Chuck: Oftentimes on the
exam room podcast, we talk about the role that nutrition
and a healthy diet can play with type two diabetes. We've heard all of the research
there and the incredible things that it can do, but we haven't
talked much about the role of nutrition and type one diabetes. What is the connection there? Well, that is what we will
be exploring today when we are joined– I'm so thrilled
that she's back on the show.

She is the director of
clinical research here at the Physicians Committee. She's the director of the
universe and she's delivering you new health for a new year. Dr. Hana Kahleova. Welcome back to the Exam Room. Hana: Thanks for
having me Chuck. you know, it's, it's such
a joy to, to talk about diabetes and nutrition. And as you mentioned, most
of the time, when we think about diabetes, we, we talk
about type two diabetes. By what about if you have type
one diabetes, is there a role of nutrition, you know, is there,
is there something that you could do with nutrition that
will influence your diabetes? So let me pull up my
slides and I'll show you what we know so far. The number of studies on the
role of nutrition in type one, diabetes is much more limited. But at least we have a glimpse
and we also need to more studies and that's exactly what, why
we're doing the podcast today. Uh, so the type one
type one diabetes is an auto immune disease. That's characterized by beta
cell dysfunction where the beta cells in your pancreas
will not produce enough insulin for, for the body's needs.

So these people need to inject
insulin for the rest of their life, but there's also a second
component to the disease and then that's insulin resistance. And when I say insulin
resistance, most of you are probably like what I thought
that would be a mechanism that's included in type two diabetes. Which is true. It plays a more important
role in type two diabetes, but it's also present in type one
diabetes to a certain degree. And insulin resistance is
basically, the inability to have the cells to respond to
insulin as much as we'd like.

So insulin is like a key that
opens the door for a glucose to come into the cells. And if the door lock is
jammed, that would be insulin resistance, all of
the sudden there's insulin, but it's just not working
and it cannot open the door. And the glucose cannot
come into the cells. And so you know, affecting
the beta cells in the pancreas is much more
challenging than influencing the insulin resistance. So we are trying to target the
insulin resistance of the com— as a component of type one
diabetes through nutrition. And now with the, with
the limited amount of studies, and that has been
published on the role of diet in type one diabetes. We realize that there is a
big need for new studies. And I need to tell you, uh, we
came up with a research study that you can participate in,
or your friends with type one, diabetes can participate in.

The study is a randomized
clinical trial, where people who are interested in participating
will be like with a flip of a coin, randomized to either
follow a portion controlled carbohydrate, watching diet,
where you need to count your carbs And uh, um, you
need to watch your portions, or to a low fat vegan diet
consisted of fruits and grains and legumes and vegetables. Now, how are these
approaches different? They're very different. The portion controlled diet is
relatively low in carbohydrates, and it's basically limiting
the amount of glucose that we. And that gets into
your bloodstream. So that's the sugar that's
inside the blood cells and we just limit the amount of glucose
that's inside the blood vessels. And that's how we can regulate
the level of blood sugar. The low fat vegan diet is a
high carbohydrate diet, right. There's fruits and
there's grains, there's legumes and vegetables.

All of these are sources
of carbohydrates and it addresses mainly the, uh,
the insulin resistance. The idea behind is that the
insulin resistance is eventually caused by fat that's stored
inside the cells, inside the muscle cells and liver cells
where it doesn't belong to. So if we can get rid of this,
this extra fat, the insulin resistance will improve. And since the, this low fat
vegan diet is very low in fat the idea behind is that we will
mobilize the intracellular fat, the fat stored inside the cells. Now, If if you'd like to
participate in the study, then you— what, what will you get? You will get weekly classes on
Wednesday evenings over zoom.

You will, you will get
a Dexcom G6 continuous glucose monitoring system. So on your phone, you will see
continually how your blood sugar looks like, but you, we will
ask you to give us access to your data so that we can also
help you if, if there is any adjustments that are needed. You will also, uh, get a
scale and a digital scale. Vitamin B12, um,
That's essential for people on vegan diets.

Uh, we give it to all
participants in both groups. Some medications also decrease
the absorption of vitamin B12. And generally speaking, as
we age, the absorption of vitamin B12 is lower and lower. So you will benefit from taking
the vitamin B12 supplement. If you are in the portion
controlled diet, you will get some resources. You will get the book,
Think Like a Pancreas. I wish all of us could
think like a pancreas. I, you know, I was
really inspired by this. I was like, you know,
this is a great book. I mean, uh, I wish all
of us could think like a pancreas and also a cookbook. Uh, but if you are on a
low fat vegan diet, don't worry, you will, you
will get other resources. You will also get a cookbook
and a book, uh, from Mastering Diabetes and also
a con companion book that will help you keep the fat
content of the diet low. Now we start in late January
with this study, or maybe even early February in
the first week, we only changed the breakfasts.

Then in the second week we
change the lunches also. And then in the third week,
finally, we also change the dinners and snacks,
which means that all the menu is already checked. Now you can probably
imagine how the portion controlled diet looks like. But you probably don't know
exactly what it means to be on a low fat vegan diet. So for the, for the low
fat vegan diet, the diet is vegan, which means no
animal products, no meat, no cheese, no dairy, no eggs. Uh, it's low fat. That means that the fat content
is up to 20 to 30 grams per day. And we also keep the
glycemic index low.

Uh, you know, when you look
at the power plate, uh, the diet consists of fruits
and grains and legumes and vegetables, uh, and how to
keep the fat content low. You may be thinking, well, if
I saute my onions I need oil. But you can also replace
the oil with soy sauce or vegetable broth, or
you can use some water. You will be asked to
watch the, the fat content of the packaged foods.

Like for example, beans
are perfect because they're the upper limit for the
fat content is two to three grams per serving. And this particular can of beans
doesn't have any fat in them. So it's ideal. And you may realize that some
of the, the vegan foods will not be compliant to the dietary
recommendations on the study. So for example, Amy's
Black Bean Burrito. When you look at the
fat content, it's eight grams per serving. So this would not meet
the study criteria. Now, uh, we know that
glycaemic index is important for people with diabetes. It helps with glycaemic
control also with blood lipids and with body weight
and with inflammation. And so when we look at our
food groups: fruit and grains, and legumes and vegetables,
we can create categories. The low-glycemic index foods
would be lower than 55, medium up to 69 and high glycemic
index foods, at least 70. When we look at non
starchy vegetables, all of them are, are wonderful. You don't need to limit
the intake of non starchy vegetables at all. When we look at
beans, it's the same.

All of them are great. Your, your beans and split peas
and your lentils, uh, no limit on the consumption of those. The same is true for most
of the fruits, except for watermelon, where, um, you
will, you may need to be more careful with the portions,
uh, or with other juicy fruit, like mango and pineapple. For grains, all the old
fashioned grains are in barley and bulgur and corn, corn
tortilla, and millet and quinoa and buckwheat and rolled oats. All of these are
completely compliant. Uh, the same with ri— rice bran
and spaghetti and wild rice. Where it gets a little bit
trickier is sweet potatoes and white rice and cous cous. You need to be more careful
with the portions and this, and, uh, there's also high glycemic
index foods in, in grains and starches baked potatoes
and instant oatmeal and white bread, for example, or a bagel. Now, does it mean that
you will not be able to eat any of those on.

Uh, no, if you want to have
a big potato, you, you still can, you can just load up
on veggies, uh, and have let's say bean chili with it. Uh, and that way you will
lower the overall glycemic index of the, of the meal. And the same applies when
you want to eat a bagel. It's a high glycemic index food. Um, but if you have just a
small piece and have a lot of vegetables and low fat
hummus, you can still eat it and you will be compliant
with the study requirements. So to summarize, the vegetables
and the legumes are all low-glycemic index and there
is no considerations needed. Uh, for fruits. Most of them will be compliant. There's just a few kinds
where you, you may need to be a little bit more careful.

And with grains, there
are some additional considerations that are needed. Now I need to let you know, if
you want to participate in the study, there might be some up
and downs in your blood sugar. If your blood sugar is going too
high, you may need to include more vegetables and more and
more beans with your meals. If it's running too low,
we may need to adjust your insulin and decrease the
dose before the meal so that you don't get too low. The next time. There's also some
digital resources. You can download the, the
21 Day Kickstart program on our on your phone. And if you're interested
in participating, I like to encourage you to contact
our study coordinator, Tati, here's her contact, email
address and her phone number.

And we also have a study
website and that one will be posted below. So which diet is best
for type one diabetes? The answer is we don't
know yet, and we need your help to to sort this out. Is it the carbohydrate watching
portion control diet that limits the intake of carbohydrate
or is it a high carbohydrate, low fat vegan diet? So I, we would greatly
appreciate your help in answering this question
in helping us with the recruitment for this study. So if you have type one
diabetes, or if you know someone with type one diabetes, or
if you're a physician and you have patients with type one
diabetes, please let us know. Chuck: Yeah. And you see the
recruitment webpage right there on your screen. So,
and as Dr. Kahleova said, we will put a
link in the episode notes below. Um, really important
research because so often, and I was talking about
this recently with Dr. Dean Ornish, as well as like
so much of this, um, focus with diabetes is on type two. Um, but now here we
are with type one.

And I think that that's
really, you're going to be unlocking some answers
hopefully for a lot of people. And I noticed that the
Mastering Diabetes book was included in this study. And, um, anecdotally
here you know, Dr. Cyrus Khambatta and Robby
Barbaro who put those two together, both of them have type
one diabetes and, and, you know have seen pretty good results. So we, you know,
that's just two people. We need a lot more than
that to be able to have a definitive answer. And that's why you're
doing this study. And I think that it's fantastic. So when does, when
does the study begin? Hana: The study will
start at the end of January or early February.

So we have enough time. You have enough time to think
about it, sign up, then enjoy our holidays and start with
the diet after new year. Chuck: I like that start with
the diet after new years. How many people say that? everybody, right. Um, so, okay, well listen,
best of luck with the study. Uh, I hope to keep tabs with
you to see how things are going and then, when it's through
and, and you guys are ready to publish, I would love Dr. Kahleova over for you to
come back on and share your findings with us. Hana: Thank you so much, Chuck.

Chuck: All right, Dr. Hana Kahleova. Thank you so very much. If your health IQ is a
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