In this episode, I am speaking with blood sugar expert Dr. Brian Mowll (a.k.a. “The Diabetes Coach”) about the most common causes of high blood sugar (and insulin resistance/diabetes) and how to fix your blood sugar issues. This is critically important, because blood sugar dysregulation and insulin resistance are one of the most common drivers of fatigue for many people.
We also talk about his upcoming masterclass series Diabetes Essentials which is for people with diabetes, prediabetes, or metabolic syndrome to help them treat and prevent high blood sugar-related diseases such as diabetes and Alzheimer’s.
The masterclass is for FREE between Nov. 2nd through 11th. You can sign up for it here.
- How To Fix Your High Blood Sugar (Insulin Resistance/Diabetes) with Dr. Brian Mowll – Transcript
- The Diabetes Essentials
- The most prominent cause of insulin resistance and diabetes
- The role of nutrition in diabetes
- How the personal body fat threshold plays a role in diabetes
- The top strategies to fix and prevent high blood sugar levels
- How To Fix Your High Blood Sugar (Insulin Resistance/Diabetes) with Dr. Brian Mowll – Show Notes
In this podcast, Dr. Mowll will cover:
- The main causes of diabetes and insulin resistance
- The difference between high blood sugar (hyperglycemia) and diabetes
- The primary driver of insulin resistance
- How mitochondrial function plays into diabetes
- The link between carbs, meat, and fats and diabetes (And why they are essential for your health)
- The number one cause of diabetes
- Why high blood sugar levels contribute to fatigue and poor mitochondrial function
- The most important factors in treating and preventing diabetes
- The Diabetes Essentials Masterclass
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How To Fix Your High Blood Sugar (Insulin Resistance/Diabetes) with Dr. Brian Mowll – Transcript
Ari Whitten: Hey, everyone. Welcome back to The Energy Blueprint Podcast. I’m your host, Ari Whitten, and today I have with me my good friend, Dr. Brian Mowll, who is a diabetes expert, and that’s what we’re going to be focusing on in today’s podcast. A little bit about his background: he’s the founder and medical director of Sweetlife Diabetes Health Centers, and serves clients worldwide as the diabetes coach—he’s trademarked as “The Diabetes Coach”, which is pretty awesome. I like that. He’s a master licensed diabetes educator, CDE. What’s CDE by the way, Brian?
Dr. Brian Mowll: It’s a Certified Diabetes Educator. It doesn’t sound that impressive, but actually quite a bit of training goes into it.
Ari Whitten: Yeah, I can imagine. And he was one of the first doctors to be certified to practice functional medicine by the prestigious Institute for Functional Medicine since 1998. He’s been helping people across North America to optimize their health and their metabolism, control blood sugar, and reverse type 2 diabetes using a natural, personalized lifestyle approach. So welcome my friend! Such a pleasure to finally have you on.
Dr. Brian Mowll: Yeah, likewise. Excited to be here with you today, Ari. Thank you.
The Diabetes Essentials
Ari Whitten: First of all, you have a—is it a docu-series or what’s the right word for it? But you have a film project that’s about to come out on—it’s all about diabetes, right?
Dr. Brian Mowll: Yeah, we’re terming in a MasterClass series: it’s a series of 10 modules. It’s called “Diabetes Essentials” and it’s there to help really form a firm foundation for people with diabetes, prediabetes, metabolic syndrome—anywhere along that insulin resistance spectrum, which we can talk about later—but who really need to understand what diabetes and insulin resistance is all about. And just to give you a five-second background on that, I realized that most of the guests I have on, I’ve been doing diabetes summits for six years. We kind of tend to talk at a pretty high level, so I said, “You know what, let’s break all this down because I want to make sure we’re not missing anything, and let’s take people through a program—step one through step 10 where I make sure they know everything they need to know about how to control and regulate blood sugar, reverse and address insulin resistance, hyperinsulinemia, hyperglycemia, and everything related to that.” That’s what this MasterClass is all about. And I had a lot of great guest experts, about 60 live interviews including yours—which is one of my absolute favorites.
Ari Whitten: Oh, thank you. You’re not just saying that because you’re on my podcast right now, are you?
Dr. Brian Mowll: No, it was probably the longest one I did, and time flew, and it was just an awesome interaction. I actually listened to it about four times because it’s really good.
Ari Whitten: Cool, thank you! Kind words coming from you, I appreciate that very much. We’re going to have a link to that, by the way—for everybody listening on this page—below this video or somewhere on this page. The podcast page is like: a piece of text, bullet points, and then the audio clip, and the video clip. It should be somewhere at the top of the page next to the initial piece of text, introducing the whole topic here, and we’ll have a link where you guys can opt in to that. If you’re on YouTube or listening to this on audio and you’re not on that webpage, on theenergyblueprint.com, go to theenergyblueprint.com/diabetes, the link will be there. Brian, when is that coming out, by the way?
Dr. Brian Mowll: On November 2nd.
Ari Whitten: Okay, perfect.
Dr. Brian Mowll: November 2nd-11th, it’s 10 days. We’re giving away the whole program so people can watch all 10 modules. They’re about an hour each, over 10 days. And—you know how these things work, but—we can give you everything for free. You can check it out and—some people obviously might want to keep it, but—it’s great information goes beyond information really to life transformation.
Ari Whitten: Yeah. Well, just to go back to what you said—you said you watched my presentation four times. There are a lot of good content that even somebody who is an expert is interested in watching multiple times, so I’d imagine there’s probably many other experts that you’ve got in there that I’ve have presentations worth watching multiple times, especially for somebody who is not already a health expert like yourself.
Dr. Brian Mowll: Yeah, absolutely.
The most prominent cause of insulin resistance and diabetes
Ari Whitten: Yeah. Okay, so first thing: diabetes. What the heck is going on in diabetes? There’s been, I think, an evolution of thought around the causes of diabetes and what is actually the sort of crux of the physiological and metabolic abnormality and pathology. Explain to me, like big picture, what is actually going on in insulin resistance and diabetes, and what is the crux of that metabolic abnormality?
Dr. Brian Mowll: It’s a great question and it really is sort of the pinnacle of metabolic dysfunction. All roads along this metabolic dysfunction pathway lead to type 2 diabetes. I classify this as sort of the “type 2 diabetes spectrum”. On one side—on one end—you’ve got things like, insulin resistance and metabolic syndrome, which is slightly elevated blood sugar, high blood pressure, overweight—but not necessarily obese—a dyslipidemia—so high cholesterol, high triglyceride levels—and then you start progressing down that pathway, and it can manifest in different ways. For example, PCOS—which is something that you don’t necessarily directly associate with diabetes—I would put along that spectrum because it’s part of that insulin resistance continuum. There’s prediabetes, which is just sort of early diabetes—type 2 diabetes. And then there’s other conditions along that spectrum that I would put like, Alzheimer’s disease and other forms of dementia, which have been tied to insulin resistance.
So it’s a huge, huge thing. And some estimates say 7-8 out of 10 Americans have some sort of insulin resistance. Hyperinsulinemia may not have prediabetes yet or type 2 diabetes, but are on their way.
Ari Whitten: Which is an interesting statistic when you consider that about that exact same percentage of the population is the percentage of people that are overweight or obese.
Dr. Brian Mowll: Exactly. And there is a large overlap but not 100% overlap. I’ll talk about what type 2 diabetes isn’t, first—and it’s not obesity. Obesity is a major comorbidity, as we say, so it goes with it often, something like 80% of the time. But there are people who are obese who don’t have a high blood sugar, or prediabetes, or type 2 diabetes. And there are many people with type 2 diabetes who are normal weight, or perhaps slightly overweight, and some who are underweight as well.
So it’s not the exact same as obesity. Again, they do oftentimes— they’re sort of cousins because they sort of have a common cause in most people, but they can “feed off of each other” so to speak.
Ari Whitten: Now, you said, “many people”—I just want to get a sense of what the percentages look like. My understanding is—and you correct me if I’m wrong—but my understanding is, those two populations that you just mentioned, the insulin-resistant or diabetic people who are not overweight, necessarily, and the overweight people who are not insulin-resistant or diabetic are more the exception than the rule.
Dr. Brian Mowll: Yeah, so let’s say it’s 20%. There’s 100 million people in the U.S. right now with prediabetes or type 2 diabetes, so 20 million—that’s just a rough estimate, of course, I don’t know that number specifically—but if we use some of the stats, 20% of 100 million is 20 million, so that’s where the “many people” comes from.
Ari Whitten: Okay, that’s 20 million between those two groups.
Dr. Brian Mowll: Between those two groups. And I tend to see more of those people, I think, because of the people who try to search out for answers, they’ve already gone to their doctor, their doctor doesn’t understand why they have diabetes when they’re normal weight, so they’re looking for another opinion. I tend to see—probably 30% of my patients, clients, fit into that category, but that is a little skewed high.
Ari Whitten: Interesting.
Dr. Brian Mowll: It’s also not hyperglycemia. Oftentimes, people think that diabetes and hyperglycemia are the same thing. And in fact, medically, most of the treatments for type 2 diabetes are, in fact, really treatments for hyperglycemia.
Hyperglycemia just means high blood sugar. But of course, there’s many other things that can cause high blood sugar. You can go on a course of prednisone, for example, without having diabetes, and end up with high blood sugar and never develop diabetes. There are other things that cause hyperglycemia other than diabetes so we can’t confuse diabetes and high blood sugar and think they’re the same thing. Because again, the problem there is if we believe that, then our treatment is all around lowering blood sugar, and we forget about the underlying root cause of why the blood sugar is high in the first place, and what is underneath that, and all the other sort of spider web myriad effects and consequences that come from the underlying cause.
Ari Whitten: Yeah, it does. That’s a perfect segue into what those root causes are. So what’s the sort of big-picture paradigm of the key… I don’t know if you conceptualize it as the key to causes or the key eight causes, but—how would you paint a picture of what are the causes of insulin resistance and diabetes?
Dr. Brian Mowll: Yeah, I know, and I’m glad you said it that way. So we have type 2 diabetes and prediabetes, and metabolic syndrome, and PCOS, and Alzheimer’s disease in this continuum. Most of the time—again, nothing’s 100%—but most of the time, underneath those is both insulin resistance and hyperinsulinemia. So we have a resistance to the hormone insulin, which helps us to regulate our blood sugar and other fuel—it’s basically a storage hormone that helps us sack away excess energy for later use—and our bodies become resistant to them. We’ll talk about some of the reasons why that happens in a minute, but we’ve become resistant to that hormone.
And then the next step—which is really what does a lot of the damage—is our pancreas then, in turn, starts overproducing insulin. So insulin resistance in and of itself is a problem, but the bigger problem is the hyperinsulinemia that comes from the insulin resistance. The pancreas starts overproducing insulin and now we’ve got all this extra insulin onboard, which causes us to store fat in strange places. We only store fat in our liver, in around the organs, in [inaudible] fat, visceral fat; we store it in the muscles—we store it just about everywhere because insulin just opens that gate. Now, it’s not going to do that—it’s not as simple as I just made it seem. There’s a lot more to it than that. But, in the presence of extra energy, we’ll say that if you’re overeating—which most Americans do, unfortunately— especially with diabetes—
If you’re overeating fat or overeating carbs or overeating both—which is usually the case—and you’ve got high insulin levels, the body’s going to force all that extra energy into fat storage and in places where you don’t want fat storage oftentimes, because the subcutaneous fat—that fat around the belly or the legs and buttocks and so forth—will reach, at some point, a threshold, and then we start storing that fat to other places. So it’s the insulin resistance and the hyperinsulinemia, which then drives all kinds of problems. We said “fat storage”. Insulin acts on the kidneys to cause us to retain fluid and electrolyte, so our blood volume increases, and our blood pressure increases, and we retain fluid. So a lot of people with hyperinsulinemia get swollen ankles, for example, and a puffy face and puffy hands, and they’re very inflamed.
Another thing that it does is degrades the endothelium of the blood vessels, so we get endothelial dysfunction, which can lead to oxidative stress, plaquing, atherosclerosis, cardiovascular disease, and stroke—so all of those things, independently of what the blood sugar’s doing. You can have completely normal blood sugar and insulin resistance and elevated insulin, and it can still cause all these problems, including—as I mentioned earlier—Alzheimer’s disease. A lot of the Alzheimer’s disease research has found that people with insulin resistance, even with normal blood sugar, are at a much higher risk of Alzheimer’s disease.
Ari Whitten: So we have to separate the high blood sugar from the high insulin. Now, I’m not saying that high blood sugar is not an issue. It is. Once that blood sugar starts to rise, which is a little later down the line in the type 2 diabetes “chain”, so to speak, now it’s compounded and we get all kinds of problems happening—which again, we can get into, if a little later if we want. But I want to answer your question and I wanted to set that stage because, to me, that insulin resistance and high insulin is sort of the cause of the diabetes, of the prediabetes, of obesity many times, of PCLs, of Alzheimer’s disease many times. But there are causes of that as well, so we have to dig deeper and look at the cause of the
Yes, exactly. That’s a perfect way of phrasing it. I’m glad you said that because I almost wanted to interrupt and add that earlier. But I just want to point out, for a lot of people listening, that a lot of the way people conceptualize causes depends on one’s paradigm that they bring to the table. I would say the conventional medical paradigm is sort of like, they stopped basically where you just left off.
Dr. Brian Mowll: Exactly.
Ari Whitten: They’ve painted the picture of hyperglycemia, hyperinsulinemia, some of these other biochemical metabolic abnormalities that you’ve spoken about here—and then they’re conceptualizing those things as, quote unquote, “the cause of diabetes”, and therefore those are the things that we need to fix. And, of course, since our philosophy and our paradigm revolves around, sort of, interruption of aberrant biochemical processes with pharmaceuticals, we need to develop a pharmaceutical or two to interrupt those, quote unquote, “causes”.
Your paradigm, which I think is—but in case it’s not clear to people listening—I think is a much more intelligent and sophisticated paradigm, is to not stop there, but then to connect all of those biochemical abnormalities with the environment and lifestyle and nutrition habits at the true root cause level. And I think we have to be careful with our use of language here because I would say the only thing that we should be referring to as “causes” are really the things at the most root cause level possible.
Dr. Brian Mowll: Right, right, I totally agree. And the only reason I went through all that is because, what a lot of these things cause is not the high blood sugar—they do in the long run—but they’re directly associated with insulin resistance and high insulin levels. So we have to look at that as sort of that important go-between. But you’re absolutely right. Most physicians, researchers, go sort of one level deep.
Pharmaceutical targets will sometimes address that one-level deep. There are, for example, a few diabetes drugs that address insulin resistance—really only one that’s used now, which is called Metformin—but most of the diabetes drugs really only address the sign or the symptom, which is the high blood sugar. So certainly, none of them really are addressing these root causes that we’re going to get into. So yeah, there’s many, and probably 10 or 12—certainly we can look at dietary factors. I think eating a sort of an “unnatural diet”—I’ll just put it that way—a diet that’s heavy in processed and refined foods, and whether that’s processed refined grain products, or refined sugars, or refined processed industrial seed oils—what we call vegetable oils, which are pro-inflammatory and highly toxic— whether we want to look at just packaged foods and fake fats and so forth—all of this stuff, not to mention the chemicals that are added to these foods, can drive inflammation. And you’re gonna hear me mention that word several times over the next few minutes but, inflammation is really one of the primary drivers of insulin resistance. There’s been several studies, for example, that show how a chronic systemic—a systemic inflammatory process—actually gums up the insulin receptors and blocks insulin from being able to interact with its receptor. Almost like, if you think of the key-and-the-lock analogy, it’s like the key can’t open the lock, and inflammation does that. Now, here’s another one: we could go another level deep on all the things that cause inflammation and I think we need to do that. But that’s another sort of factor a that tends to drive this whole process.
These foods though—these fake foods, “unnatural foods”, so to speak—are one of the primary drivers of that inflammatory process. We don’t move like we used to. And I think even people who do exercise—a lot of times, they’ll go to a one-hour exercise class and the rest of the day they’re sitting, they’re sleeping all night, they wake up, they sit in the car, they sit in the office, they come home, maybe they get an hour of exercise, and then they sit on the couch, and then they go back to bed—it’s like the body’s not meant to do that. We’re not designed that way. Unfortunately, that’s a factor that is an important one because, there’s so many important things that exercise does for the blood sugar regulation system, including driving glucose into the muscles to be burned for fuel, emptying our glycogen stores—which is the storage sugar in the liver and muscles that we then need to refill—
We actually don’t even need insulin when we’re contracting muscles to soak up glucose into the muscle cells. Just the muscle contraction alone will allow glucose to get into the muscles, into the mitochondria, and the muscles to be burned for fuel. So exercise is hugely important, not to mention cardiovascular health, and circulation, and lean muscle mass—which increases metabolic rate and so forth.
Ari Whitten: What to add to that, I have seen at least one, if not two maybe three studies—this is a few years back when I was digging into the literature on this, so I’m a little rusty, but—at least one talking about measurable increases in insulin resistance from just like, 2 hours of sitting, if I remember correctly.
Dr. Brian Mowll: Yeah, for sure. And not only that, it’s a good segue because another one that shocked me—I mean, it’s not shocking, but it’s shocking of how impactful it can be—and that was a study which showed one night of poor sleep did the same thing: basically decreased insulin sensitivity and increase blood insulin levels. I think it was by 20-40%, somewhere in that range—it was a huge number. And these things can have a huge impact, so, yeah, absolutely. Exercise, poor sleep—which I just mentioned—has a major impact. And sleep can decrease our insulin sensitivity, leading to insulin resistance. It can change our microbiome. Then there’s other more psychological factors like: when we’re fatigued, we tend to not eat as well and we tend to exercise less, our behaviors aren’t as maybe ideal as we would want them to be or they might be when we’re well-rested.
There’s gut dysbiosis which is a huge issue. There’s obesogenic guts and diabetes-inducing guts, where they’ve actually been able to replace the micro-organisms—the microbiome—of thin people and make them fat, and fat people and make them thin, with the change in microbiomes, or at least in my [estimate]. I think they did repeat in people too.
Ari Whitten: So there’s been some mixed data in humans.
Dr. Brian Mowll: There’s been mixed data, yeah. This isn’t clear science, but it’s interesting.
Ari Whitten: There’s definitely enough research to show that the microbiome matters into whether…
Dr. Brian Mowll: It matters.
Ari Whitten: …people can be obesogenic and diabetogenic.
Dr. Brian Mowll: Yeah.
Ari Whitten: But yeah. To your point, I think some of the data is like, “Well, no, it didn’t fully make someone obese expressed through the microbiome,” which is like, of course. Did we really think that it was just the bugs in the gut that was the entire cause of obesity? That’s a lot to ask to replicate studies like that.
Dr. Brian Mowll: Yeah, for sure. A lot of these things lead to changes in dietary patterns. So when you have different gut bugs, you might crave different foods and eat differently when you don’t sleep as well. Same thing when you don’t exercise. same thing. A lot of these what I’m calling “underlying root causes” oftentimes change your dietary patterns, too, which is obviously a big one. And I’ll mention one more:
I mean, there’s hormone imbalance, there’s chronic infections which can drive stress, there’s adrenal dysfunction—all kinds of things that can affect your blood sugar. But another big one is mitochondrial dysfunction. There’s been several studies on the connection between mitochondria and blood sugar and diabetes. We know that ATP, for example, is necessary to release insulin from the beta cells of the pancreas. ATP is actually the signal that tells the beta cells to release insulin when there’s a glucose level rise in the blood. So when we don’t have adequate supply of ATP, we don’t get proper insulin signaling. It’s also mitochondrial dysfunction that’s been associated with insulin resistance. Again, there’s a lot of different connections here and this is one of the reasons why I get sort of frustrated when I hear people talking about diabetes in such simple terms like, “Oh, if you would just stop eating sugar and start exercising, diabetes would go away.”
Certainly, in some people, that’s the case. But oftentimes, there are other underlying factors that we have to look at.
The role of nutrition in diabetes
Ari Whitten: Yeah, well said. One of the things that I want to point out here is the way that you’ve talked about nutrition and the role of nutrition as it relates to insulin resistance and diabetes. I think that might have left some listeners confused in the sense of wondering, “Hey, is this guy low-carb or is he one of those vegans, and is he low-fat or is he low-carb? Because he said bad things about both carbs and fat.”
I’ll just be clear that I fully agree with everything you said, and I know exactly where you’re coming from—but let’s dig into that because there’s a lot of this highly polarized landscape when it comes to nutrition, a lot of diet gurus who are sending a lot of totally-opposite messages to people about what are the “good foods” and what are the “bad foods”. We have everything from the keto—now “carnivore”—diet, to zero-carb all-meat diets, to basically saying, “Low-carb high-fat is the only answer! It’s the best diet! Our ancestors ate this way and this is the optimal state for human health and we should be running on ketones all the time!” And keto diets are a panacea to a lot of vegan-diet gurus.
For example, Michael Greger has been publishing a series of videos on the dangers of keto diets and basically stating that the only way to cure diabetes is if you are carb-tolerant—if you’re on a diet containing carbs, and you’re not insulin-resistant, and not hyperglycemic, and your body can process that—that’s the “true sort of curing diabetes”. And he’s sort of demonizing the keto low-carb stuff.
So those are the ends of the spectrum. There’s a whole big landscape in-between that people like you and I inhabit. So talk to me about why you’ve, to some extent, implicated both fats and refined carbs and sugars in this causal role in insulin resistance and diabetes.
Dr. Brian Mowll: What a great question and that is a very, very common question that I get, or at least a common frustration that I hear. The answer is, of course, somewhere in the middle. But we have to be careful of how we walk that line down the middle—and I’ll explain what I mean by that. You could make a case that the standard American diet falls right in between those two. You’ve got low-carb on one side, low-fat on the other, and right in the middle is what everybody usually eats which is high-carb and high-fat. So certainly I’m not going to make a case that that’s the right answer. But…
Ari Whitten: Yes.
Dr. Brian Mowll: … we have to sort of look at each of these and tease out, using the best logic we can, the truth. And the truth, of course, is not relative, but in nutritional science, it’s not always easy to find the truth. So I think that, basically the bottom line—we’ll get into the depths here in just a minute, but—the bottom line is, I believe that real food is the answer. I think that it’s hard to go wrong if we’re eating real food. Now there are certain cases like someone who is type 2 diabetic, highly insulin-resistant—there is a case to be made for a therapeutic diet to help them heal or basically get to a better place, and then shift to more of a well-rounded, real food diet.
But I think we can’t go wrong with real food for the most part. So, when we evaluate some of these—as you said— “extremes”, I think we have to ask, “Does this really make sense?” For example, does it make sense that the ideal diet would eliminate an entire macronutrient? Like carbohydrates, for example. When carbohydrates are ever present in our environment—I mean they’re everywhere—it’s hard for me to believe that, in reality, we’re not supposed to eat carbs. Now, again, from a physiological perspective, you could say that the body doesn’t require carbohydrates like it requires the 2 essential fatty acids and the 9 essential amino acids, but the body works a whole lot better on some carbohydrates.
Ari Whitten: Real quick digression on that point: I agree with everything you just said, but there’s a lot of, I would say, low-carb keto gurus that I’ve seen misrepresent some of those facts. They like to claim carbs are, quote unquote, “non-essential”. Because in nutrition science, there’s this term for like—we refer to certain nutrients as essential or non-essential, and these are meant to determine which nutrients we need to acquire from outside sources versus which nutrients our body synthesizes or just not needed for any particular function. In the case of carbs and many different kinds of fats, our body synthesizes them, so therefore they’re non-essential. But you see a lot of people misrepresenting this and saying, “Carbs are non-essential. We don’t need them, therefore they’re totally useless and not good for us and don’t do anything!” And fats are essential. And the truth is, only a couple specific types of fats are, quote unquote, “essential” fats. And the vast majority of the types of fats that someone would actually be eating, for example, like mono and saturated fats, and even fats like the different kinds of mono and saturated fats that are genuinely associated with good health—are also “non-essential”.
Dr. Brian Mowll: For sure.
Ari Whitten: I just want to point out that there are people out there who kind of misrepresent those things and play little semantic games to mislead people.
Dr. Brian Mowll: No, I totally agree. And I would throw the same case in the other direction. There are vegan advocates who make the case that meat is “non-essential” and you could make that case. But again, just like eating some carbs is a whole lot easier on the body than trying to make all your carbs out of amino acids and fatty acids and stored glycogen and so forth.
Ari Whitten: Yeah… I’m not going to touch that one because the vegans are going to come after me and I’ve learned my lesson enough times on that one. I’ll let you take the heat for that one, but I’ve learned to stay away from that.
Dr. Brian Mowll: I’m not saying that animal products are necessary, but what I’m saying is that, there’s easier ways to get certain nutrients from animal products than from plant products in many cases. So, anyway, the point is that I think, again, eliminating these huge groups of foods—it’s not that you can’t do it, it’s just that you’re making life a lot harder on yourself, and I think that it becomes more difficult to optimize your diet when you’re doing that. Now, you could argue how much meat we should be eating, or how much protein we should be eating, or the amount of carbs and so forth, and I think there’s a lot of individuality there and we have to go back to the health of the person, too.
There’s a concept that I want to talk about today which is called: metabolic flexibility, which is something that I think is really important. And I think when we go to the extremes, we lose that. For example, you mentioned Dr. Greger and these series of videos that he’s put out on ketogenic diet. And this is not just Dr. Greger—we see this in the popular, current vegan movement. And, again, a vegan diet or certainly a plant-based diet can be very, very healthy. But there’s some faulty assumptions with demonizing fats or animal products in some of these videos. And just to give you an example, the latest one I watched that Michael Greger put out: he starts with this premise that “diabetes is essentially glucose intolerance,” as if they’re same thing. And then he also says that “glucose intolerance causes diabetes,” but that’s not exactly true.
Glucose intolerance is part of diabetes, but they’re not the same thing, just like diabetes and hyperglycemia are not the same thing. They’re associated. What happens is, people who are diabetic typically have a problem handling carbohydrates—in other words, they eat carbs and their blood sugar goes up. We call that carbohydrate intolerance. There’s different ways to help the body become more carbohydrate-tolerant. Ultimately, what you’ve got to do is fix the insulin-glucose-signaling pathways so that, when you eat carbohydrates, your body can handle them. You release the appropriate amount of insulin, you use the glucose for what it’s supposed to be used for—it either gets stored or burned or what have you. That’s what’s supposed to happen. But just because you’re improving glucose tolerance doesn’t mean you’re fixing diabetes necessarily.
One thing I found that is also true in diabetes is that there’s a fatty acid intolerance. This is something that’s completely ignored there. I’ll give you an example: there was a study done many, many years ago, and they called it the “Rice Diet” where they put people on only rice. There was another study done where they just gave them basically a sugar infusion.
Ari Whitten: I’m glad you brought this up. The Rice Diet is actually even worse than only rice—it was white rice plus added sugar.
Dr. Brian Mowll: That’s right.
Ari Whitten: And then I think also orange juice, if I remember correctly.
Dr. Brian Mowll: You’re exactly right. It was basically not even just pure sugar, not only just pure glucose—it was basically glucose and fructose together and, almost exclusively, sugar-based simple carbohydrates and processed.
But what that study showed is that those people improved their glucose tolerance. But what you have to understand there is, if you eat only glucose, what do you think your mitochondria is going to get better at doing? It’s going to get better at burning glucose, so your glucose tolerance increases. What do you think it’s going to get worse at doing?
Ari Whitten: Probably burning fat.
Dr. Brian Mowll: Burning fat, exactly. We know that the more glucose comes in, the more that a carnitine transfer gets downgraded and suppressed, and we don’t transport fatty acids in the mitochondria very well.
Ari Whitten: But the other big thing that happen there is—that we shouldn’t leave out— is that it was also a low-calorie diet, it was calorie-restricted.
Dr. Brian Mowll: It was, exactly.
Ari Whitten: And that they lost lots of weight.
Dr. Brian Mowll: True.
Ari Whitten: And I assume you agree with this, but I’m under the belief that just losing fat in and of itself can often reverse and cure diabetes and insulin resistance.
Dr. Brian Mowll: Yeah, absolutely, you can. And that’s ultimately one of the things that we need to do if we’re going to reverse insulin resistance. We need to get rid of that fat that we talked about that’s stored around the liver and stored around the organs and the muscles and forth. So, a high-sugar diet will help you burn sugar better, but you’re not going to be able to burn fat as well. So, for example, in Dr. Greger’s video, he gave examples of people who ate a lot of fat, and then they gave them glucose, and their glucose tolerance level was way down. That’s not really a surprise. If you just tuned your mitochondria to burn fat really well and you’ve taken a lot of glucose, you’re not going to be able to handle the glucose that well.
And that’s why we see people who eat high-fat diets—and I’m not advocating that—but what happens oftentimes is they’ll upregulate their fat-burning and downregulate their glucose-burning in the mitochondria. It’s kind of like a seesaw, a little bit: the mitochondria can do both, of course, but it’s going to tend to shift its preference one way or the other because it’s just mechanically more efficient. So we see those people not being able to handle glucose very well. If, for example, someone is on a moderate-fat diet, low-carb diet, and then every two days they binge on ice cream or they go out and eat a bunch of sweets or carbs, their blood sugar’s going to be disastrous, it’s going to be all over the place.
Then they’re going to be causing major issues because they’re not very good at burning glucose and they’re eating a lot of it. However, if someone is eating that type of diet and not eating glucose, they’re not gonna have any problems because—well, there could be other problems—but they’re not going to have any problems with glucose intolerance and glucose spikes because they’re not eating it in any way. But we could say the same thing on the other side: if someone’s solely eating fruits, for example, like a fruitarian, and then they go out and eat a big bowl of high-fat ice cream, their triglycerides are going to shoot through the roof. And I’ve actually done this with my clients and we see triglycerides jump up.
It’s almost like a—you know there’s a glucose tolerance test—this would be a triglyceride tolerance test or a fatty acid tolerance test. Those levels jump up because they don’t burn fat very well. And then, unfortunately, all that fat just gets stored in those organs and so forth. So if you’re going to follow one of those two diets, I guess the bottom line is, you need to stay on it. If you’re going to do an ultra-low-fat/higher-carb diet—that could be vegan or not, but it’s probably going to be vegan if that’s what you’re going to do—then you need to stay on that. Because if you keep going back and forth and eating a bunch of fat, you’re going to continue to drive metabolic problems.
On the other side, if you’re eating more of a lower-carb diet, moderate-fat diet—I don’t really recommend high-fat diets, but moderate-fat diets—you’ve got to stick with that, too, because every time you eat glucose, it’s going to drive your blood sugar up. So, these two diets—just real quick, I’ll just give you my piece on them—I think they actually can both help people with type 2 diabetes, used therapeutically. I would never want to see somebody on a lifetime diet of that—either one, to be honest. But I think they can both be used therapeutically to help you. And I’ve seen people reverse diabetes on an ultra-low-fat vegan-based diet. I’ve seen people reverse diabetes on more of a low-carb/ultra-low-carb ketogenic diet-type of thing.
They do work, and we could argue about what reversed-diabetes mean. But ultimately, reversal of diabetes means you got to get—like you said, Ari—got to burn through that fat in your liver and organs and muscles and lean down, so that you can then start to add back in whatever food you’ve been cutting out, so you can eventually get back to a normal diet again.
Ari Whitten: Yeah, excellent explanation. I think, also what you said, I just want to emphasize the part about “real food”. I personally think that the last few decades of conversation that we’ve had about the low-carb and keto and vegan low-fat and all this kind of stuff—this focus on carbs and fats in particular—I think has been missing the forest for the trees. I think the focus has been on the wrong thing. Real focus should be food quality…
Dr. Brian Mowll: Absolutely. I totally agree.
Ari Whitten: … and real food is the key to that. And choosing specifically nutritious real foods: specific real foods that we know are associated with good health, and disease prevention, and lower risk of obesity and diabetes. I personally think that’s a much more intelligent approach—to design the plan, not around macro-percentages of carbs and fats, but around the specific foods that we know are associated with good health, and kind of balancing them in the right way.
Dr. Brian Mowll: And—just to reiterate a point you made earlier—if we’re going to burn that stored fat, we’ve got to get into an energy deficiency. We can’t overeat because no matter how good the quality of the food is, if you’re overeating, you’re going to have an energy surplus and you’re never going to be able to really tap into that stored fat which you’ve got to burn through in the liver and organs. That’s sort of my approach; I’m kind of dietary-agnostic that way. If somebody comes in and says, “Hey, I’m a vegan,” I’m like, “Great, let’s do it on a vegan diet.” And if somebody says, “I want to eat more of an ultra-low-carb diet,” I’ll say, “Okay, well we can probably make that work too. Let’s just figure out how to do that using real foods and whole foods and eventually get you back to a more balanced-eating approach, but keep you on that energy deficiency so that you’re burning your stored body fat instead of just staying in sort of homeostasis.”
How the personal body fat threshold plays a role in diabetes
Ari Whitten: Yeah. I want to come back to something we’ve talked a bit about earlier that I think needs a little bit more elaboration, which is: the role of calorie overconsumption. We’ve talked about this percentage of the population of diabetics that can be relatively lean and still have insulin resistance or diabetes. I’ve heard people say that basically, in those cases, the most likely thing that’s going on is that they’re still somewhat overweight, but then there’s this invocation of something called the personal fat threshold, which is basically that each individual has somewhat of a tolerance of amount of body fat that they can accumulate before they start to become insulin-resistant. Some people basically have a very low threshold so they may not necessarily be noticeably that overweight and yet still have insulin resistance, and then other people might be considerably overweight and not have exceeded their personal fat threshold.
So I’m curious about that. And then the other layer I want to add to this is” my general understanding of the main cause of diabetes is this chronic calorie overconsumption, and exceeding this personal fat threshold such that the fat cells basically become leaky. They grow and grow and grow so much that they can’t effectively soak up more nutrients from the blood anymore, and that insulin resistance is actually a protective and adaptive mechanism, trying to protect the cells from this chronic energy excess that’s in the bloodstream. Having painted that picture, I’m curious what your thoughts are on all that, if you agree or disagree.
Dr. Brian Mowll: I do totally agree with that, and that’s one of the reasons I tried to make the point earlier that: it’s not just insulin resistance, it’s this compensatory hyperinsulinemia that really is driving a lot of the problems. Insulin resistance in and of itself, like you said, is largely protective. And there are situations, for example, where we can become insulin-resistant that’s not pathological. We do that to downregulate fat storage or conserve energy or other things. There’s different reasons why we might become physiologically insulin-resistant and it’s not necessarily a pathological state. And you’re right—most cases, it’s there as a protective mechanism. And in fact, our subcutaneous fat, in a way, is there as a protective depo for extra energy. And there are certain phenotypes—certain body-makeups—where people don’t store fat all that well.
The fat cells themselves can only grow much. And some people just don’t make new fat cells and their fat cells don’t grow as much as others. So the fat cells themselves will swell, but maybe they only swell 50% or 30% of what somebody else’s might, and other people will continually lay down new fat cells. As they do that, when the body’s stimulated to do that, they become fatter and fatter and fatter. That’s why there are people who are 600-700 pounds who are not insulin-resistant because…
Ari Whitten: Really? Wow.
Dr. Brian Mowll: Yeah.
Ari Whitten: It just blew my mind. I would’ve never guessed that because my assumption…
Dr. Brian Mowll: It’s not common.
Ari Whitten: Yeah, I assume it’s uncommon, but I’ve read some studies basically suggesting that, even that segment of the population that you mentioned earlier that’s overweight but not insulin-resistant—it’s actually just a “temporary” state where they’re still maintaining some degree of metabolic health, and that if you track them for another 5 or 10 years, they actually will then be insulin-resistant or diabetic.
Dr. Brian Mowll: Well, I would think it would be safe to assume that at some point, they are going to reach their fat threshold, whatever that may be.
Ari Whitten: Apparently for some, it’s 750 pounds. Geez, I would’ve never guessed that.
Dr. Brian Mowll: Yeah, it’s amazing that humans can even get that large. Obviously there’s some serious genetic differences because I would venture to guess that it would be impossible for you or I to ever get that large, no matter how much we ate, because it’s just not in our genes to do. Maybe I’m wrong, but anyway—the more practical point is that we each have a personal fat threshold. There’s countries where diabetes is skyrocketing and is, in fact, growing faster than it is here in the U.S.—China being one of them, and India being another.
And, Asians typically, genetically, have a lower personal fat threshold so they don’t get the sort of obese phenotype that we get here in people from European descent or African descent here in the U.S. So they show it much differently. However, if you do MRI studies and look at their organs, you’ll see a huge accumulation of fat in those who have diabetes around the liver, around the pancreas, in the muscles—it’s like cutting into a steak that is sort of really marbled with fat. That’s what their muscles look like because they’ve sort of maxed out their subcutaneous fat storage—again, that’s the fat that’s right under the skin, on the belly or the bud or the thighs or the arms—they’ve maxed that out long ago and now they’re storing fat in other places and that that’s the fat that gets really dangerous because it ends up getting a direct path to the liver, the liver becomes really fatty, and then that leads to a whole host of problems.
The top strategies to fix and prevent high blood sugar levels
Ari Whitten: Interesting. Okay, I feel like we’ve covered the root cause level of insulin resistance and diabetes pretty well. I’m sure that you could talk for five more hours on the nuances of a lot of these things. Let’s do maybe a little segment now just to wrap up on some of your top strategies—understanding that you’re a diet agnostic and you’re not going to give, like, “Here’s the meal plan for everybody with diabetes to go on right now,” but some of the principles—both nutrition and other lifestyle principles—that you think are the most effective strategies for preventing and/or treating diabetes. And you can treat those as the same or different, I don’t know to what extent you feel they should be separated out into two distinct things, but do that. Also, I would like you to—this a weird request, I’ve never requested this, but—I would like this you to scare people a little bit about diabetes because I feel like we should’ve covered that at the beginning about how prevalent this is and what are the consequences and comorbidities of this.
Dr. Brian Mowll: Yeah, and I’ll start with that. To me, the scariest thing about diabetes—and the reason I think this is the scariest thing—is because most people listening to this don’t have out-of-control diabetes. Most people listening to this don’t have blood sugars in the 300-400 range, and most of them aren’t out of control with their diet and lifestyle, smoking cigarettes and slugging down big gulps, and hitting the buffet and eating 300 calories of processed food every day at lunch. So—though, I’m not going to really talk about that stuff because I don’t think that’s the audience here; it’s not my audience either—the really scary thing to me about this “diabetes spectrum”, as I described it earlier, is it is largely hidden. It’s largely under the surface. It’s quiet. And that’s, again, because most of the problems are related to not only high blood sugar, but the high insulin levels. There was a pathologist by the name of Joseph Kraft who did 40 years’ worth of studies, and he found that: most of the people he looked at—I can’t remember the exact number but something like 60+%—had high insulin levels, and only a small percentage of those actually had diabetes. And again, we’ve talked about those numbers earlier—I said, somewhere between 8 out of 10 Americans have insulin resistance and high insulin levels. The CDC said that almost 50% of Americans have either prediabetes or type 2 diabetes already. This is a huge deal. There’s about 1.5 billion people worldwide with prediabetes or type 2 diabetes. This is a monstrous issue.
But again, the scary thing to me—and I think what should be scary to most of my audience and your audience—is that doctors aren’t running tests that check for these things. And unless you’re really paying attention, this can be developing over decades, causing problems—it’s not like it’s just in waiting—causing problems way before diabetes has ever diagnosed.
Ari Whitten: Way before you have noticeable hyperglycemia.
Dr. Brian Mowll: Exactly. One thing that’s common knowledge—we see this in conventional diabetes care—is that oftentimes, the presenting complaint for someone on the visit where they get diagnosed with diabetes, is a diabetes complication. In other words, they go to the doctor with numbness and tingling in their feet, or they’re peeing all the time and they don’t understand why, and they find out they have high protein and other issues with their urine, and their kidneys are already in trouble. They have like, Alzheimer’s disease for example; early signs of dementia might be the first complaint.
Ari Whitten: And just to be clear for people listening to those symptoms who may not fully understand the implications of that, that means that you’ve already accumulated significant amounts of damage to capillaries or to peripheral nerves or nerves in the brain, and you’ve actually damaged and/or destroyed cells of your body to the extent that you’re now experiencing subjective symptoms—you can feel that damage.
Dr. Brian Mowll: Right. And the doctor runs you, sends you down to the lab, you get a blood test, and your blood comes back, your glucose comes back at 140—and last year they did the same test and it was 106. And diabetes is diagnosed at 126 mg/dL. So you were fine last year, and this year you’re not. And now you have nerve damage in your feet. That didn’t happen in the year between those two tests; that’s been happening for decades. And to me, that’s the scary thing. If you’re not really evaluating your metabolic health, these things can develop quietly over many, many years. And then once you do start to see these more noticeable symptoms or you get that blood test that shows, yes, you have diabetes, you’re probably many years if not decades into it, and it’s much harder to reverse and you’ve done a lot of damage. So you want to be super proactive.
Ari Whitten: Yeah, the only thing that makes sense is to not wait until you get it, but to be thinking about it now and taking action to prevent it.
Dr. Brian Mowll: Yeah. And make the connection. If you, for example, feel like your belly is sticking out a little bit further than it used to, or you feel like you really get sort of tired in the afternoon and there’s no real reason for you to be tired, and you just feel really groggy and lethargic—and of course, there’s a lot of reasons for that—but these are some of the symptoms of insulin resistance. Or perhaps, you’re just constantly craving sugar and you don’t know why, or you have brain fog, or you’re a menstruating female with PCOS symptoms, or early cognitive decline. So certainly look for these—I guess some of these aren’t “early warning signs”, but look for those signs because that should really alert you to pay more attention to this.
But as you said, it’s always better to act as if, and do the right thing now or do the best you can now.
Ari Whitten: Yeah. So what are those “right things”? What are your top 3 or 5 strategies for people to prevent diabetes?
Dr. Brian Mowll: I think clean diet is super important. And to me, clean diet is if you’re going to eat animal products, eat good-quality animal products; don’t overdo it. If you have a lot of lean body mass, hit the gym a couple of hours a day; you probably need a bit more protein. But most of us, probably need a little less than what the average American eats. We don’t need to overdo animal products and if we are going to eat them, make sure you get clean—whether it’s organic grass-fed beef, or pastured/free-roaming poultry, or wild-caught fish, organic eggs—that type of thing. Do quality proteins because quality is more important than quantity. You can get away with less meat but do better quality.
And load up on the veggies. To me, green fiber vegetables are the most important thing—they should be the majority of our plate; at least 75% by volume, I think, of the plate. Broccoli, cauliflower, salads, Brussels sprouts, bell peppers—all those yummy, fibrous vegetables. You can do some starchy veggies, but that’s one of those things that we sort of look at—How active are you? What time of the year is it? What’s your metabolic health look like?
There’s a few categories of foods to me, like fruit, starchy vegetables and beans and legumes—I would put in there and say it depends on the person. Not that you can’t eat them, but how much of those we eat, it depends on the person’s metabolic health and some other factors. But they’re real food. We want to eat those. And then, again, I’m not against fats. I just think we need to get good fats. To me, added/processed/refined oils, sugars, whatever it is—we should try to minimize those. If you’re gonna eat fat, for example, try to eat the food that has the fat in it. So eggs, for example, or avocado; or, if you want coconut oil, eat some coconut as a snack or part of a meal or in a smoothie. There’s lots of ways to get these foods.
Ari Whitten: If I can add something or just a personal story that just happened to me—a really good friend of mine, very close friend, mentor of mine—sent me his recent blood test results and asked me to look them over. To make a long story short, there were certain abnormalities that I started questioning him about his diet and I discovered that he’s using lots of added fats. For example, lots of coconut oil and coconut butter in his smoothies, on top of very carb-rich smoothies. And then he’s also using like supplemental oils of various kinds like mixes of Omega-3s and -6s and -9s, and things like that, and kind of using these different oil supplements very liberally. And I encouraged him to get rid of those oils because he’s already eating tons of nuts and seeds and avocados and things like that—he happens to be vegan—and so he’s eating tons of nuts and seeds and avocados and foods with good, natural fats.
And I’m like, “You’re covered! You don’t need lots of additional fats.” And he said to me, “Well, where am I gonna get my good fats from then, if I get rid of these oils?” And I thought that was interesting because—there’s these different trends within nutrition, but as of the last 10 years, we’re in this trend of, “The more fats, the better! We all need more good fats and if you can just pile on the good fats, it’s just going to make you healthier and healthier! Fat doesn’t make you fat—it’s carbs that make you fat!” And people think fat doesn’t contribute to any problems anymore, it’s just this healthy substance and “the more of it, the better.” And I thought it was so interesting that he actually said to me, “Where am I going to get my good fats from?” And I’m like, “You already eat tons of nuts and seeds and avocado. You’re covered! You don’t need to worry about whether you’re going to have a fat deficiency if you get rid of coconut oil and your other refined oil supplements.”
Dr. Brian Mowll: Yeah, great story. And—this is different but similar in some ways—a lot of people who are heavy will ask, “Should I be eating a lot more fat?” And you can metabolize more fat, but use the fat that’s already stored on your body. You don’t need to be putting a ton of fat in from the outside if you’ve already got all these reserves of fat waiting to be burned. So I think you’re right. And again, it just comes back to: let’s try to eat real food and not eat the refined/processed versions of those foods. Even if it’s something that’s minimally processed or seems to be natural, like virgin coconut oil or something. I’d much rather see somebody eat the coconut with all the fiber and in its natural state—if they’re going to eat coconut than to put a blob of coconut oil in a smoothie. But then we’ve got to go beyond that. We talked about movement and exercise, and those are really important.
One thing I like people to do, and this is one thing that we’ll do with our clients is, we take an inventory. We’ll look at a lot of these root causes—dietary factors, physical activity, sleep, stress factors—and that could be mental/emotional stress or it can be physiological stressors like chronic pain and chronic infections and things like that—we look at gut health as best as we can evaluate it, we look at hormone balance as best as we can evaluate it, and we try to evaluate a mitochondrial function as best we can. And there’s certain questions you can ask people to try to glean some information about how these systems are working. And then we kind of look at all that and say, “What seems to be ‘the thing’ for you?”—or the “one or two things that seem to be the ones that really stick out.” I’ve had people who start with me and they’re eating 50 grams of carbs per day, and their first question is, “Should I go to 20 grams of carbs per day?” And I look and find out that they’re only sleeping 3 hours a night and every night their sleep’s disrupted and they’re getting up at two o’clock in the morning and pacing for 3 hours and then trying to go back to sleep. And I’m like, “I don’t think that 30 grams of carbs is going to make much of a difference. What we really need to address is, why aren’t you sleeping and how can we fix that?”
Ari Whitten: And then where do you go from there? Where does that line of thinking end? It’s like, you’re on a super ultra-low-carb ketogenic diet with only sources of those 20 grams of carbs or 50 grams of carbs is green leafy veggies and broccoli and stuff like that—and then you start getting convinced it’s still the carbs that are the problem, so “I need to go to 20 grams” and then it’s still the carbs that are the problem—and then you arrive at, “Well, the solution must be, I have to eat nothing but meat. I need to go on a carnivore or zero-carb diet now.” I just think we have to be careful of the lines of thinking that we end up going down.
Dr. Brian Mowll: Yeah. Or it’s something else—or they’ll flip-flop to another diet, or they’ll want to do fasting, or they’ll want to go no-fat, or they’ll want to take this or that supplement that’s supposed to fix diabetes. But again, they’re overlooking some of these other key areas that are really important. Like, they do all that, but they haven’t gone for a walk or run or done any resistance training or gotten their heart rate above 70% max in 5 years, but they’re looking for the magic supplement. We have to lay all that out and say, “Okay, what are the ‘missing pieces’ for you?” Maybe it is diet, but oftentimes, it’s not. Oftentimes, it’s something else.
Ari Whitten: Are there one or two tips that you want to give people here, and are there any supplements that you do feel are worth using in the context of dealing with insulin resistance?
Dr. Brian Mowll: Yeah, for sure. And again, I don’t want to give the impression that I don’t like supplements. Supplements can be really helpful. I group supplements into two categories: there’s the nutrient-based supplements, and then there’s more of the botanical herbs-type supplements. So one is stuff we could normally get through food—vitamin C, vitamin E, different types of antioxidants and polyphenols and so forth—Omega-3 oils and all that. And then there’s herbs and things like, berberine, for example—it’s like an alkaloid compound found in certain plants, but not plants that we would normally eat. We use that as more of a therapeutic agent to help with people’s blood sugar and insulin sensitivity short-term. So there are some that can be really helpful, and I think it’s important to cover your bases. For example, if you don’t eat a lot of fish or you don’t eat any fish and you’re not getting adequate—other sources of Omega-3 fats from things like walnuts and flax and chia and so forth, then you might want to consider supplementing.
If you’re a vegan, you can do a vegan source of Omega-3 fatty acids. If you’re not, then certainly a good-quality fish oil can be important. And that’s been shown to make a big difference—it can help with the mitochondrial membranes, for example. It can help with cell membranes to help the hormone and nutrient fuel metabolism. Those are good. I love Alpha-Lipoic Acid, I think it’s something that’s really important. It has a lot of different functions in the body and it’s been one of those things that has been shown to improve blood sugar, improve insulin sensitivity, improve lipid health, improve mitochondrial function, and it’s something that is found in foods, but not usually in the doses that are therapeutic. So I love Alpha-Lipoic Acid, that’s sort of one that anybody along that insulin resistance spectrum, I think, should look into taking.
And then there’s a few, like in the therapeutic description that I gave—berberine is one of them. Metformin actually is a drug that’s diagnosed for diabetes, and Metformin has been shown to have a variety of effects: it upregulates this AMP kinase pathway which, again, can help blood sugar metabolism, insulin metabolism. Berberine is a compound that does a lot of the same things and it can be taken naturally without a prescription—so berberine is a good compound. And the last one I’ll mention is, black cumin seed oil or black seed oil. It’s been used for a long, long time to reduce inflammation, to improve blood sugar health, and insulin sensitivity.
So those are therapeutic agents, but they can help to get to—maybe not that underlying root cause—but at least that insulin sensitivity and improve the physiology there.
Ari Whitten: Yeah, that’s a great mix of recommendations. I’m curious if you think there’s any herbs or spices that—and maybe berberine falls into that category—but are there any others? I know cinnamon has some kind of insulin-sensitizing properties. I’m curious if you think that’s…
Dr. Brian Mowll: Yeah, cinnamon, I would put turmeric in there—also curcumin. It’s been shown to be anti-inflammatory, it helps protect the beta cells, for example, from oxidative stress. And Alpha-Lipoic Acid does that as well and reduces inflammation. So curcumin, or turmeric, is really good.
There’s one called amla, which is basically Indian gooseberry that’s dried. I actually do a golden milk where I will stir in some turmeric and amla powder with a little black pepper and some warm coconut milk—and I drink that in the evening. It’s sort of an anti-inflammatory metabolic cocktail that can be helpful. And cinnamon, also. The challenge with cinnamon is the studies on minimal cinnamon use—like if you just dust your coffee or tea with cinnamon or throw a little bit on top of a smoothie or something, it’s really not going to make much of a difference. Not that it’s bad, but large doses of cinnamon and where you get into like, the teaspoon-or-two range, can have really powerful benefits on improving insulin sensitivity and glucose.
Ari Whitten: Yeah, I’ve noticed that. I’ve experimented with it pretty heavily and with real Ceylon cinnamon and in really big doses to the point where—it’s not going to make your food taste bad because you’re using so much of it—like, I’ll actually usually just put it in a little thing of water like this—like, just a little bit of water and glass, and put like a big heaping teaspoon on it with a meal, and just chug it like that—which is not the most pleasant thing; not as bad as a lot of the things I’ve done—but I actually have noticed effects from it, like very positive effects from it. So my experience with cinnamon has been very positive. But yeah, you gave a nice list of various compounds there. Is there any other one strategy that you want to give here or… I think that probably covers most of it pretty well, most of them.
Dr. Brian Mowll: Yeah, I said this earlier but I’ll just say it one more time: I think there is a place for people with type 2 diabetes, with insulin resistance, and hyperinsulinemia, who need to do something more aggressive to reverse the condition or make a huge impact in the condition. I think there’s a place for therapeutic approaches—short-term therapeutic approaches—and you have to match that to the person, because people respond differently to different things. For example, an ultra-low-fat plant-based diet is one of those that can be very effective for some people. Other people, it’s disastrous. I’ve had women who have come to me after doing that and they stopped menstruating, and their hormones went crazy, and they broke out in acne, and they just turned into a mess—because they weren’t eating any fat to drive those steroid pathways.
You could say the same thing on the other side. There are studies that show that ketogenic diet can be used therapeutically, for reversing—or at least, making a huge impact—putting type 2 diabetes in remission. I don’t recommend that as a long-term dietary approach, but I think in a supervised setting, if that’s something that you feel like you really want to jump in and try a therapeutic diet to make a huge impact on your health status, it is an option. There’s fasting strategies that can be used in that same regard. And you don’t have to just do a 14-day water fast. There’s fasting-mimicking diet; there’s a protein-sparing, modified fast. Our friend, Robyn Openshaw, has her “Flash Fast” that she created, which is a 3-day hypocaloric, basically modified fast—and these strategies can be very effective therapeutically. But then we just have to remember that these aren’t long-term strategies. We want to come back to real food, whole food—a more balanced diet—at some point, once we’ve kind of worked through some of that.
Ari Whitten: Yeah, absolutely. Dr. Mowll, this has been awesome. Thank you so much for coming on the show and sharing your wisdom. I think this is critically important information—obviously for people who already have insulin resistance and diabetes, but also given the statistics—7-8 out of 10 people—I think this is critically important information for everyone to know how to prevent diabetes.
So where do you want to direct people? Again, we’re going to have a link below this video, theenergyblueprint.com/diabetes. If they go there, we’ll have a link to opt in to your free MasterClass training on this subject. But do you work with people one-on-one, or do you have a clinic that you operate or anything like that, or any online programs that you want to direct people to?
Dr. Brian Mowll: Yeah, I appreciate that. The best place is just drmowll.com. D-R-M-O-W-L-L dot com. That’s the hub. You can find my podcast, the Mastering Blood Sugar podcast there. You can find courses and programs that we offer for clients—but I really think the best place to start is this 10-part MasterClass. We have a whole module on these specialized diet topics. I actually go through every diet or strategy that’s been shown through clinical research, through published research, to put diabetes in remission or reversal. And there’s 4 or 5 of them. We do a whole module on that and we dig deep into the pros and cons of each—that’s just 1 of the 10 modules. But really, that sort of A-Z—everything you need to know about insulin resistance diabetes spectrum.
Ari Whitten: Perfect, awesome. And that was at drmowll.com. M-O-W-L-L, right?
Dr. Brian Mowll: Right. And the diabetes essentials will be at that link that you gave.
Ari Whitten: Okay, awesome. Thank you so much, Dr. Mowll. I really, really enjoyed this. This was awesome. Thank you again for sharing your wisdom with my audience, I appreciate it.
Dr. Brian Mowll: Thanks for having me.
How To Fix Your High Blood Sugar (Insulin Resistance/Diabetes) with Dr. Brian Mowll – Show Notes
The Diabetes Essentials (01:18)
The most prominent cause of insulin resistance and diabetes (4:45)
The role of nutrition in diabetes (26:28)
How the personal body fat threshold plays a role in diabetes (45:28)
The top strategies to fix and prevent high blood sugar levels (52:12)
Find out more about Dr. Mowll’s work on his website