Show #2675  part 1
DIALOGUE
Reverse Your Type 2 Diabetes, now
with guest, Dr. Frank Tortorice

Carl Lanore
A lot of people have type two diabetes today and they're taking meds thinking they’re protecting them but the reality is even if you're on medications for the next 30, 40 years, you're still going to have the negative effects of having type two diabetes, it just happens a little slower.

Today we are talking with Dr. Frank Tortorice

My proposition that 99% of those with type two diabetes could reverse it if they understood how to. What do you think?

[00:03:42] Dr. Frank Tortorice
I think there's a good amount of truth in that statement, A a practicing internist, I wouldn't put a number on it, but yes, especially if we get people early.  If we get someone before a formal diagnosis of diabetes type two, the odds are even better. If they've had diabetes for less than a few years, depending on whether or not they have co-morbidities the odds are reasonably good. If they've had it for a number of years, it’s probably a little bit more challenging, but not totally unreasonable.

[00:04:14] We are talking about major lifestyle changes and using medicines in a supportive way. We know stories of people who were on high doses of insulin, 40 50 units, multiple times a day, getting completely off of insulin in less than three months, sometimes in six weeks. That being said, if you're on insulin, don't go do this on your own, only under the care of a practicing endocrinologist or a medical doctor. , That’s what we do here.

People that have been on medication come to me and say they would like to see if there's a different way. We do it in a healthy manner. We don't pull them off all meds, we gradually wean them off medications as their sugars allow.

[00:05:17] We sort through their lifestyles to make sure that what we're doing is a good fit for them. We do it in a very personalized manner 

[00:05:33] Carl Lanore:
Over the years I have done numerous shows about type two diabetes. To summarize some of the messages we got from scientists who published papers. the first show was a scientist from Rutgers university. He had published a paper that showed that glucose signaling is what causes cellular senescence. That was probably 12 or 13 years ago. 

We’re all talking about aging better. Can you actually age better if your blood sugar levels are all over the place? 

[00:06:17] Dr. Frank Tortorice:
When the blood sugar is high, it's a very inflammatory, process to the body. A lot of people think that their blood glucose is a major determinant of inflammatory risk, but it's actually the insulin.

[00:06:30] Insulin is all over the place when you're young, you have a lot of insulin, you build up muscle. When you're an adult having too much insulin can cause a lot of different complications, many organs, the heart, the kidneys, the eyes, etc.

[00:06:46] Cellular senescence is, is brought on by a lot of different actions that happen in the body. We try to keep the blood sugar as stable as possible because when the blood sugars go up and down, the body gets overwhelmed, and it causes a stress response.

[00:07:19] We want small amounts of stress. But we don't want excessive prolonged stress. 

Carl Lanore:
Is it not a mistake for the medical orthodoxy to look at blood sugar and not look at insulin? Just because my blood sugar is within the limits desired, my pancreas could be working overtime to keep it there. Why don't doctors look at small peptide or C-peptide insulin along with blood sugar to say, wow, your blood sugar is great, but you're producing gobs of pro-inflammatory insulin to keep it there.

[00:08:14] Dr. Frank Tortorice:
In my training in internal medicine it was the blood sugar in the A1C. We never thought to look. The endocrinologist maybe looked at insulin and C-peptide etc, but when I started  we just didn't do that.

[00:08:35] Now, with my training in functional medicine, we're looking at root cause resolution and root cause analysis. Many times we do extensive comprehensive labs get the blood sugars. Maybe on page one, there's an A1C that looks really good but then I'll go to the insulin, and it’s like 30 or 40. People should have a fasting insulin of at least less than 10. Some people would say five or three, but certainly less than 10. The A1C is the last thing to go high so if you're already having high A1C, you've already missed the boat, so to speak. So we check our patients’ insulin. At times where it makes sense, we'll do a 75 gram or glucose tolerance challenge. We'll check blood sugar. But at the same time, we'll check fasting insulin - one, two, and three hour insulin levels because we want to see the response.

[00:09:36] Insulin being a pro-inflammatory mediator, we are very mindful of that when we're doing our testing. 

[00:10:47] Carl Lanore:
I think that A1C  is now obsolete. This is just my opinion. We assume that the red blood cell has a specific lifespan. I think it's 90 days. Wouldn't it be fair to assume that people who have metabolic compromise, may have red blood cells that don't last 90 days. Maybe they only last 45 days. And so that 5.5, if it was allowed to go out for 90 days would maybe be nine.

[00:11:22] Dr. Frank Tortorice:
That is correct. The assumption is that the red blood cell life is 90 days. If you've had a transfusion, If you have iron deficiency, anemia, that number no longer is valid. You have to look at and make sure that you understand that. The A1C has to be interpreted properly under all those different circumstances. It's just one piece of the pie. We need to see what metabolic processes are driving blood sugar. 

Carl Lanore:
Heart disease is said to be the number one killer in America. Cancer, I think is number three. Alzheimer's disease and dementia are occurring, younger and younger, but the reality is all of the those are offshoots of insulin resistance and type two diabetes.

So really if we want it to be honest, we could say type two diabetes is the number one killer in America today. 

[00:13:42] Dr. Frank Tortorice:
You’re exactly right. There's said to be a hundred million people in America that don't know that they're pre-diabetic.  84% of them have no idea that they're there on the road to becoming diabetic in five to 10 years.

That’s a third of the population. So to say this is an epidemic is probably an understatement and everything you're saying is true. Even in my classic training having diabetes was considered an equivalent risk factor to having a heart attack in terms of managing cholesterol.

[00:14:16] Even traditional doctors would probably agree that diabetes is a metabolic arrangement and many complications can come it. When, when I see patients in the office and I tell them their blood sugars are high, a lot of times they'll say nobody ever told me that before. 

We need to do something about this. I see it every day in my practice. 

The other thing is blood pressure. I would argue that 80% of high blood pressure is a result of angiotensin converting enzyme, and that's tied to insulin production. You lower insulin and ACE goes down and you don't need an ACE inhibitor. 

Carl Lanore:
When you look at all of diseases today, and metabolic syndrome, it's all a result of what I like to call acquired diabetes. People want to blame it on genetics. The reality is that you have to work for decades to tank your pancreas. You have to eat a certain way every day, every week, every month for years to give yourself type two diabetes. People don't like to hear that but I say, that means you can get rid of it yourself. 

[00:16:15] Dr. Frank Tortorice:
You’re absolutely right. It's an acquired disease. 

It's recognized that high blood pressure is part of the syndrome. These are multiple inflammatory factors that we need to take control of. We really try in our clinic to help patients feel good about the process of getting a chance to take control of their health.

We have a dialogue with our patients especially in functional medicine, we have a collaboration. Different people want to do different things so we talk with them and are able to be in a position to help them with what is important to their health. 

[00:17:32] Carl Lanore:
diabesitydoc.com or email This email address is being protected from spambots. You need JavaScript enabled to view it.

If you go to your doctor and say you want to learn to control your blood sugar naturally, that you want to fix your body, and he gives you any kind of pushback or a discouraging message, find another doctor.

[00:18:19] Most doctors are just like mechanics. You can get a bad mechanic and he'll spend a lot of money doing nothing for you. Every doctor works within the confines of medicine differently. You must find a doctor that will work with you on your goal, but you have to have a goal.

[00:18:49] First. You have to say, I don't want to be on these meds. I'm going to die sooner if I don't fix this problem.  I want a doctor to help me fix this problem. That's a legitimate conversation for a patient to have today with a doctor, Is it not? 

[00:19:04] Dr. Frank Tortorice:
Yes, it is. I've been on both ends of it. We are more successful than not, but I can't say we have a one hundred percent batting average. I tell patients that I work for them. 

In most instances the doctor doesn't work for you. He works for the company who says you need to get this amount of money, see this many patients and just turn them through and the doctor has a mortgage, maybe kids and a wife… he has kids, maybe a wife, you know, What are you going to do?

I want to preface this. Most of the doctors I meet, wherever they work are some of the most fantastic doctors and human beings. There are doctors that aren't so great. I have patients come and say I was with my doctor, he gave me three minutes. He gave me a prescription. I talked to the nurse and that was it 

I'm not sure that's enough now. Americans die 75% of the time because of their lifestyle issues. I that's the case, you can't put somebody in and out.

[00:20:50] My nurse is always knocking on the door saying doctor, you're late, you have move on to the next patient, because I keep going with a patient. It may not be the best financial model, but I just stay in the room, I have to get this information. With the Institute for functional medicine, they have a list of all functional certified doctors who understand this model.

[00:21:09]You can go find one right near where you live now. Some take insurance, some don’t. What some functional medicine doctors are doing now is what's called group lessons. The group lessons can be $50 or less, and you meet other people with diabetes. This came about from a backlash saying it costs too much money to see a functional medicine doctor.

[00:21:24] You talk to them, you make friends, you go on the diet together. We’re trying to make it affordable for everybody. It's your life. You have to take control. If you love your doctor, stay with them. If you don't then consider something else, because you only have one life. I can't stress this enough. You’re the boss you really are. Please take control of your health.

[00:22:03] Carl Lanore:
You know, some of the problems are due to the patients. We can't lay this all on doctors. I know someone with type two diabetes, and I say to him all the time, you can correct this. It'll take about a year, but you can correct it. He has no interest because it's too easy to keep eating crap and not sleeping well and taking a pill. Sometimes I think the pill mitigates the guilt of having a crappy lifestyle. Like I'm doing all this crappy stuff, but I take these pills and they're protecting me. 

I want people to understand something loud and clear. They're not protecting you if you're taking these drugs and you're still having episodes of postprandial blood sugar at 300 and above, and your fasting blood sugar in the morning is 125. You're broken. You're going to get cancer. You're going to get dementia. You're going to have heart disease. You're going to have it all. It may happen slower, but you're still not fixing the problem. I used to use an analogy early on, if you went to a mechanic and you said, my engine is making this loud clanking noise. The mechanic calls back and says, ah, I see the problem here, and  hands you a pair of ear plugs and says, put these on when you drive the car, then you won't hear the problem. You would not take that advice and say okay and drive down the road because you know that the car is going to blow up eventually.

That is what the medical orthodoxy does today with type two diabetes. Am I being too hard? 

[00:24:25] Dr. Frank Tortorice:
No, I've seen this time and time again. I think some of the failures come about because it is not only about the medicines, it's about what's going on inside emotionally. If you don't address that initially, you don't get compliance. Patients want to be healthy for the great majority. Depression can also be caused by diabetes and blood sugar rollercoaster. So we really try to see what is going on with the patient and if they need more help, we have available a registered nurse and a certified nutritionist.

[00:26:08] Dr. Frank Tortorice:
It is really important to listen to patient. Having a team approach allows you to have the time a lot of our patients need. 20% of the patients need 80% of the time.

We need to understand where they're coming from and come up with a game plan that works for them. Not every patient is going to be the same way, each patient is different.

Carl Lanore
[00:29:18] Sleep affects blood sugar, improve the quality of your sleep, change your diet. Get away from the high carbohydrate, low diets, which taxes the pancreas. Now obviously if you been diabetic for a decade you can't just say I'm just not going to eat carbs because you're going to end up hypoglycemic and pass out. But you have to move in that direction, start to restrict the carbohydrates, start using carbohydrates that digest slower, using supplements like R-alpha lipoic acid, even apple cider vinegar reduces the carb load effect on blood sugar.

[00:30:07] Dr. Frank Tortorice:
I would say this, just as I probably couldn't read a manual and fly a commercial aircraft -Same thing with diabetes. The order of things is important. You mentioned about the car, like you put the, you put the oil in, you put the gas in and then, then you drive the car. If you try to drive the car without gas or oil, you're not going to get too far. 

Carl Lanore:
The American dietetic association has a book for people with diabetes, the book has nothing but carbohydrate foods. Isn't that a mistake.When, when you have somebody who can't manage blood sugar, do you really want to constantly be raising blood sugar? 

[00:33:53] Dr. Frank Tortorice:
Yes. I've seen those same documents and we've had those referrals. I've talked to the dieticians and basically that's what they've been trained. In our practice, we use a functionally trained nutritionist, either with the IFM or one of the other certified institutes.

[00:34:12] Carbohydrates are the foods, in general, which cause a higher raise of insulin. So if they already have a problem with insulin and insulin resistance what happens when they have to keep secreting more and more insulin, eventually the pancreas is no longer able to handle it. A lot of our patients on a lower carb diet, we like a monitored measured approach. Everything is in moderation.

[00:34:50] We don't believe necessarily in going one end or the other end. We have vegetarians and vegans in our practice. We try to accommodate their choices, but we give them good alternatives. We educate them so they can make better food choices

Carl Lanore:
[00:35:30] A more athletic population will tell you that they'll eat between one and a half and two grams of protein per pound of body weight and there’s a group of people out there who say rapid absorbing proteins, like whey protein will just spike blood sugar. However, I've done shows with scientists that will tell you that gluconeogenesis is a very metabolically expensive process.It doesn't happen willy-nilly. The body has to really be losing blood sugar quickly in order for it to turn on gluconeogenesis, which would mean that maybe protein doesn't really just spike blood sugar. What do you think about the protein conundrum? 

[00:36:17] Dr. Frank Tortorice:
Excess protein does spike it in certain instances. It depends on what is eaten with it, if you have a lot of fat in there, it slows down absorption, but, if you're a bodybuilder or physically active to a high degree and probably need the higher amounts of protein. Most people can do well with half a gram of protein. 

If you have a super human sized steak, you're not gonna be able to assimilate all that. 

[00:37:05] They say a palm sized amount of protein three times a day is a good approach. Not super technical, but it's about 20 grams three times a day is all you need. The great majority will not need anywhere near that. 

[00:37:47] Carl Lanore:
I know that a lot of people in our audience are eating higher protein. I eat 200, 250 grams of protein a day, but I train and I'm trying to maintain and build muscle at an advanced age. I know that I need that extra M-Tor flip to get there, but then I do combine that with the time restricted feeding. I'm allowing M-Tor  shutdown autophagy to occur and I'm honoring the, the evolutionary edicts that my body has developed under. 

What do you think are the top three mistakes people make when they're looking at addressing and reversing their own type two diabetes.

[00:38:42] Dr. Frank Tortorice:
Most people, if they develop diabetes because of lifestyle issues, have either learned things which aren't benefiting them, or things have changed. 

[00:39:06] There’s also a lot of advertising that may be not as accurate as it could be. Oatmeal, for example, a lot of people can’t handle oatmeal and it turns them into a diabetic. There are some people that have a gene that allows them to handle more carbohydrates, but for a lot of people, any type of oatmeal is like taking pure sugar.

Restricted eating is very good as well. That's been shown for longevity.

[00:40:04] We have patients that work the graveyard shift and that's not necessarily great for their bio rhythms and hormones.

[00:40:22] If you're 50 or 60 and you're doing this, and you're really adding extra stress to your body, and the worst is when you work mornings one day or one week, and then evenings the other week. That's probably the most dangerous 

[00:40:41] Carl Lanore:
I would love to see an analysis of the occurrence of type two diabetes as it correlates with nighttime television watching, I'm willing to bet that as nighttime television watching went up blood sugar management became a problem.

I did a show probably in 2007 with a fellow who worked with Olympic athletes when we had Winter Olympics out in the Northwest. They short slept the athletes one night. These are athletes, metabolically perfect. They got less than 5 hours one night and the next day they had the metabolic dis-regulation of an 80 year old.  The study said they had trouble managing blood sugar. That was one night in a human being that is ideally functioning. So what do you think it does when you stay up and watch Jimmy Kimmel and snack a little bit night after night after night? Don't you think modern technology has contributed or is contributing to the problems we see with, with the metabolic dysfunction today?

[00:42:26] Dr. Frank Tortorice:
Yeah, there's no question. One night of poor sleep causes insulin resistance. People now have glucose tracking monitors and they notice when they miss a night of good sleep, their sugars are all over the place.

[00:43:26] Sleep is something that's non-negotiable. Problems is with blood sugar can be caused in part by sleep apnea. How many people know they have sleep apnea? 

[00:44:11] Carl Lanore:
I would respectfully suggest that we have gut dysbiosis. You can see people that are relatively lean but they have distended stomachs. You see people that look pregnant. This is an indicator of not visceral fat but Inflammation and that inflammation in my humble opinion, travels North, it goes up the esophagus. It starts to affect the esophageal sphincter. They have a silent GERD. There's a swelling that occurs.

The airway starts to narrow. 

[00:49:57] Carl Lanore:  Great question from Robert Thompson:  
In your opinion, are there any downsides to Metformin? 

I've been a staunch opponent of Metformin for anti-aging and now some Doctors are saying that unless you're already metabolically challenged, it provides no benefit.

[00:50:24] What do you think? 

[00:50:27] Dr. Frank Tortorice:
 If you're a diagnosed diabetic, we initially use it because it helps with the liver and blood sugar and also patients who need to lose maybe three pounds. Long-term however, you're looking at B12 deficiency, vitamin D deficiency, and a lot of other things that we see in our diabetics.

[00:50:49] I think the query is still out on this. Giving it to a healthy person, you should be really be careful with that.

[00:51:12] Carl Lanore:
Cancer has been associated with women using Metformin. I know a doctor whose wife is in her thirties and he's had her on Metformin for six, seven years for anti-aging. She was just diagnosed with breast cancer. I wonder sometimes if he's thinking to himself, Hmm. Look time, restricted, feeding. Increasing metabolic flexibility. These are all end points of managing your type two diabetes and fixing it. Metabolic flexibility,  fasting for 16 hours and eating for eight - you can achieve all these things without berberine, without Metformin. When you take a drug you can be lazy. It's a mistake in my opinion.

[00:52:24] Dr. Frank Tortorice: 
They call them supplements for a reason they're supplemental to sleep, eating, stress reduction. With the CBO or the gut issues, a lot of diabetic issues are exacerbated by either a small intestinal bacterial overgrowth or infections, and then you have GERD and other things, which can also cause inflammation and it can also contribute to diabetes.

[00:53:45] Major depressive disorder has been tied to inflammation. It's sad, but it's exciting to me because people have this information available. 

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