Dr. David Cavan: Reversing Diabetes through Lifestyle Medicine

Discover the transformative power of lifestyle medicine with Dr. David Cavan, who joins us to share his remarkable shift from a traditional to a pioneering approach in diabetes management. Prepare to be enlightened by Dr. Cavan's insights on the potency of nutrition and patient empowerment in turning the tide against type 2 diabetes. Drawing inspiration from Professor Roy Taylor's innovative research, our conversation illuminates how simple dietary modifications, primarily the reduction of carbohydrates, have set patients on a path to reclaiming their health. This episode promises to change your perspective on managing diabetes and introduce you to practical strategies that could lead to its reversal.

This week's discussion cuts through the confusion surrounding diabetes, clearly distinguishing between the autoimmune nature of type 1 and the lifestyle-induced type 2. We tackle the stigmas and misconceptions associated with these conditions, emphasizing the importance of a sympathetic understanding of every individual's battle with diabetes. Dr. Cavan and I shed light on the dark corners of food culture, sugar consumption, and their contributions to the diabetes epidemic, offering a compassionate roadmap for making informed changes to one's diet. Through engaging stories and a focus on personalized care, we underscore the significance of dietary choices and glucose monitoring in potentially reversing type 2 diabetes.

We wrap up the conversation with an inspiring story of Eric, a patient who found diabetes remission through a holistic approach, and discuss the synergistic roles of diet, physical activity, and intermittent fasting. These practices, which once were ancestral norms, are now powerful tools in our modern fight against diabetes. Dr. Cavan also gives us a glimpse into his forthcoming book, promising to be an invaluable resource for anyone looking to take an active role in their health journey. Tune in for an episode that not only challenges conventional wisdom but also champions the idea that it's never too late to make life-altering improvements to your well-being.

Florence's courses & coaching programs can be found at:
www.FlorenceChristophers.com

Connect with Florence on:
FACEBOOK | TWITTER | INSTAGRAM | YOUTUBE

Transcript

Speaker 1: 0:02

Welcome everybody to an interview today with Dr David Kavan. Let me read you his bio. He is an endocrinologist specializing in diabetes in the United Kingdom and he's been doing this since 1996. From 2013 to 2016, he was a director of policy at the International Diabetes Federation and since then has worked on diabetes projects and professional training around the world, including Bermuda, kenya and the Democratic Republic of Congo. He has always prioritized patient education and has developed in-person and online education programs and has authored several books for people with diabetes.

Speaker 1: 0:43

One of which I will mention right now is coming out in January of 2024. And the title is as simple as it could possibly get how to reverse type 2 diabetes and pre-diabetes. Like there. It is as simple as that. It is possible to put a diabetes into remission type 2. And his book is going to walk you through that, but we have to wait till January, but make sure you get that on your schedule. He's a very particular and passionate interest in helping people work with their lifestyle, to do lifestyle medicine, which could include carbohydrate restriction, and he also helps people manage type 1 diabetes. So he's our diabetes doctor. Welcome, dr Kavan.

Speaker 2: 1:30

Well, thank you very much. Thank you for inviting me to speak to you today.

Speaker 1: 1:34

So what inspired a doctor to work with lifestyle medicine as opposed to just prescribing medications and saying the message this is progressive, the best we can do is manage it. Don't worry about what you're eating, just as long as you've got enough insulin. You chose a totally different path and you chose it pretty early as a doctor. What inspired you to do that?

Speaker 2: 2:00

Well, as you said, I've been doing this for a very long time now and yes, I've been. So I've been doing diabetes. I've been an endocrinologist for 30 years nearly, but actually it's only in the last 10 to 12 years that I switched my focus. So I hate to have to admit it, but for the first 15, 20 years, I was following the medical model that I'd been trained in and in respect of type two diabetes. The belief was that this is a progressive condition, that once you've got it, it's just gonna get worse and worse, that you're likely to require ever increasing an intensification of treatments and likely to need insulin injections eventually. And I certainly had disbelief. I shared the belief, I think, of many of my colleagues that lifestyle changes didn't really work, because we had this understanding that whatever you do, it's just gonna get worse. And I have to say, looking back, that was always quite a negative and dispiriting prospect for someone diagnosed with a condition, and I can easily see how any motivation to make lifestyle change perhaps just wasn't very strong. But yeah, I changed track, and I changed track quite significantly. It was about 2010, 2011.

Speaker 2: 3:33

And there are two things that happened at about the same time. The first was that, as a specialist based in a hospital department at the time, most of my time was helping people manage type one diabetes. That was just the nature of the work that I was doing. But in the years up until then, I'd made a definite decision I wanted to do more of the clinics with people with type two diabetes, because there are lots of exciting new medications coming along and I wanted to find out how they worked and how people did with them, and so I began to see more patients with type two diabetes. These new medications came along with great promise. I was prescribing them left, right and center, which again, I think is a terrible confession really to make, because but it's the truth, let's not hide the fact that that's the way that we're trained. That's the way a lot of our exposure to medications is to encourage us to prescribe and prescribe more. And what happened was that some people did really, really well initially, but as time went on, people would come back to me and they might have done well for a bit, but they were pretty much back at square one and nothing really much had changed. So I really began to question my belief in these medications and in the trials that had said that they were going to be really great. And for the first time in my career and by then I'd been in diabetes probably for nearly 20 years in total For the first time I actually began to ask people well, what is it, what do you eat and what do you drink?

Speaker 2: 5:21

And I was actually quite shocked like perhaps not surprised, but quite shocked at the answers that came back. And it was obvious that people were eating a lot of carbohydrates, a lot of starchy foods, and that wasn't their fault, because at the time that was a recommendation that if you have diabetes, you should base all your meals on starchy carbohydrates. But there was also this notion that actually you can eat whatever you like, but within moderation. But what does that mean? And people just interpreted that as well, I can eat what I like. And so then I began to think well, why don't I just offer patients the option? And what I said was well, normally in this situation, what I would do is prescribe another medication. But how about? We might be to avoid that if you could make some changes to what you eat and what you drink? And it seemed obvious that the obvious change should be to reduce the amount of sugar and reduce the amount of starch that you eat.

Speaker 2: 6:23

So that was the first experience, but at about the same time 2010, 2011, we began to get through the quite remarkable results from the work of Professor Roy Taylor in Newcastle, in the north of England here, who did these really to my mind, pivotal and paradigm-changing experiments in people with obesity and type 2 diabetes and showed that if they could lose a lot of weight and it was, on average, around 15 kilograms or 35 pounds in weight their diabetes reversed. All the markers, all the physiological measurements, they all got better and this was revolutionary. So I put the two together and people were beginning to come back to me. They cut a lot of the carbohydrates they were eating. Their sugar levels were coming down. I had people coming off insulin, and this was unheard of People. Once you're on insulin, you need to stay on insulin as a mantra, and so that's really the sequence of events, how I came to change my practice, and it was a big, big change that has influenced my practice and a lot of the other things that I've been doing ever since.

Speaker 1: 7:40

Incredible, incredible, and I can imagine that it wasn't just to the benefit of your patients that their lives were improving. They were getting off of medications, that their health was heading and not just being managed or slowing down the inevitable. They were actually putting their diabetes into remission and I'm sure that was joyful and they were grateful. But I imagine, as a doctor, that brought so much more joy back into your career too, like I can imagine how discouraging and depressing it must be having these people that you care about and wanna help just watching them get worse all the time, with all your best effort to help them.

Speaker 2: 8:26

Yeah, absolutely right, and if I'm honest, then managing patients with type two diabetes was not a terribly satisfying part of my job, and very often again as a specialist in the hospital center, the patients with type two diabetes we saw were those with quite advanced complications, having foot disease, having had amputations, having diabetic eye disease and so on, and so to engage with people and help them make changes that were actually improving their health and going against everything that we believed it was yeah, it was. It turned a negative into a very positive experience for me as a doctor, as well as for the patient, and, as I said, set my career on a much more exciting pathway for the subsequent 10 to 12 years that has passed since.

Speaker 1: 9:26

All right, it's brought the joy back into it. I'm sure what actually motivated you to go to med school in the first place, what motivated you to become a doctor?

Speaker 2: 9:37

That's a very good question. I'd love to say it was because I had this burning desire to help people and do good and all the rest of it which I guess is in the mix. It certainly wasn't for the money, because in the UK that isn't a big feature of being a doctor, but it's something that was just always within me, and I remember I was speaking to someone just recently. One of my early memories at school was at the age of about seven or eight, telling a classmate that I wanted to be a doctor. I have no idea where that came from, but it never really left me.

Speaker 2: 10:14

I don't come from a medical family. In fact, I was the first in my family who ever went to university, so there were lots of hurdles to try and get through. But yeah, however many decades later, here we are and, yeah, I became a doctor. I became interested in diabetes while still at medical school, largely as a result of an inspirational teacher. I knew nothing about diabetes until then, had no family experience of it, but yeah, that's shaped really how I've ended up doing what I'm doing.

Speaker 1: 10:46

You know if I could tell you the number of doctors. I've asked what inspired you to become a doctor.

Speaker 1: 10:50

They said I don't know how to describe it I was about five or six, I was seven or eight, it's like it's a calling Like really, dr Kavan, like over and over they're like I just felt a calling, like I just knew, like it's so interesting. So I'm so glad for doctors that there's this opening to sort of bring in lifestyle medicine into their practices so that they can really have the joy and the satisfaction of watching clients come in for help and actually get better. Yeah, yeah, I feel so much gratitude for the calling that you had and the services that you offer us. So let's talk a bit about diabetes. So I don't know, maybe you could just do a quick little diabetes 101. Like what do you want us to know about this condition? And then maybe we could talk about the role sugar plays in the mess that.

Speaker 2: 11:44

Yeah, no, no, absolutely. And I guess most of the focus really in this type of conversation is around type two diabetes and we'll come on to that. I always feel an obligation to say a little bit about type one diabetes, because people with type one diabetes, I think, get quite a raw deal. They very often and there shouldn't be any stigma about having any type of diabetes, but unfortunately there is and people with type one diabetes feel very much they're lumped in with the other type of diabetes and they don't, you know, they feel a bit of grieve by it. And the reason is that type one diabetes has absolutely nothing to do with lifestyle, with gaining weight, with obesity or with any unhealthy lifestyle behaviors. It is an autoimmune condition that happens because the body's immune system fires off in the wrong direction and kills the cells that produce insulin, and so it usually occurs at a young age, but can occur at any time of life, and it's a condition where, therefore, by definition, you rely on insulin injections every day, several times a day, for the rest of your life to stay alive. Diet has a huge role in type one diabetes, you know, maybe we can expand on that later, but it's essentially an autoimmune hormone deficiency that requires replacement of the missing hormone, which is insulin. Actually, how you replace it is extremely complex because it's not like some other hormone deficiencies where you take a tablet every day or twice a day. It is really really very complex because the amount of insulin you need varies, but really minute by minute. So that's type one diabetes.

Speaker 2: 13:44

Type two diabetes is very, very different, and the problem in type two diabetes is not that your body can't make insulin, it's that your body can't use insulin. It's what is termed insulin resistance and that arises from the metabolic changes that result from modern day lifestyles typically characterized by carrying excess weight, eating excess calories, particularly sugar, and foods metabolized into sugar, so carbohydrates. And what we understand now is that that excess of carbohydrates in your diet leads to that excess energy being stored in the liver as fat. And if there is excess fat in the liver, that, through other changes, makes the liver resistant to the effect of insulin. And what insulin does to the liver is basically controls the release of glucose from the liver into the bloodstream. And when the liver becomes resistant to insulin, related to the abnormalities because it's for the fat. I'm simplifying it and it's sounding complex, I know, so please stop me if we need to go over some of this. But it's really, really critical, because what then happens is the glucose stores in the liver just begin to leak out into the bloodstream. So, almost whatever you do, your glucose levels, your sugar levels, are high, and that's aggravated by the food and the drinks that you're taking in that increase the sugar levels as well. That stimulates the body to produce even more insulin to try and keep those levels down, because that's what insulin does, but because of insulin resistance, it doesn't happen. So you get this terrible vicious cycle where high sugar levels means they're higher insulin levels. High insulin levels means the body becomes resistant to insulin and sugar levels just go up and up and up and up. So giving insulin to someone with diabetes type two diabetes, where there's too much insulin clearly is not necessarily going to be the right thing to do and very often just makes things worse. So that's how type two diabetes develops.

Speaker 2: 16:04

I would just add one final thing that I said. There's a lot of stigma around diabetes, and around type two diabetes in particular, and that's because it is related to our modern day lifestyles. But I would always, always emphasize that that is not to pin any sense of blame on that individual, because all of us, wherever we are, our food is directed by the, or what we eat is determined by the food environment that we're in, and anyone who's lived more than 30, 40 years will recognize that the foods that we are surrounded with now and it's now no longer just in Western countries like the US or Western Europe, it's all around the world it's very high in sugar, it's ultra processed food and it's designed to make us consume more and more and it's causing these problems. So it's not a personal choice, it's the fact that that's the food environment we're surrounded with and that's driving this huge epidemic of type two diabetes right across the world.

Speaker 1: 17:13

Totally. Yeah, it's a food culture malfunction and you're the victim. You're the victim, you are and this is not your fault. There's obesity and obesity and diabetes and all those other sort of lifestyle disease sugar connected. Chronic diseases are really because of an environmental and because of misguided food policies. Commercial profit driven lobbying like it's just a mess and you're caught up in it. And this conversation today and the summit, our work separately and together right now is really to help you have the information that you need to compassionately go okay, body, I didn't do this to you, no one, you know like, let's just going forward, I'm going to figure out how to feed you well and care for you well so we can get this reversed, or you know, as best as best we can. So there is a message out there that diabetics can have some sugar, you know to moderate, some that you know no one can totally give it up and it's not necessary. What is your opinion on that?

Speaker 2: 18:28

Well, in some senses, it's quite difficult to avoid all sugars, because a lot of foods will have a degree of natural sugars, you know, including vegetables, for example.

Speaker 1: 18:43

Yeah, I mean refined, I mean not what.

Speaker 2: 18:46

I yeah, but what I say to people is you know, if you want to go on on this journey of reversing your diabetes, of achieving remission of type two diabetes, then really you need to understand that means trying to exclude sugar from your diet as much as you possibly can. And I think that it gives completely the wrong message to someone to say, oh yeah, it's fine to you know to have some candy or you know to have an ice cream in the evening, as long as it's only a small amount. And I think what people are realizing more and more is now that so many people with diabetes are wearing glucose sensors so they can see what's happening to their glucose levels minute by minute. You know they're getting quite a shock that you know a banana that for many people has been been promoted as doing a really good snack to have it can push your sugar level up really high and quite quickly. So but it's a message that people understand because it's sort of obvious, isn't it? If you have, if your body it has a problem in controlling the level of sugar in the blood, don't add to it. And I often think of. You know other health conditions, so, for example, celiac disease, where people are intolerant of gluten or in wheat products. They are told in no one certain terms, you must not eat anything with gluten and, even to the extent, do not use the same utensils as other family members who may, because of what they've eaten on that plate previously.

Speaker 2: 20:33

And it's always been a bit of a puzzle to me, you know, long before I changed my focus towards lifestyle management of diabetes. Why are we saying people with diabetes, which is, after all, a condition of carbohydrate intolerance? Why are we saying it's okay to eat carbohydrates? So sugars? Absolutely To my mind, the goal should be to minimize them as much as you possibly can, and you know.

Speaker 2: 21:04

But then I'm a great believer in people identifying their own goals, making their own decisions, and if some people want to have something with sugar in every so often, then they'll be able to see what it does to their sugar levels and they may be able to manage it once in a while and be happy to do that. But we've got to be very careful about something else which I'm it's quite new to me, I'm only really learning about in the last couple of years, and that is sugar addiction and the power, the addictive power that sugar has and, I think the food industry knows all about, which I think drives a lot of people's sugar intake and their journey towards type two diabetes. And if there is sugar any sense of cravings or addictive feelings towards sugar or sugar containing foods what I'm understanding is the only real way, just as with any other addiction, is to exclude it completely. Moderation just doesn't work.

Speaker 1: 22:06

There's an expression in the dozens of 12 step programs oriented towards sugar addiction food addiction recovery is 99% is a biot or a bugger and 100% is a breeze. That for those of us on the addiction spectrum like just breaking up, like just clean, we're done. I'm a whole food woman, I'm a whole food man and rebuilding an identity around that is peaceful, it's joyful, it's doable. It's when you're dabbling and you're fighting with cravings and oh, should I have a little, or was that too much? And you're just in crazy in your mind all the time about food. It's so much more doable sometimes to just say no, I don't smoke, I don't eat rad poison and I don't eat sugar. It just doesn't help my thing.

Speaker 1: 22:55

Yeah, so what are so, beyond just deciding to break up with refined carbohydrates, to what extent do you feel diabetics would do well to go low carbohydrate, like can some sort of just eat like potatoes and rice and fruits and stuff like that and still be able to put their their their diabetes into remission? Or do some have to go quite low carb sometimes?

Speaker 2: 23:24

So yes and yes, and I think this you know this is we're still learning all the time about this, but I I certainly have have patients who who go low car. I think reducing carbohydrate intake not just sugar, but reducing the large portions of rice and potato and pasta is is also very important, because your body it is all sugar. And people are quite shocked sometimes when I refer him to the glycemic index and I tell them that if you have a bowl of white rice, that will push your sugar level up quicker than if you're eating table sugar. You know if we believe in the glycemic index. So so all those white foods, or beige foods to the to the body are sugar and you need to reduce. You need to reduce across the board. But I have some patients who will achieve remission and remain in remission, but do still eat some carbohydrates, some starchy carbohydrates.

Speaker 2: 24:36

I had a patient recently and one of my messages is just just stop breakfast cereals. You know breakfast cereals are ultra processed, refined carbohydrate, even if it's not got a lot of sugar in it. So it's all starts and it's the worst time of the day in the morning is to challenge your body with with a big load of start. So my message has always been choose a breakfast that is not based on cereals or skip breakfast. But this lady came back and I don't know if you have it in the States, but we have this breakfast cereal called wheat of eggs, which is sort of wheat biscuit things, and she said oh, I just love it so much three times a week. I just have one in the morning and I looked it up it's only 13 grams of carbohydrate, but it is 13 grams of carbohydrate.

Speaker 2: 25:29

But to her one it was important for her to. She was able to have a small amounts without, you know, having cravings to have more and more and more, but she stayed in. You know she remained in remission from her diabetes. So that's why I would always encourage people to to find their own path and their own level. Now other people will need. You know that wouldn't work and other people need to go to a very low carbohydrate, maybe a ketogenic level of carbohydrate restriction, to stay in remission. And you know that's fine. I don't ascribe to the fact I sometimes get criticized. I was criticized quite recently quite publicly in a meeting when I said that not everyone needs to be in ketosis, you know, to manage their diabetes, because we are all different, but some do, some don't.

Speaker 1: 26:31

Wow, whoever's criticizing you for that is wrong. They're not working in the front lines. They're not Well they're not.

Speaker 1: 26:39

They're not, I can tell you, they're not. The minute you start working with people, you very quickly get there's such a thing as bioindividuality. Yeah, end of story. And, and I'll tell you, I first discovered that diabetes could go into remission.

Speaker 1: 26:56

Twenty years ago I entered into a 12 step program for food addiction recovery and it was an in-person meeting and we would meet three times a week and at one point I was probably in program, as I recall, about three months. I had just got, but I was three months in and I was starting to get the hang of things. And I remember very, very clearly there was this guy I call America wasn't his name and he came in and he was probably early 60s, maybe mid 60s. He was big, he was moving slow. You could feel the negative, dark storm cloud around his head. He was, he was greasy, he smelled terrible and he sat right beside me and his hair was very thin, but he grew it out on one side so he would slick it over and he did not want to be there. And I'm painting a picture of somebody who was miserable, because he was. He looked miserable, he smelled miserable, he you know what. He was hanging by a thread and he thought what the hell, I'm desperate, I got to do something. So it came into this meeting and because we all have been there we're all food addicts, sugar addicts, and we know how miserable we can feel and how discouraged and self-loathing and suicidal like we get it and so at the break we all swarmed them right Like welcome, you're in the right place, you can do this. People figured it out. We didn't. We just got blessed to figure out what we need to do to turn this whole mess around, get a sponsor. Here's the mail plan.

Speaker 1: 28:29

Well, if Eric didn't just go to the front of the room just about six months later, having lost 75 pounds, he was at the front of the room and he's like by the way, I came into this room, he goes. He held up his jeans, he goes, I can almost, almost fit into one of these leg pants now, like one of the legs. He brought his belt, his you know like yeah, almost could have gone around him double. It was unbelievable. But he said here's the thing. He said I've been diabetic for decades. I was on 11 different medications when I came in six months ago and he said I'm down, I'm off 10 of them, there's one left and my doctor's optimistic that we can get that one sorted out in time. But he said I am no longer diabetic. I am no longer diabetic and I remember what. And he nudged the guy, ron, beside me. I'm like Ron, I don't think you can reverse diabetes. And he goes, lawrence, he goes.

Speaker 1: 29:26

We reverse diabetes all the time. We know that if you haven't reversed your diabetes within 30 days, that your doctor isn't cutting your medication or your blood sugars aren't stabilized, you're not doing the program. Now, that program, david, I can tell you exactly what people ate on it because everyone weighed and measured. It was like very precise, and there was six ounces of fruit with breakfast and there were four ounces of carbs at dinner. It could be any whole food carbs. All the meal plan was 100% whole foods and we ate anywhere from 10 to 14 ounces of vegetables for lunch and dinner. There was plenty of carbohydrate Now, all whole food sources and not excessive amounts and there were certainly no refined carbohydrates.

Speaker 1: 30:16

And people reverse diabetes all the time and after a while I watched it happen over and over and I kept saying, oh my God, like this should totally be on the front page of the New York Times. I used to walk around and say randomly to people did you know you could reverse diabetes? Oh yeah, no, no, you can't, I guess, right. It was just such an incredible revelation when the light bulb goes on and you're just so excited and you just think why is this not on the front page? Well, it's getting there.

Speaker 2: 30:44

It's getting there, but it is slow. And it's very exciting because in the last few years the acceptance amongst my colleagues, amongst physicians, a medical community it is growing. 10 years ago when I first started it was very much. People were very skeptical, very, very skeptical. Even five years ago. I remember working in one of the clinic site work meeting with not just skepticism, I mean almost outright opposition. You can't possibly tell people they can't eat these foods. There's no such thing as bad foods and blah, blah, blah. But what happens is that people are doing it, they're achieving it and they're going to their doctors and their doctors saying wow and so.

Speaker 2: 31:38

I think, it's spreading, but it is very much bottom up, very much bottom up.

Speaker 2: 31:43

It seems to be spreading, but I think there is more and more an acceptance now that we'll get to a tipping point where, before too long, people are going to be demanding. I've been diagnosed with type two diabetes. I need your help to put it into remission. Is that should be? If it was a cancer of any source, we'll talk about remission straight away. Now, sadly, there are some cancers where that's not possible. But I have person experience. My dad died about 10 years ago of a quite an aggressive form of. It turned out to be leukemia, but almost until a few weeks before he died, they were talking about the positive, about the hope, about what we can try and achieve.

Speaker 2: 32:31

I'm thinking why, if we had a 10th of that type of attitude in diabetes, focusing on the positive, what you can achieve, not all the negative, or it's so difficult to follow it changed your diet. People can't change their diet. I mean, where does this come from?

Speaker 1: 32:50

Right, and if doctors had any idea how much power they have, they are still gods for many people. And if a doctor looks a patient in the eyeball and says, honey, you need to get onto whole foods, right, and there's a range of whole food meal plans, right, maybe you try moderate, put on your CGM, stay in this range. Whatever gets you in that range and keeps you in that range, that's what you get to eat, right? And if you need to go lower carb for a while to stay in that range, do that. As your metabolism heals, you'll probably be able to bring some stuff back. Right now. We're saving your life, and it does not just have to be keto. That's garbage. People can do keto, wonderful. People can do carnivore float your boat. But people can also just do moderate whole foods, three meals, no snacks, and absolutely turn their diabetes around too. Now, it really is bio-individual, but everything's possible.

Speaker 2: 33:49

Well, I completely agree and I think that, yes, it's great to have the people who are very enthusiastic about one type of dietary plan or another, but I think, accepting that there are lots of ways of doing it and the right way is the way that the person themselves is able to maintain and sustain, and totally the wrong thing is to criticize someone because, yeah, even what I say, I have to accept that what my approach has been informed by my own experience and experience of my patients over the past 10 years. But that's not the global knowledge and there may be things that I'm saying to people no, you shouldn't eat that, but actually, within their overall meal plan, they can incorporate it and they do really well. So, absolutely step back, provide the guidance, absolutely, to my mind, sugar, you need to exclude it as much as you can, but I always say as much as you can, because that's for that person to determine. And, as you say, whole foods, real foods, food, quality foods and just cut out the junk. I'm reminded, as you were speaking, I've done some work in Bermuda in recent years and there was one young guy I think it was only in his 20s very overweight, on a lot of insulin, type two diabetes.

Speaker 2: 35:35

He often wasn't taking his insulin and I just asked him about his dietary plan was, and it was largely Kool-Aid Is that a sugar drink you have in the States, I think and he was just drinking through points of sugar. So the sugar drinks several times a day. It's a hot place. But so it was refreshing and I just did a sort of deal with him. I said you know what, If you cut out the sugar drinks, we can stop your insulin. And we did there and then Wow, and while he did, also Sorry.

Speaker 1: 36:17

Just like that, just from his doctor saying cut that out, and he did it.

Speaker 2: 36:22

Well, that was, that was the conversation we had. He didn't cut it out completely, but over the couple of years you know his age B1C came right from being in the teens it came right right down. He didn't reverse his diabetes, but it was, you know, literally that exchange will. Actually, if I'm not putting in this whole sugar the whole time, I don't need this insulin and this insulin isn't working anyway. So why don't we just try and cut them both out? But but you know, it is at one level. It's as simple as that. Just just stop feeding yourself the stuff that is being marketed all over the place and quite blatantly as a normal thing to be eating and drinking, and there's nothing normal about drinking sugar.

Speaker 1: 37:13

I know people say it's so extreme to cut all processed junk food out, like that's too extreme, like that's neurotic, like that. That isn't even psychologically healthy. And I think, oh dear, if you knew the science you would know it's extreme to even considering putting processed junk in your body. It's absurd. Well, it is.

Speaker 2: 37:32

And I heard a wonderful quote recently of someone who said well, of course we shouldn't be thinking about for processed foods as foods. And you know, I said to I said quite a while well, actually, they're not really foods, they're just chemicals formulated into something you eat. But I said, well, really, it's recreational drugs. Yeah, you know they are. They are chemical compounds designed to make you feel happy and want to have more of them. Well, isn't that what recreational drugs do?

Speaker 1: 38:07

Oh, they do one of two things they either sedate. Sedate us, they put us into a bit of a coma, a comfort zone, a numbness, or they stimulate us. And so these natural whole foods, like the salmon, broccoli and black beans, they don't do either. They're just grounding, they're just nourishment. There's no party, it's like what's this? This is boring, this isn't doing anything. And then you realize, oh right, foods actually just nourishment, it's just fuel. It's not a time to be.

Speaker 2: 38:41

And I think, in response to the people who say to you well, it's far too extreme and unnatural to be cutting out all those foods. Well, how did human kinds manage for all those thousands of years and more, until about 100 years ago? Because they didn't exist.

Speaker 1: 39:00

Right, right. I often joke that if 100 years ago, I told people what I did for a living, which is I help people to eat three meals a day, more or less Sometimes it's two, sometimes it's four, depending on if they've had bariatric surgery or whatever but let's say, generally speaking, three meals a day, no snacks, whole foods only, people would laugh their heads off. They'd be like what People pay you to tell you what Like what's a snack?

Speaker 2: 39:32

Yeah, exactly, exactly.

Speaker 1: 39:36

Yeah, I know it's absurd, Like just, it's the most obvious thing in the world. Eat like a farmer. Eat your protein, your veggies, your healthy fat, if you can right, if you can your complex carbs a little bit here and there. Keep it low if you've got diabetes or a medical condition of any kind, and figure out what you can bring back in when you're healed. Easy. Talk to us a little bit about snacking, because I'm assuming that's a recommendation that you make as well. So the sugar, the process, refined carbohydrates are a no go. Yeah, if you're serious about not getting diabetes or putting it into remission, just like honesty. There's recommendations for people with cancer Don't eat sugar, because cancer feeds sugar. So same thing. We're saving your life, so that's. But then there's this issue with snacking. So what are, what's, your thoughts on that?

Speaker 2: 40:22

I've done some work in recent years with a guy who used to work. He used to market junk foods until he developed type two diabetes and he read one of my books. He's reversed it. He gave up marketing junk foods. He now markets vegetables and fresh fruits and he told me he said well, the snacks are essentially a creation of the food industry because they have huge profits from them and it's a completely unnatural concept. Interestingly, until about 10 years ago probably perhaps a bit longer people with diabetes were advised to have three meals a day and then to have snacks between meals.

Speaker 1: 41:10

Yes, Three snacks, three meals.

Speaker 2: 41:12

And that that you know. I get the. The was at one point some logic to that, because it came from the time when people with type one diabetes were treated with insulin usually, you know, one or two injections a day, no means of monitoring their sugar levels, because that's relatively recent. So we're talking up until the 1980s and insulin was very erratic in the way it was absorbed and it was seen as a safety thing. You need to have snacks through the day just to stop your sugar level going too low. But unfortunately, despite all the advances in treatment, despite, you know, all the monitoring techniques we have now it until relatively recently, it stayed the same message Bizarre.

Speaker 2: 42:02

And so a lot of people believe that they need still, you know, to be having snacks several times a day and quite often they feel liberated when I say, well, don't and don't. You know but, but more more than that if you're not hungry, just don't eat. You know you don't actually have to have three meals a day. If you're not hungry in the morning, don't have breakfast is a great form of intermittent fasting, which you know is another technique that could be quite effective. So the sort of sugary snacks, those sort of snacks, I think absolutely shouldn't have any any place at all. We have to acknowledge that people do get hungry sometimes and you know, if they've not maybe eaten enough one of their meals and they're hungry later on.

Speaker 2: 42:48

So when I say to people, is you know I, yeah, I, rather than just not eating anything to your next meal and risking getting getting grabbing a sugary snack because you're really desperate, make sure you have some healthy snacks available so that, if you know, if that, so that if you are hungry and you need something before the next meal, you've got something to eat. And people absolutely love it when I give them the freedom to eat cheese, because there's still this amazing thing that cheese is bad because it has saturated fat in it. And you know, despite all the sort of refining of the message and I say, well, no, you know, dairy, dairy fat is healthy again, probably always was. That's not an issue. You know, cheese, nuts, hard boiled eggs, there are a number of things that you can have and just have them available. So snacking in itself is, you know, sometimes needed, but absolutely it's got to be real food, old food, and not, you know, the sugary type which will send you back to where you started.

Speaker 1: 43:56

Mm, hmm, so there's nothing but hope. So what other things can people who have prediabetes or diabetes do to get this turned around and get them back on the right metabolic path?

Speaker 2: 44:13

So the main thing is changing diet, as we've been talking about, and that probably accounts for, as a guess, but probably 80% of the impact that you're going to have. So often people come to me and say I know I need to lose weight, but I can't exercise my leg. I've got arthritis. I can't exercise, I can't walk. I said, look, I don't want you to exercise, I just want you to change what you eat. So I don't use the word exercise. But physical activity has a role and there are two things that I say to people. One is try and avoid sitting down for longer than an hour, because we know that long periods of sitting down sort of puts your body into a metabolic sleep mode to conserve energy. Sugar levels will tend to rise and you're more likely to, or less likely to, reverse the problem if you're sitting down all day. So set your watch or your phone or something to buzz every hour, and so you have a desk job where you're in front of a screen every all day. Just get up out of your chair, walk around for a few minutes, sit down again. I say to people make your office as inefficient as possible, don't have everything to hand, have some print to the other side of the room, whatever. So avoid sitting down for long periods is the first thing. The next thing is try and build walking into your routine. Because there was this thing we've been told you've got to go for a 30 minute brisk walk every day. Well, that means that you need to find 30 minutes where you can go out for a walk every day, and that's the focus. Well, real life isn't like that. But what you can do is begin to think well, I've got to get from A to B, but so, supposing I just build walking into some of that. So if I'm driving somewhere, park a few hundred feet away from where I need to go. So I've got to walk the last 10 minutes of the journey. If I'm using a bus, get off one or two stops beforehand. If it's less than a mile, we'll just walk, finding ways of building walking into your routine. So there's the physical activity, but the one point just beyond that, one point where going for a walk really really can help, is just after a meal, particularly in the evening. If the weather's reasonable and you've had your evening meal rather than just sitting down in front of the TV, go for a 15 minute walk. It can really help keep the sugar levels down, avoid it spiking too much. So that's all I say about physical activity.

Speaker 2: 47:03

There are some programs here, and the rapid weight loss program that's built upon the work of Professor Roy Taylor, who I mentioned earlier. They actually ban exercise. They say don't exercise. They want the focus to be on changing the diets and they also don't want people to injure themselves Because they're very overweight and they've never done any exercise. Don't start exercising. But as people lose weight they feel better, they feel motivated. They say, oh, I can get on my bike again, I can go cycling, I maybe can start swimming again. That's the time to start the more exercise type of activity.

Speaker 2: 47:43

And then the other thing is intermittent fasting. And again, I knew nothing about fasting until I started on this journey, but from the work of Jason Fung and others who clearly are great experts in it, and I now get and I understand the benefits of fasting and we have got time to go into them all now. But particularly for someone with type 2 diabetes or with pre-diabetes I mentioned, you're insulin resistant and your insulin levels are high. Reducing your carbohydrates will reduce your insulin levels, but in some people, eating protein well, in everyone. Eating protein will keep your insulin levels up a bit and in some people quite a lot, and so actually, if you really want to drive those levels down, fasting is a surefire way. It's guaranteed your body will not survive if you have very high insulin levels through and on fast, and so having a 16-hour fast two or three times a week, just by skipping breakfast, in itself has additional benefits.

Speaker 2: 48:55

Some patients will choose to have just one meal a day on certain days, but I would just say to people and very often it's very easy because people say you know, I don't eat, I don't like eating breakfast, I'm not hungry in the mornings. I only started eating breakfast when I was diagnosed with diabetes and I was told I have to have breakfast and I have to have three meals a day. So again, it can be very liberating just to get breakfast. But make sure you don't end up really hungry and hit the sugar at 10 o'clock in the morning. But plan it that you'll have an early lunch and busy yourself.

Speaker 2: 49:29

I do it for my own health benefits I don't have diabetes but I choose to do it on days that I'm really busy. I'm in clinic and so I haven't got time to think about food till I get to lunchtime and I do need to eat. A longer fast for me, I'm not sure I'd be very effective in the afternoon. So be more active. Spend more time on your feet, less time sitting down and skip meals. Introduce intermittent fasting. They're the only other measures that I introduce alongside the dietary changes.

Speaker 1: 50:03

Wonderful. Last question Is it are you able to practice within the mainstream medical system in the UK or did you have to go private? And is it safe for you to be a doctor who's not following standard of care around diabetes management?

Speaker 2: 50:21

So I do work in the public health system in the UK, in the NHS, and I do also have a work with it within a private clinic. So, yeah, yes, of course, yes, yes, yes, it's, it's, it's safe. And it's safe because just about every diabetes guidelines says that the first intervention is lifestyle and dietary change. Okay, Now if you were to print out the guidelines that come from, you know, the American Diabetes Association or the equivalent in the UK or UK, nice guidance. Usually it's one line across the top, diet and exercise, and then drop, drop, drop, drop, drop. You know pages and pages of different medications.

Speaker 2: 51:16

But I believe I'm following the guidelines because I'm encouraging lifestyle change and I will use you know I use medications. You know we have to be realistic. We know that the longer you've had diabetes, statistically the less, the less likely or the less likelihood of remission. But we know it can be. You know you mentioned someone who had diabetes for many, many years. I've had people achieve remission after 30 years of diabetes. So it is possible, but we have to accept that in some people medication is part of the package, Right? So, to my mind, I completely follow the guidelines because I focus on lifestyle, but I will use medications as appropriate and as per the guidelines, as required.

Speaker 1: 52:06

Yes, got it. I'm just thinking of Dr Gary Fedke, who was a doctor who had cancer. It just really struggled to put it into remission. You know he was doing all the proper protocols. He was drinking sugary drinks and insurer and that kind of stuff I shouldn't pick on any particular company because whatever like these sugary sort of drinks that they recommend for people in the hospital when they have cancer and they don't have much appetite and they're losing weight and he just couldn't get his cancer to go into remission.

Speaker 1: 52:34

Then one day he came across some information about how cancer feeds on sugar and he changed his diet and he went on this whole like Eureka oh my God, it's my lifestyle, it's my food, it's my stress, it's all of it and turned it around and he's healthy today. And then when he got back, when he was well enough to go back to the hospital to act as a doctor, he was telling his patients don't eat sugar, don't look me the eyeball, don't need it. No refined carbohydrates, you need to eat whole foods if you want to heal anything. Your body needs that good nutrition and just get off the junk. Anyways, he got ratted out by a dietitian and lost his license, like he wasn't allowed to say don't, you know, eat whole foods and avoid the junk. Like it's just shocking. So I'm always so worried about for doctors, right that somehow someone's going to come along and say, wait, no, so good to hear that.

Speaker 2: 53:29

So there are, you're absolutely right, and that was in Australia.

Speaker 2: 53:32

And there's obviously been a professor, tim Nokes, in South Africa, and you know I'm not aware of any anyone who's been through that sort of experience in the UK, and we are part of a growing number of doctors and but, but, but yeah, I guess I've, I'm of an age and I've been doing this long enough that you know I'm doing it because I think it's the right thing to do. I think it's the most effective way of managing diabetes and if people want to have a go at me then then maybe they will, but I don't want to invite it.

Speaker 1: 54:13

No no, no trouble, please. But you could easily say oh, by the way, here's all my files, let them speak for themselves. Yep, reversal, reversal, reduced medication, reversal, blah, blah, blah, like I'm saving you money and I'm saving lives. That's what you know my job is. So please correct me if I'm wrong. Is there any final words you'd like to share today on the topic of sugar, kicking sugar diabetes.

Speaker 2: 54:42

I think you know. I think we've had a very wide ranging discussion and thank you for that. I think we've covered quite a lot. I think that the final message I would just say to someone you know who may be watching this, who may be feel you know that they are eating a lot of sugar and they perhaps a bit guilty that they're eating sugar, is just to reiterate you know there is no place for guilt.

Speaker 2: 55:05

It's negative and, yes, we can all explain, we can all, you know, criticize ourselves for the way we are, but you know it is as it is and but actually, you know, there is always hope and you know the person you mentioned from all those years ago. For many people he was a no hopper, but there is always hope. It's never too late. It's the other thing. I think my oldest patient who I don't think he quite achieved remission but he turned his diet around completely. He came off a lot of medications, he improved his sugar levels. He was 88 years old, wow, and it was during the COVID pandemic. We did a consultation on the phone, because that's how we did it at the time, and then, six months later, you know, that was all he needed.

Speaker 2: 55:55

He needed a 15 minute telephone consultation. I'd never spoken to him before he came new onto my clinic list and that was enough for him to get it and make some changes. And he was 88 years old.

Speaker 1: 56:10

Oh, that's an incredible story and I wish every doctor could hear that, because when you, when you write us off as incapable of making lifestyle changes, when we're desperate and keen to turn out, you know, to stop being in pain or stop having a chronic disease, you underestimate, underestimate us. So what a great, what a great wait, please to end, thank you very much for your time today, dr Kavan.

Speaker 2: 56:33

Thank you very much for inviting me to speak to you.