of stem cells, and it might walk out from under this thing yet. So, it's a great program all the way around.
Dr. Laurie Marbas
(55:41)
Excellent, and with that, I know we're at our hour. So, thank you, Robby and Cyrus, for joining us. Is there any last words you'd like to share and exactly where they can find you on the internet and other places?
Robby Barbaro, MPH
(55:54)
First off, you can find us at masteringdiabetes.org. That's the best place to go. We have a quiz in the upper-right corner which you can take and see how insulin resistant you are. We have a podcast. You can check that out. Just type in Mastering Diabetes into any podcast platform, Apple, Spotify. We have a lot of fun there. We are pretty active on Instagram, @masteringdiabetes on Instagram. We have a YouTube channel. So, all that, and then the book is available everywhere books are sold. If money is tight for you, I would love to just give away the book for free, if I could, and the best thing to do is go to your library. Every library, if they don't have it already, they will have it. Nobody's going to say no to carrying a New York Times Bestselling book. I'm sorry. They're going to carry the book.
Robby Barbaro, MPH
(56:36)
So, get it for free through your library. If you have never opened an Audible account. You can get the book for free by opening up an Audible account. You get your first book for free, and you can hear us read the book, which we had a lot of fun doing, and we actually added some extra stuff at the beginning of each chapter, and some updated research was included in the audiobook. So, check that out, or you could just buy it on Amazon. Internationally, you can buy it from bookdepository.com, and they will ship you the book anywhere in the world for free. I don't know how they stay in business, but somehow they discount the cover price of the book, and they ship it to you for free. It's crazy. So, that's how you get the book, but my final words are I just hope that anybody listening to this, if you have not set up an appointment with one of these three fine doctors-
Cyrus Khambatta, PHD
(57:24)
Amen.
Robby Barbaro, MPH
(57:25)
I don't know what you're waiting for, like literally. I think everybody who joins our program should also be under the care of you guys. You get the support. There are nuances to medicine. I think a lot of people have been thinking, “Oh, I'm just going to eat plants, and my life is going to be fixed.” It doesn't work like that. You're using a lot of medications already. There are nuances or things to consider, and the amount of experience in this room is really is unbelievable and so to have that trust in plant-based diets and my current conditions and the medications I'm using, how to safely get off of them, what ones do I actually need, but hey, maybe if I'm using this medication, there's a better one that has less side effects with my plant-based diet.
Robby Barbaro, MPH
(58:09)
There's nowhere better to go than right here, and you guys make it affordable. It is absolutely affordable. So, please. I don't know what you're waiting for if you haven't set up an appointment. I also hear that you guys are booked. It takes a long time to get an appointment. So, if you want one, you should take care of it now.
Dr. Laurie Marbas
(58:26)
I am booked until the third week of January, and I'm seeing almost 40 people next week. So, I'm busy, busy, busy, which is great, and you guys are a big part of that. We really thank you for… I mean, I'll pay you later Robby for the PR.
Cyrus Khambatta, PHD
(58:45)
You guys are so busy I can't even get in for an appointment.
Dr. Laurie Marbas
(58:48)
Well, there are special people. We can make that happen, but yeah. So, no. We really appreciate both of you and all the amazing work you're doing, and Chris, Dr. K, is there anything else you'd like to say?
Dr. Chris Miller
(58:58)
I'd say thank you for everything you've done.
Dr. Michael Klaper
(59:00)
Thank you. Thank you.
Dr. Chris Miller
(59:00)
You guys really are mastering the diabetes world, and we really appreciate it. It's helping so many patients. Like beyond in people who have diabetes, people are coming in with all sorts of things, and they're following what you're doing, and they're already on track. So, thank you. It's a game-changer for sure.
Dr. Michael Klaper
(59:16)
Thank you for your courage. This is a courageous thing you're doing to launch a new paradigm, and it's a hopeful one and a positive one, and it's really done really well and professionally. So, we're in your debt, and we're all helping each other. So, thank you. Thank you. Thank you, and thanks for being here today. It had a great touch to the webinar. Thank you so much for all the-
Cyrus Khambatta, PHD
(59:37)
You guys are incredible. Correct me if I'm wrong. There are only three states in the United States right now from which patients are unable to see. Is that right?
Dr. Laurie Marbas
(59:46)
There will be two. I just got New Mexico. So, I just need Indiana. I just need Massachusetts and D.C., if you want to consider that a state, which… I mean, there's 600,000 people there. I did look it up.
Cyrus Khambatta, PHD
(59:56)
Okay. I want to call it a state. Massachusetts, Indiana, D.C.
Dr. Laurie Marbas
(59:58)
Yeah, that's it.
Cyrus Khambatta, PHD
(01:00:00)
Here's the thing that blew my mind the other day. If you live in Massachusetts, Indiana, or D.C., those are the only three locations on the entire planet that cannot make an appointment with you guys. You can be in India. You can be in Iceland. You can be living in Antarctica, and you can still get an appointment with these guys.
Dr. Laurie Marbas
(01:00:16)
Yep, and I'm sure Dr. K sees a lot more international than me, but I've seen Ireland, Egypt, Portugal, Mexico, Canada. Dr. K, where have you been?
Dr. Michael Klaper
(01:00:26)
Oh, Antarctica, the moon.
Cyrus Khambatta, PHD
(01:00:31)
North Pole.
Dr. Michael Klaper
(01:00:34)
The word's getting around.
Cyrus Khambatta, PHD
(01:00:35)
I have a friend who lives in Atlantis. Can they make an appointment with you?
Dr. Michael Klaper
(01:00:40)
Absolutely. Everything comes up [inaudible 01:00:40].
Dr. Laurie Marbas
(01:00:45)
Oh my goodness gracious, but I know you've had them in Europe and Australia, and Chris as well.
Dr. Michael Klaper
(01:00:49)
Yeah, absolutely. New Zealand, Malaysia, Australia, Poland last week. Russia the week before. Yes.
Dr. Laurie Marbas
(01:00:55)
Amazing.
Cyrus Khambatta, PHD
(01:00:56)
You know what I really want to see? I want to see you guys do a telehealth appointment with somebody on the International Space Station. That's your challenge.
Dr. Chris Miller
(01:01:01)
They need it. They need it, yeah.
Dr. Laurie Marbas
(01:01:08)
That's hilarious. Oh my goodness. Well, thank you guys. It's always a joy, and it's always full of laughter, and we so appreciate you and all your work and all your support, and we're here to support you in any way we can, and thanks again everybody for listening, and please share this, and go to masteringdiabetes.org. You will not be disappointed.
Robby Barbaro, MPH
(01:01:24)
Thanks a ton guys.
Dr. Michael Klaper
(01:01:25)
Bye everybody.
Robby Barbaro, MPH
(01:01:25)
Okay, bye.
*Recorded on 12.10.20