looks like ketones might suppress endogenous 
glucose production. higher fat, and particularly   saturated fat, cause greater hepatic insulin 
resistance. your chance of getting remission   at one year is 86 percent. here's one thing you 
could tweak in the diet that can help control   your glucose without it being related to weight 
loss. what are the best dietary approaches to type   2 diabetes? Our Guest today is Dr Nicola Guess, 
who has an extensive background of both clinical   and research experience in diabetes and nutrition. 
she's a registered dietitian and she also received   a PhD from Imperial College London for research 
on diabetes prevention. she also trained at Johns   Hopkins and at Tufts where she was a Fulbright 

She's currently research program manager   at Oxford University where she studies diabetes 
remission interventions. we discussed the effect   of different diets on type 2 diabetes and why 
information on this topic seems so confusing.   people get a lot of mixed messages, they go 
on social media and every Guru is promising   that their diet is the one that cures diabetes and 
conversely that every other diet is ridiculous and   even criminal. why would you put people on this 
diet or that diet? and the story sounds similar   from all of these sources, and it is true that 
you can find some evidence, we can talk about   levels of reliability and data quality but it's 
true that you can find some some arguments for   all these different dietary patterns in terms of 
putting diabetes in remission and things along   those lines.

You must get these same questions 
from your patients all the time, I wonder how   you explain this this confusion to them. yeah, 
I mean generally what we know definitively in   terms of remission, so cure I don't, I prefer to 
use remission because I think it describes what's   happening most accurately, it's that right now you 
don't have diabetes according to the diagnostic   criteria but it doesn't mean that it's not going 
to come back, so I think that's the right term to   use, and the best evidence we have now is that 
weight loss, however you achieve it, probably,   is the primary determinant of remission, so 
there's that wonderful graph in the direct trial   where if you lose 15 kilograms or more your chance 
of getting remission at one year is 86%, and it   goes down if it's just 10 kilograms or more, and 
down further, so you can see there's kind of a   dose response effect of weight loss on remission 
and that's a pretty strong bit of evidence.

Right   now that trial is the best one done so far, it 
was with a meal replacement product, do I think it   means that you need to use that diet to get to the 
weight loss? no I don't. everything that we know   about physiology and short-term trials suggests 
calorie restriction and weight loss, however   you achieve it, are going to help you get to your 
goal. so that's what I tell my patients, and there   are a million ways to lose weight. there are two 
things that I think are interesting independent of   weight loss, and the first one is what my research 
is actively looking at and that's dietary protein,   and the basis for this is that what we think from 
the direct trial and accompanying physiological   studies is, what´s getting people remission is 
they get back the first phase insulin response   and that is, let's call it a spike, like a massive 
spike of insulin that basically happens after you   have a glucose load or a meal, so it goes 
up, it brings down glucose straight away,   and it helps you control your postprandial 
glucose concentrations in particular,   and what the DIRECT study showed is, 
with weight loss, people who did get   remission and didn't get remission both 
had improvements in insulin sensitivity,   they both had improvements in liver fat, they 
both had improvement in pancreatic fat, but the   distinguishing factor was the first phase insulin 

If you got back the first phase insulin   response, you got remission, if you didn't get 
the first phase insulin response back, you didn't,   so this pulse of insulin after a meal seems to 
be really key for controlling blood glucose,   and so what's interesting to me is that protein, 
specifically the amino acids and protein,   nudge the pancreas really powerfully 
to produce more insulin after a meal,   so that's one thing that I think is intriguing. 
even more intriguing is that the pancreas or   the beta cells remain responsive to amino acids 
even in late stage diabetes, so what we know with   regard to beta cell functional failure in type 
2 is they don't respond to glucose very well,   so even if your glucose goes up after a meal, 
you have two slices of bread whatever it might   be the sensor on your beta cells no longer 
detects the glucose as efficiently as before   so it can't send the signal through to produce 
more insulin but guess what, amino acids do,   so the signaling Pathways of amino acids on the 
beta cell seem to remain intact even if you've had   type 2 diabetes for 10 years, and so that's really 
exciting because it probably means, I think,   my hypothesis, that higher protein can lower your 
blood glucose independent of weight loss, there's   a lot of evidence that it does, but secondly, it 
might be an effective approach for people who've   had type 2 diabetes for a long time.

So that's my 
basic description of where I think the evidence   is. there is some some earlier data on plant-based 
diets, super high fiber and high carbohydrate as   well, on achieving normal glucose concentrations 
in type 2. I don't think that evidence is as   strong for everybody else but it's a way of losing 
weight and many of my patients go that route.   so then does that mean that in addition to the 
general advice of whatever sustainable diet   helps you lose weight, you also advise 
a substantial intake of protein together   with that? yeah I do, with with most of my type 
2 patients absolutely yes I do, I mean not only   do I think it is physiologically a powerful tool 
for glucose homeostasis per se, there's moderate   maybe, let's call it semi-poor quality evidence, 
that it might help with weight management, and   I say that just because the effect size is pretty 
small, like on average if you look at weight loss   maintenance trials it looks like higher protein 
diets do a bit better but it's not a huge effect,   so I don't really hinge my treatment on that 
because I don't think it's very strong data but   you know, if you have a patient with overweight 
or obesity and type 2 and NAFLD, because lots of   patients with type 2 diabetes have high liver 
fat, protein helps you fix those three things,   but one thing I would add, it works pretty 
well because I deal with a Western population,   people are happy to have more protein, it's 
quite acceptable, but I always consider the   cardiovascular side of things, so I really try and 
promote half animal-derived, half plant-derived   protein because you get a good mix in there, if 
you're going for the plant derived proteins it's   fiber and all of the other goodness as well, but 
it's frankly easier to meet your protein targets   with animal-derived products for most patients. 
yeah, molecularly do we know how the glucose,   presumably the insulin signaling Pathway is 
blocked in the beta cells but the protein response   seems to be preserved, do we have any idea how 
the selective preservation of the signaling works?   no we don't, but I have a paper 
hopefully coming out soon,   it's basically a review, and the whole purpose of 
it is I think and my co-authors believe, we have   ignored the potential of amino acids for promoting 
an insulin secretory response, and actually even   more interesting as well and scientifically 
intriguing in the sense that maybe this is   where nutraceuticals could go is that glucose is, 
there's only glucose, glucose-stimulated insulin   secretion is just one thing, it's the glucose 
and it's the coupling to produce a release of   insulin.

There's 20 amino acids, and we think they 
all work slightly differently so… I was going to   say the stimulus secretion coupling of glucose is 
pretty well characterized and it's easier because   there's just glucose, with amino acids there's 20 
of them, there are shared and distinct pathways,   so they're shared with glucose-stimulated 
insulin secretion but some pathways are distinct,   the different amino acids probably work through 
slightly different pathways and that probably also   explains the potentiating effect that, because 
they work differently, adding a couple of amino   acids together, maybe just three of them, you 
could get the maximal insulin secretory response   compared to whole protein, and we think that's 
where that could be a really exciting path for   nutrition research. in terms of quantifying, if 
we were to compare the effect of weight loss to   the effect of manipulating protein intake, what 
are we talking? whether it's rate of remission or   however we would quantify that to put the two in 
relative terms. so I can't answer that question   because we simply don't have the data, and the 
studies that have been done are not comparable,   the thing about weight loss that is worth 
acknowledging is it does improve hepatic insulin   sensitivity, improves muscle insulin sensitivity 
and it seems to fix beta cells if you've had   type 2 diabetes for short duration, you know, it 
improves a bunch of cardiovascular risk factors,   and the level of certainty there is much much 

What amino acids do, I think, the most   exciting part of it is just almost like an added 
benefit, almost an adjunct, you know, so I don't   think you would ever in many cases intentionally 
design a clinical program where you wanted   to maintain someone's weight loss, hopefully 
you'd still get some weight loss, but for me   this adjunct of adding amino acids might mean that 
instead of having to lose at least 10 kilograms to   get remission, maybe if you could just get to five 
to seven kilograms, the added benefit of amino   acids on that insulin response might help you 
get there, and I think if we could achieve that,   we would increase the number of people at a 
population level who we could help get remission.   in terms of an increase of protein, that would 
be a swap with some of the carbohydrates,   some of the fat, or does it not matter? I 
think it probably has to…

Hopefully, one   ongoing study I'm doing is trying to tease this 
out a bit, what the ideal proportion should be,   and I've got a few other studies planned. based 
on the data available, I think you have to be   about 30% kcals from protein and about 30% kcals 
from carbohydrate, probably as a maximum, and the   rest fat, and again let me reiterate, I always 
emphasize predominantly unsaturated and minimize   saturated. it's worth mentioning, we don't 
do dose-response studies enough in nutrition,   and the reason I say 30 is because that's what 
the studies that looked at this looked at,   and the comparative group was 15 or 17. so maybe 
25% of calories from protein and 30% calories   from carb would do the same, we don't know if 
there's a cut off so the higher or the closer   my patients can get to 30%, great, but if it's a 
bit of a struggle I don't worry too much about it it can be tough to get enough so I give out 
diet sheets and I call things primary proteins   and secondary proteins and I emphasize that they 
should try to get both in every meal particularly   lunch and dinner, breakfast is the hardest so 
for breakfast I might even encourage a protein   powder shot or having protein powder in a cereal, 
whatever that might be, but for lunch and dinner   what I would be looking at, the primary protein 
would be something where the vast majority of   the calories in it are just protein, so you're 
talking chicken breast, tofu, mycoprotein, that's   like a corn vegetarian alternative, where there´s 
not much fat in it, there's not much carb in it,   it's just protein.

I call that primary protein 
and that's the easiest way of getting enough,   and then in addition I have secondary proteins, 
so those might be things like pulses where yes,   they've got a decent amount of carb in but they've 
also got enough protein that if you combine the   two you can get closer to your 30% of calorie 
mark. we've talked about what the best diet   would be and it's not really a a name diet as 
people like to throw around on social media but   technically any of these name diets would 
work. low carb, low fat, low calorie,   intermittent fasting, all these approaches 
could work and I think we see evidence that   all of them do work at least for a subset of 
people, and by the way I've always wondered if   the fact that we only see them, all of these 
pretty much work for a percentage of people,   if that means that it's the percentage of people 
that are attuned to that intervention or is it   the percentage of people that would do well on any 
intervention because they are the most disciplined   ones or the ones that stick with whatever you 
give them, do you have an opinion on that? I mean,   I think based on the type of studies that have 
been done, and they are typically free-living,   very rarely do studies provide food so the onus 
is on the participant in the study to stick with   the dietary intervention and so forth, so for 
me the evidence is on the side, based on the   the type of trials that have been done, that it's 
people that would probably do well on most diets,   but nonetheless one of the things that I always 
find striking is the amount of extra support that   you can have in any weight loss trial and so I 
mean I've worked on lots of weight loss research   and even when you're putting out an advert, 
so let's say, I did my PhD, I did my postdoc   at Imperial College, it was well known for doing 
really exciting work in appetite hormones so they   develop, they do first in man studies of hormones 
that reduce appetite so it had a good reputation   for research, and whenever you put out an advert 
say in a newspaper to recruit participants, people   are so desperate for something that works and they 
see that it's, you know, whether it's Imperial   College, whether it's Cornell, whether it's, you 
know, a big name, they think you finally got the   answer, so the first thing is, the response that 
you get are people who are absolutely desperate   for weight loss, they are so determined to make 
this work, and then you consider that they come   into an environment where they get way more 
input than anyone will ever probably be able   to give them in Primary Care, and you have what 
should be a state-of-the-art diet to the extent   that that exists, and yet, dropouts are about 30 
to 50% from trials even with that, and you know we   see the weight loss is generally pretty modest, 
until DIRECT, I mean 10 kilograms at one year   was incredible, and by the way I don't want to be 
biased, like VIRTA, it wasn't a randomized trial   but it was a single arm open label trial, they 
got 10 kilograms in one year so you can do it but   that's rare, most weight loss trials it might be 
five, seven kilograms at one year and from then on   it's straight up again, so I guess what I'm saying 
is weight loss is really really hard and yes,   to your point, I think the people that do well 
in these trials are people that would do well   on probably any dietary intervention, at least 
over the short term.

So in terms of the clinical   approach, when you get a new a new patient coming 
in, do you explain that end goal is going to be   to lose x amount of weight, do you give them 
a repertoire of possible dietary approaches   or do you have a default that you suggest, how 
does it work? yeah, a really great question,   it's really a lot of listening and very often, 
often the first thing is you have to understand   how much a patient knows, your average patient 
knows more than me so you don't want to be as   the clinician like telling a patient "oh by the 
way this has this many calories" because your   patient's going to be super knowledgeable so the 
first thing to do is gauge how much they know.

The   second thing is I try to understand their goals 
and this is important because remission might be   the gold standard as far as the NHS is concerned. 
Why do we want that? because it saves money,   gets people off medications, lowers medical 
costs and so forth but that might not be what   a patient wants so you have to you know, what 
are their goals, what do they want to achieve?   and then you also want to try and understand 
what are they willing to do, to give up,   because many interventions are tough, and so you 
want to gauge all of this but in general yes,   what I would do is I would explain, 
if remission is what they're after,   I would explain the research in as lay fashion 
as I can and I would say, here's what we know,   what do you think about that, you know, let the 
patient lead that consultation, and then we would   try to tweak things.

I do always try to educate on 
protein because I just think, I'm a pragmatist and   as much as weight loss definitely helps, and 10 
kilograms does and so does 15 kilograms, people   do struggle to lose that amount of weight and 
then they very often fight against regaining it,   so as a pragmatic approach, kind of saying, well 
here's one thing you could tweak in the diet that   can help control your glucose without it being 
related to weight loss and that can be empowering   for them to see their glucose go down and their 
A1C go down. so you try to gauge which foods are   very important to them and which foods they could 
take it or leave it. and then maybe focus on those   to phase out. yeah exactly, and I'm always really 
honest, I mean sometimes I might just have like   meal plans or pictures of foods and talk about 
what the approaches involve because for example,   like the meal replacement approach, you're talking 
two to four months of meal replacements and people   differ immensely and they tend to be quite black 
and white about this, whether they're going to   do that or not, I mean some people just go hell 
no, I'm not eating milkshakes for three months,   are you crazy? and it's a non-starter so you might 
say, well what about doing two meal replacements   in a meal, but you would work with them in 
that way.

If someone says, oh I love carbs,   I'm really into bread, really into potatoes, 
or culturally it's really important to me,   it's how my family eats, there are certain things 
that just aren't going to work, because you're   running uphill as it were. yeah that makes 
total sense. going back to this idea of   susceptibility to different dietary patterns, 
do you ever get patients who don't do well on   maybe the first thing they try, maybe they try 
a low fat diet first and it just doesn't work   for them and then try a low carb diet and it 
works really well, or the other way around?   I mean in general, patients are often fighting 
with their weight as a lifelong battle and I can't   remember the last time I met a patient that hadn't 
at least tried those two. so very rarely is it   trying something as straightforward as low fat 
or low carb.

I like the tweaking approach and   kind of food exchanges, so whether it's replacing 
some saturated fat with polyunsaturated, usually   with cardiovascular risk that can be useful for 
patients, whether it's replacing carbohydrate with   protein, that's a switch that's not related 
to cutting calories, whether it's increasing   the amount of dietary fiber they have, these 
are things that fit into any dietary pattern,   so even if they've tried something and it hasn't 
worked, or maybe they might have done keto and it   helped them lose weight but their cholesterol went 
up and their doctor said ´forget about it´, like   trying to work within a dietary pattern that 
a patient likes and then using those tweaks   generally works better than low fat over here and 
you go to low carb, so that's generally how I try   to work it. yeah so not being bound by the labels 
but rather flexibilizing these things to whatever   works for the individual. for sure, yeah. in terms 
of people on different stages of the progression,   let's say someone who is healthy and wants to 
prevent pre-diabetes or diabetes versus someone   who might have pre-diabetes versus somebody who 
has established diabetes, is there a fundamental   difference in terms of the dietary approaches 
or is it all the same? I mean that is such a   great question, so certainly with type 2 diabetes 
because you have this beta cell functional failure   and that's the primary reason 
the glucose is all over the place   and we now have a growing amount of evidence in 
that population, so to me they're quite different,   if you go back to say someone with normal 
glycemia, do I think they'd have benefit   from doubling the proportion of calories from 
protein? no I don't, and the reason being is   that beta cells work just fine, they produce 
enough insulin and so there is some evidence,   I'm not totally convinced by it, suggesting that 
high protein causes peripheral insulin resistance,   if it does happen the effect size is probably 
small, so I kind of weigh it up like this,   if I think about someone with type 2 diabetes, 
the benefit of a high protein approach is that   you're going to fix the beta cell which is the 
huge problem and probably simultaneously not have   much of an effect on insulin sensitivity, but 
if it does, it's like, say you worsen insulin   sensitivity by this much but you're improving 
beta cell function by this much.

Sorry,   trying to capture that. your net result is a 
win for glucose homeostasis. conversely, if you   take someone who's got normal glucose tolerance, 
you're not going to get any improvement in beta   cell function that means anything because like 
I said the beta cells work fine, but even if you   do in a healthy person increase insulin resistance 
this much, well the net result is you´re possibly,   possibly worsening their prognosis, and it's just 
almost not necessary unless you are exercising a   lot, over the age of 60, 65, I don't see 
any reason for having any more protein.   okay, so the protein would be kind of a more 
aggressive step that you would only go to if   the person already has established diabetes? yes, 
and then to the middle point, my answer is going   to be non-committal, the reason being we have 
such a poor amount of data in that population,   all we know, the diabetes prevention trials 
have shown us weight loss of five to seven   percent however you pretty much achieve it 
seems to prevent the development of type 2,   there have been some smaller studies trying 
to isolate, well is it the fiber? is it the   saturated or polyunsaturated fat? none of it's 
convincing, it just seems to be weight loss,   I'm interested in the idea of protein helping to 
keep glucose under control because what we do know   is you do have some deficit of beta-cell function 
in prediabetes but some of the things that we   don't know is what the long-term effect of high 
protein might be on beta cells that work okay,   and I think we should be cautious as scientists 
and not jump ahead and say, well it works fine in   type two so let's try it in pre-diabetes.

yeah so the focus would still be on the general   body weight and the amount of body fat that the 
person carries, and for prevention it would be try   not to put it on and for pre-diabetes/diabetes 
it would be trying to lose some.   yes exactly, and I think the intensity of the 
intervention differs or increases as you go along   the pathway to type 2, so actually prevention of 
weight gain is relatively easy compared to weight   loss, prevention of pre-diabetes is easier than 
prevention of type 2 once you've got pre-diabetes,   so the interventions can be far less intensive and 
probably for most people general healthy eating,   I know that sounds so vague and unspecific but 
that's basically the truth, exercising, not   gaining weight, eating a reasonably healthy diet 
within a wide boundary of choices is fine for most   of the population to prevent the development of 
pre-diabetes. yeah, if we were to insert another   category in the middle, which is people who might 
have insulin resistance but still normoglycemic,   so the pancreas is still able to compensate and 
maintain normal glycemia, there would it still be   an issue of essentially a little bit excess body 
fat but just not enough to be pre-diabetic? for   me when I think about insulin resistance, to me 
that is just synonymous with overweight, I think   that the proportion of the population who have 
overweight and obesity is pretty similar to the   proportion who have insulin resistance, and it's 
worth mentioning there's no actual, that I know   of, consensus definition of insulin resistance.

might be a fasting insulin above a certain range   or the insulin:glucose ratio for example, but 
in general those two things track so closely,   there hasn't been a whole bunch of decent 
research on nutrition independent of weight   loss on insulin resistance, and part of the 
reason is like I said there's no definition, you   could measure fasting insulin, and I think that's 
perfectly good, from all of the studies I've seen,   weight loss has such a huge effect on fasting 
insulin that nothing else matters that much,   so again, it's a question of lose weight however 
you can.

We also talked about effects of specific   diets aside from weight loss, like for example 
low carb diets or low-fat high carb diets,   which viewers often ask about. now there's 
less evidence on that aside from weight loss   but there are some studies so we discussed 
possible effects of those dietary patterns there is some evidence in healthy people that 
going on a keto-style diet, and to my knowledge   most of these have been like high poly low 
saturated fat, kind of healthy keto diets,   do lower insulin independent of weight loss 
so that's something that's interesting because   it seems to do so both in the fasting and the 
postprandial states but I don't know if there's   long-term data, not that I necessarily think it 
would stop happening over time.

I don't think that   lowering carbohydrate in the diet independent of 
weight loss, unless you get to ketogenic amounts,   lowers glucose independent of weight, so I think 
where we have these trials where it looks like   low carb does really well and lowers glucose 
independent of weight, I think it's the protein.   where I think low carb lowers glucose under normal 
protein intakes is where it's ketogenic, because   it looks like ketones might suppress endogenous 
glucose production, so I should just say that, so   when I'm talking about low carb diets with you I 
basically mean a high protein low carb diet, and I   think by the way that's what most low carb people 
are doing, we just call it low carb and people   forget that it's actually high protein and I think 
it's the high protein that's the active ingredient for the crowd that loses weight and who puts their 
diabetes in remission by eating a boatload of,   like low-fat high carb diets, a lot 
of times they eat a lot of fruit,   a lot of starch, but they cut out the fat, is 
that just because it's an elimination diet so   they're losing weight and that's the mechanism 
by for the remission of diabetes in those cases?   I mean, I don't know for sure but whenever 
you see the large amount of weight loss and   we know of the dose-dependent impact of weight 
on remission, it's really hard to attribute that   normalization or lowering of glucose to anything 
else with any degree of certainty, and the same   is true for any plant-based approach where you 
see this marked weight loss, because it's like,   how do I distinguish these two factors, you 
can't, it's just speculation, I mean I wouldn't   be surprised at all if all of those beneficial 
compounds in a plant-based diet are improving   some insulin signaling mechanisms in the muscle, 
do something good to the beta cells, I mean that   wouldn't surprise me, I would think the impact 
of that is small, what we know from for example   clamp studies is if you feed more carbohydrate you 
have greater uptake of glucose into the periphery   and so I would have thought if you switch 
someone to a high carb diet you improve their   peripheral insulin sensitivity so that could be 
another mechanism but before someone has, in the   overweight or obese phenotype of type 2 diabetes, 
a weight neutral study, high carb High plant,   I can't speculate further that it does 
anything much beyond or added to weight loss you can measure what degree of insulin you 
need to shut down hepatic glucose production   and so if the amount of insulin you need to do 
that goes up, we call that insulin resistance   specifically of the liver, and from memory, 
some of the studies that look at higher fat,   and particularly saturated fat, cause greater 
hepatic insulin resistance, so effectively you   need more insulin to shut down glucose production 
from the liver and in that sense what we might be   looking at with those studies isn't necessarily 
a positive effect of excess carbohydrates on   insulin sensitivity, it's the negative effect of 
a higher fat diet on hepatic glucose production for prevention of type 2 diabetes and cardiometric 
disease, maintaining a healthy weight and doing   a good amount of physical activity are so 
above and beyond in terms of effect size of   your risk of type 2 diabetes and everything else, 
nothing else really matters, I mean does dietary   fiber probably help a bit? probably.

Does having 
more polyunsaturated or mono than saturated fat   probably help a bit with insulin sensitivity? yes. 
but the effect of not gaining weight and keeping   pretty active, they just slaughter everything 
else in terms of risk of type 2 diabetes. okay   quick summary of all that. the strongest evidence 
points to weight loss, however you get there,   so that explains why we hear all these different 
anecdotes for completely different diets,   there's no contradiction, one guy lost weight on a 
low carb diet, another on a low-fat diet, another   by fasting and another by counting calories.

all got to the same destination using slightly   different roads. in addition to that, there 
might be specific effects for some nutrients   independent from calories and weight loss, 
for example protein and amino acids stimulate   insulin production by the pancreas, ketones 
May inhibit glucose production by the liver,   unsaturated fat seems to be a little 
better than saturated fat for liver   insulin resistance and carbohydrate may improve 
insulin sensitivity peripherally, in the muscle.   several viewers have asked previously about these 
classical studies looking at very high carb diets   improving glucose tolerance even in the absence 
of weight loss, and it's not completely understood   but this might help explain those findings.

again, the effect of these specific nutrients is   relatively small compared to weight loss, so the 
role of protein is an adjunct, as Dr guess called   it, knowing about this may help some people reach 
their goals, others may not need to increase their   protein and go on these very high protein diets 
if they can lose weight and get to where they   want with other dietary patterns. and we looked at 
several examples of specific dietary patterns, we   looked at a high protein one with 25 to 30 percent 
of calories coming from protein and another 25   to 30 coming from carbohydrate, and Dr guess uses 
that routinely, we also touched on ketogenic diets   and high carbohydrate diets, so usually low-fat 
high carb which some people do well on. all three   of those dietary patterns can be designed to check 
all the main boxes: low in Ultra processed foods,   decent amount of fiber and mainly unsaturated 

Most of the time diets can be tailored to   support all aspects of health at the same time. 
these examples are not exhaustive and they're   just tools in your tool belt, they're not shackles 
so don't let your hands get tied by these labels,   if something's not working for you, change it. 
just tweak it to fit your goals. so we heard   from Dr Roy Taylor a while back also on type 2 
diabetes remission and now we heard from Dr guess,   and you see that there are some patterns that 
emerge, right? so this is why it's really cool   when we get the opportunity to talk to different 
people all with a very high level of expertise in   a field.

and we also see some other details pop up 
around the edges, like these roles of the specific   nutrients, so we're working towards a unifying 
model of type 2 diabetes. really cool, right? and   for people working on prevention, so completely 
healthy right now and want to stay that way,   maintaining healthy body weight is number 
one as far as prevention of type 2 diabetes,   and again, that can be done with a variety 
of dietary approaches. I know you guys have   questions about diabetes in thin people, type 
1 diabetes, continuous glucose monitors, CGMs,   especially in healthy people, and a lot of 
other questions, and we have videos on all of   that in the pipeline, so stay tuned, thanks 
for watching, I'll catch you next week, bye.

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