105 : The Insulin Resistance Lie? What Actually Causes Type 2 Diabetes | Dr. John Poothullil

We have over 50 hormones in the body. Why should the cell pick on insulin? It doesn't make sense. It does not make sense. It gets even more bizarre because we have 200 different types of cells in the body, but only three become resistant to insulin. The liver, the fat, and muscle.

Why? Why 197 have no problem responding to insulin? But these three are rebels. Why? What a paradigm shift like that would implicate in terms of the massive changes that need to be made across our entire understanding of law in our metabolic system or the part of our metabolic system that has been hijacked by the abundance of food and especially, you know, highly processed food that we have today.

Type 2 diabetes, it is triggered by our food intake behavior and conditioning. Insulin is a lifesaver for type 1. For type 2, it is a problem. It is not a solution. I wrote to NIH, the director of NIH, and asked, your website says type 2 diabetes starts when muscle, liver, and fat cells don't respond to insulin.

So I sent a letter asking, do you have any evidence as to there is actually a resistance to insulin and what is the mechanism. Welcome to Going In Blind. I'm your host, Zach Tidwell, and my guest this week is Dr. John Puthuli. We're going to get into an area that I haven't been able to cover on here before, but something that is very, very...

pertinent issue in in our country at least in the united states i believe almost 40 percent of americans are obese uh a lot of that is obviously lifestyle choices poor lifestyle choices probably a lack of education as well but dr john has His career has spanned everything from endocrinology, you know, hunger research and obesity and cancer prevention.

And all of these things are linked together, as you can probably suspect that or. deduce that that is why his studies would have covered all of those areas. But, you know, I think this is very important stuff to talk about. So I'm very excited to do that with him this week, because he's also proposed a new model of diabetes that hopefully we'll all come out of this with a new perspective on that.

So without further ado, Dr. John, thank you for being here. Thank you for having me. And I thank the audience for listening. Yeah, I think we're probably going to leave this one with a whole lot to think about, which is kind of the goal behind these conversations. So, you know, I had tried asking you before we started recording just to be able to accurately describe the fact that you've proposed this new model and we started getting into the weeds of what diabetes is.

And so I had to stop you so that we could. Make sure everyone heard about all this. So let's go back to that. Basically, I had asked my understanding of what your model was from a very, very high level, and then you asked me what I understood diabetes to be.

I asked you what is your understanding, and you said diabetes is a condition where a person becomes insulin resistant, leaving glucose in the blood so the cells cannot use it. The first question is, I'm going to ask you, I'm becoming the host right now. What is, how does insulin work?

What is your understanding of the work of insulin? I thought that it was produced by the pancreas to absorb glucose in the bloodstream. That is, whether that, yeah, whatever the input was that was from. That is correct. But what I'm looking at is the mechanics of it. So I asked the question, I would like to ask the question, when somebody comes to visit you, either in your apartment or in a house, how do you know there is somebody outside?

I'm blind, so my sense of hearing is very, very sensitive. I hear everything. I know someone's knocked on the door or rang the doorbell. Or doorbell. Yes, exactly. Every cell in the body, we have 30 trillion cells in the body. Every cell in the body can use glucose to produce energy.

But when glucose is outside the cell, glucose has no way of ringing the doorbell. That is what insulin does. Insulin does not get into the cell. Insulin cannot tell the cell what to do with the glucose. All insulin can do is to inform the cell. By ringing the doorbell, glucose is outside.

Once that happens, the cell has to decide. Each cell, each 30 trillion cells, each one is an independent living unit. Just like you have your own home, your neighbor has some other home, each one is an independent living unit. And the cell can decide whether to let glucose in or not based on its own need.

So the cell has to... mobilize a wagon, go to the door, open the door, bring in glucose in the wagon and take it to the power plant. So that is how it works. Now, tell me, how would you consider the cell insulin resistant? I'm guessing... that it becomes accustomed to having all of that noise outside of it.

And so then it doesn't know when to actually recognize to let, or now it's flooded. There's so many people knocking at the door that when it opens it, a bunch of it is getting in. No, no. What endocrinologists claim is the cell can hear the ringing, each ring.

for different cell needs multiple nutrients and each nutrient the ring tone is different so the cell can identify this is glucose this is insulin or insulin ringing the doorbell and it has to mobilize the particular agent or the wagon or the carrier to bring it in so those are finely tuned signaling what in an endocrinologist claim is When insulin rings, the cell is ignoring that ring tone.

It is not sending the wagon. And so they call the cell insulin resistant. Now, let me ask you a question. I don't know, did you have lunch already? Uh, no, I got my workout in and then came straight to, to talk to you. Okay. So what time do you, within how much time will you have lunch?

Uh, it'll, well, I guess I skipped it today, but I'm, yeah, normally it would have been around noon. No, after you had your meal, when you have your enjoyed, somebody else brings in your favorite food. Will you eat it again? Will you eat that also? If I'm already full from a lunch?

Right. No? No. So if the cell refuses to bring in glucose, could it be because the cell doesn't need it at that time? And if that is the case, can you call the cell resistant to insulin signaling? No, because it's not the actual mechanism at play. Right. So the question is, if the cell...

functioning normally. If that is the case, the cell is producing power, enough power, maybe from an alternate source, just like a hybrid engine in a car, which can generate power either from electricity or gasoline. If it is using gasoline to produce power, can you call that it is electricity, is it resisting insulin at that point?

Or vice versa, if it's running on electricity, is it resisting gasoline? This is what is happening in the body because when you are diagnosed with type 2 diabetes, you have no weakness of your muscle. All your organs are functioning. You are breathing, you are running, you are playing basketball, whatever.

So how can you say you are resisting one of the two fuels that your body should be using? Does that make sense to you? It does. Yeah. Well, and we know, I mean, we know the body can run in the absence of sugars, right? Well, you know, if we go into ketosis, where then it's gluconeogenesis is then producing the alternate means of fuel.

And so we know that, I mean, that... unless I'm misinterpreting this, is perfectly accurate, where we know that we are a hybrid. Right. So you're saying endocrinologists basically just aren't recognizing that when they're assigning all of this responsibility to the insulin. Exactly. Now, let me ask you another question.

We have over 50 hormones in the body. Why should the cell pick on insulin? What is the reason? It doesn't make sense. It does not make sense. And it gets even more bizarre because we are 200 different types of cells in the body, but only three become resistant to insulin, the liver, the fat, and muscle.

So why? Why 197 have no problem responding to insulin, but these three are rebels? Why? And liver has millions of cells. Fat tissue has millions of cells. Who is coordinating all these to make sure that, okay, you cannot use insulin. You cannot respond to insulin. You are resistant.

How does it work? I have no idea. Nobody knows. Oh. And is the mechanism of resistance the same at the liver cell? Fat cell and muscle cell? Nobody knows a mechanism in any one of these sites. So tell me, how can you trust when you say your body is resistant to insulin?

It doesn't make any sense. That is what I thought. I've been trying to get an answer from endocrinologists for over 20 years. They don't want to talk to me. why you know i guess there's a i think we know as humans i mean we we are victims to dogma so or maybe victim isn't the right word because that's a choice but the is that what you think it is is this is just the accepted science and then you know if we accept that there's if you've been trying to have this conversation for 20 years and you've gotten pushback that entire time is it just because that goes against what has been accepted and the i mean what what a paradigm shift like that would implicate in terms of the massive changes that need to be made across the entire our entire understanding of the metabolic or this this I guess, flaw in our metabolic system or the part of our metabolic system that has been hijacked by all of the abundance of food and especially, you know, highly processed food that we have today?

You have hit the nail on the head. Let me just give you an example of how this came about. There are, as you know, there are two types of diabetes, type 1 and type 2. Type 1, you mentioned the pancreas producing insulin, whereas in type 1, the pancreas does not produce insulin.

So even if there is glucose, the cells cannot use glucose because they have no way of knowing. So these children, this happened mostly in childhood, and these children used to die by age 10. 100 years ago, In Canada, two researchers identified and purified insulin. And when insulin was injected into these children who have type 1 diabetes, their lifespan became normal, their quality of life improved.

And the person who treated the maximum number of children with type 1 diabetes is Dr. Elliot Joslin of Boston. And even now there is a clinic there in his name to honor him. He found out, he was so amazed. He trained nurses to go into the community, give insulin to anybody who has high blood sugar.

So the nurses called him back and asked him, how much should we give? Because each person, each child is different. in their activities, their need for glucose. So how much? So he looked at his charts and told the nurses, give enough to keep the blood sugar, give enough insulin to bring the blood sugar back down to normal.

So controlling blood sugar became synonymous with controlling type 1 diabetes. So what endocrinologists did was take the same approach for type 2. And the argument being, if you control blood sugar, you are controlling the disease or the condition, which is not the right attitude. Because you need to know Why is the blood sugar high in type 2?

Because at the time of diagnosis, they have enough insulin, and some of them have more than enough insulin in the blood. So if you have high insulin and high blood sugar at the same time, you have a problem. When endocrinologists found out that a person of type high blood sugar, type 2 diabetes, an older person, have, say, adequate levels of insulin.

They had to explain that. Why? So their conclusion was, remember, by that time, pharmaceutical companies were already producing synthetic insulin. And insulin was bringing the blood sugar down. And you could tell the patient, oh, insulin is doing great because your blood sugar is down, everything is fine. However, when the endocrinologist, if they want to get reimbursement from Medicare, they have to show whether the type 1, whether the adult diabetes in adults or high blood sugar in adults is the same disease or a different disease.

When they found out adults have enough insulin, whereas children with type 1 diabetes don't have insulin, initially they thought the adult -onset diabetes was non -insulin dependent. So, which means it has a separate mechanism. And they did recognize that initially. Oh, yeah. They did recognize it. But if it is a separate independent disease, in order to get a CPT code, you have to say what is causing it and what can correct it, because you need to treat it, right?

Yeah. That means you have to find a mechanism of insulin resistance. It was difficult because they didn't know how only three cells become resistant to one of 50 hormones. So the easiest way to work around that is piggyback type 2 on type 1. So you call the children's diabetes type 1 and adults type 2.

So those who award CPT code, they say, oh, these are connected. So if it is connected, there is no problem getting a CPT code. That is so gross. And the other side of that is then, you know, you're on insulin for the rest of your life. So we've got a lifelong customer, which is all of the, it, I wonder that, you know, you see it.

I think this is a similar thing we see with psychotropic medications, you know, like antidepressants. So I lost my sight to a suicide attempt seven years ago. I shot myself in the face. I was on antidepressants for a couple of years afterwards, tried getting off, had issues, got back on them, and then I've been off for a while now.

But my mental health team pushed me to not. They were like, Zach, some people have to be on this all the time. Last time, it didn't turn out well because I went into a very, very dark place after I got off on the first time. But it's always...

we are we have such a culture of treating the symptom and not the cause and then you know there's there's that and i i wonder how much of that is a byproduct of these systems like this where these people are trying to get money both pharmaceutical companies and obviously the the researchers or the doctors who were contributing to this and it's at the same time That in and of itself is disgusting, right?

But no one, I think by this point, everyone is aware of the corruption in big pharma. I think the opioid crisis really, really pointed that out and being on the back end of that now and as where I think people are more aware of it now than ever.

But the other side of that makes you wonder, the other side. of the costs there like is is going down these lanes is that impeding our own medical advancements because we're so honed in on these subscription basically lifetime subscription models for medications and like they took here i mean this is because you said the original The application of insulin in type 1 diabetes, you said, was like 100 years ago.

But when was all of this recognized? I mean, you said that they knew that it was not the same mechanism for type 2 diabetes. Is that recognized in the literature? Well, they don't know the mechanism. So they are still... About 20 years ago, when I first started this, I wrote a letter to the NIH.

Because on their website, it will say, by the way, this is all my opinion. You can take it, leave it, change it, modify it. It doesn't matter to me. I'm just expressing an opinion. Okay. I wrote to NIH, the director of NIH, and asked, your website says type 2 diabetes starts when muscle, liver, and fat cells don't respond to insulin.

So I sent a letter asking, do you have any evidence as to, no, there is actually a resistance to incident and what is the mechanism? And he said, the reply was, no, we just put on our website what the experts tell us. We don't change anything. If you don't like it, you have to disprove it.

In other words, I have to disprove something that does not exist, in my opinion. So how do you do that? Yeah, there's no... If that's not the mechanism at play, well, could you not? Is there not a way for you to... You know, we do contrast in different scans where they track glucose entering different cells.

And so could you not do something like that? Or I guess you can't, you don't know if that's attached to insulin or obviously my, my, this is where my very, very limited knowledge is going to. I'm a retired medical doctor. I don't have any, nobody supports me. I have no outside supporting resources.

I'm using my own money here. I own the sources and just I don't sell anything, no medication, no gadgets, nothing. So this is all I have talking to people like you and spreading the message. And my article about for the first time in March of this year, the Medical Hypothesis published my concept.

So I'm very happy about that, at least now. people are beginning to question the established dogma of insulin resistance. I'm really glad you said that you don't sell anything. I mean, I understood that from the notes that your team sent to me and then the research that I did on you.

I mean, I know you've got some books, but they aren't on this. And so I think that really... that erases any or at least a large ability for people to dismiss what you're saying because you're not like hey this is this is we're doing the wrong mechanism but i have the answer and you can pay 90 a month to get it or what whatever that that would look like but and so i think that's that's very critical in this conversation that you don't have any skin in the game on this other than caring about this.

And so how has all of that been received from the medical community? Well, first of all, I thank you for emphasizing that. The medical community, especially the endocrinologist, the best way is not fighting me, but ignoring me. That is where it starts. If there is a fight, then I have won because they had to pay attention.

As long as they ignore me, They can continue to do what they have been doing because, in my opinion, they have got a confirmation bias. They are looking at it from a perspective that they have already accepted. So how do you change that? Yeah, I mean, that's an incredibly uphill battle.

not again that's the tactic is you know if you were getting attention from this then it's drawing people's attention to it and then there's going to be a foothold of your at least of other people buying into this opinion that you have and starting to push it forward and so do you have actually before before i get into that what is why do you do you have an idea as to why 20 years later now they've you've finally been able to get something published on this?

There are some other noises coming into the forefront that people are beginning to pay attention. The main thing is, if you keep the blood sugar low using insulin, you still suffer from complications of diabetes. You still have kidney problems. eye problems, heart problems, Alzheimer's. So if control of blood sugar is control of the condition, why are these people having complications?

So that is where people are beginning to think there is something that's not right here. So, but you just said, I mean, controlling the sugar. Are you... Do you not, I understand that you don't think insulin is the mechanism here, but are you also saying that you don't believe sugar is a problem in this, what's going on here, that it's not a part of the equation?

No, sugar is the problem. Okay. But the first thing is, how did the sugar go up in the first place and what's the best way to control it? Just getting the number, some people, just to give you an example. They have now continuous glucose monitors, okay? And if you look at the ad, it will say, oh, you just know the number, you are in control, you are in charge.

Now, if you know your blood pressure, if you know your triglyceride or your cholesterol, are you in charge? You have to do something to be in charge. You just have a metric. You have information to act on. Right, exactly. So just because... Is there any other chronic medical condition where you monitor something continuously for 24 hours?

You don't continuously monitor your blood pressure, your heart rate, your breathing. So why should you know what your blood sugar is all the time? How does it help to control it? Now, if you do it sporadically after a meal, you want to know what was the effect of that meal on your blood sugar.

I understand. And you're acting on it. Then you can act on it next time. Eat less or more. No, blood sugar elevation is important. You need to keep it down. For that, you need to know the best way to do that is to find out what caused it to go up in the first place.

Right? And when you say that, you're not saying literally in the sense of, hey, you're eating, you're drinking soda and your blood sugar went up. You're saying, you're again, referring back to, we need to understand the mechanism at play. And do you have any hypothesis as to what that would be if insulin is not the, what's insulin resistance is not what's making this happen?

Okay. 60 years ago. we had what is called the agricultural revolution. And every government in the world is subsidizing farming, especially grain farming. In the United States, we spend $25 to $40 billion a year as farm subsidies in different forms. And most of the subsidies go to grow grains, rice, wheat, and corn.

Now, think about it. Are they meant for humans, the grains? No, which is hilarious that until earlier this year was the base of our food pyramid. That's how twisted this stuff is. They're like, oh, we make a lot of this. Let's tell everyone they need to eat it.

So if grains were meant for humans, we would have had beaks to pick them up and the ability to digest the chaff. We don't. But the Industrial Revolution and the Agricultural Revolution made it possible for governments to feed billions of people the cheapest way by filling up their stomach with grains -based foods.

And all the processed foods, when is the last time you had a meal or a snack without a grain -based food? I eat. without grains every day, but most people don't. Correct. Yeah. So after the agriculture revolution 16 years ago, 15 to 20 years later, the obesity epidemic started.

10 years after that, the diabetes epidemic started. 10 years after that, the cancer epidemic. That is where we are now. Within the next 10 years, we will have dementia. and alzheimer's so these are the chronology of what things are going on well there's more to it than that like yes obviously this is all this is all accurate but our country is also uniquely affected by these things you know other you go to italy everyone eats pasta with every meal they're also eating wheat i'm not saying we're supposed to be eating it but we are doing things to ours that other countries aren't that are having a worse effect on us than they have on everyone else you know you don't think so no because the three countries with the largest number of type 2 diabetes are india china and the united states okay and every country is experiencing an increased incidence of obesity and type 2 diabetes regardless of which part of the world you live.

Especially developing countries are affected more because the governments can produce grains much cheaper than vegetables or fruits or nuts or animal products. That's the cheapest produce and fill them up with food. When you put a complex carbohydrate in your mouth, you are essentially putting sugar in the mouth because when they are digested, they're absorbed as glucose.

So that is what causes high blood sugar. Not your body resisting usage, you're putting in type 1 diabetes, blood sugar is high because of underutilization. In type 2, blood sugar is high because of oversupply. Yeah, I understand that. I think a lot of people do. But you're saying that, like, we're recognizing that, yes, the poor diet is making the high blood sugar.

But I thought that unless I'm missing something, I've thought this conversation was all specifically like, yes, we know the blood sugar is high. We know why. But we don't know that mechanism or why that insulin happens to be the reason that the body isn't able to get it back down.

But, go ahead. At the molecular level, at the cellular level, after a meal, let's say, what time do you have supper? Give me a time. I usually, I eat pretty early, like at five. Okay, five. Within four hours, whatever you have eaten have been digested and absorbed into the blood.

If you have a mixed or a balanced diet, you will have nine o 'clock. If you take the blood out and measure, you'll have high blood sugar, high glucose, high cholesterol, high fatty acid, high amino acid. And because of the elevation of sugar and fatty acid, the insulin will be released.

So insulin, glucose, cholesterol, fatty acid, amino acid will go to every cell in the body. Insulin will knock on the door. The cells will pick up. what they need and the leftover will come to the liver. And the liver has to process it for storage. The liver can keep only 120 to 200 grams of glucose as glycogen to be released back into the blood if your blood sugar goes down.

Whatever is left over, the liver has to convert that for long -term storage, which is fat, also known as triglyceride. And that is sent to the fat cell. We have about 50 billion fat cells in the body. So when it reaches there, the triglyceride is too large a molecule to enter the fat cell.

Outside the fat cell, there is an enzyme that chops down the triglyceride. Triglyceride means three molecules of fatty acid with one molecule of glucose. So this enzyme chops down to the fatty acid level. And the fatty acid can enter inside the fat cell. The fat cell produces a new glycerol to produce, to attach three fatty acids to one glycerol, then it becomes triglyceride.

That new glycerol is produced from a new molecule of glucose that the fat cell uses to produce glycerol. So fat cell is... a consumer of glucose just for storage purposes. Imagine if the fat cell is already full. The fatty acid that was released outside cannot get into the fat cell.

So it will stay in the circulation. The fatty acid level will go up. Muscles are automatically programmed to switch over to fatty acid burning. When fatty acid level is high, even if blood glucose is available. So you can go into ketosis, but that wouldn't technically be ketosis or it would?

No, it is not ketosis. It is a normal default mechanism. That is why, you know, you can have high blood sugar and high fatty acid level. The fatty acid will be used. The reason being. There is no outlet from the body for fat. Whereas glucose can be eliminated through your kidneys.

It is water -soluble. So nature designed it that way. If there is excess fat, you'd use it first. Does that make sense? Yes. Okay. So that is why blood sugar stays in the blood because... The body cannot use both fuels at the same time. There is plenty of fatty acid.

You bring the fatty acid level down and the blood sugar will go down automatically. But, I mean, if you're not eating any complex carbohydrates, You're eating fat and protein, so you're going to have a higher level of fat in your diet. So you're going to have a higher level of fat in the blood, but less sugar in the blood.

Let me ask you a question. Now, this might be a personal question. You said you became blind when you were an adult, right? Yes, seven years ago. Okay. Have you ever seen a person who is blind from childhood being obese? We know of it. I'm curious now. I don't know.

I'd never met a blind person until I was blind. So, yeah, I'm a bad sample, I guess. Yeah. My thinking is now in your case, if you take it, all you're eating is based on natural instinct. If you take children two to six years of age, do you have any children?

I don't. I've got an eight -year -old sister. So that's the, yeah. I've got two sisters with the youngest. Even that will be fine. Look at, she will eat only when she's hungry. She will eat what she wants, regardless of how much food is available. And once she's done, she would rather go out and play, could care less how much is left on the plate.

Yes, that's entirely accurate. Right. So she has a capacity to eat when she wants, what she wants, how much she wants, and grow up normally. And we all went through the same conditioning in childhood. If we can control it for six, seven, eight years of our early life, why can't we do it as an adult?

Do you, is some of that, I mean, you're obviously, you're being modeled on the types of food to eat by your family, like, which is, you know, you can instill some good. dietary knowledge in a child to where they understand at least you know to a basic level like okay we don't need to eat bread uh we don't need to eat cereal and stuff but the other side of that i'm wondering how much is a lack of education moving into when you start to get more agency in life to make your own decisions so you're making uneducated decisions which in a dietary case or you know acting with less information is usually bad just in general compared to having more information so i think it's that but also if you've that whole time if you've eaten like shit your entire life because your family eats like shit.

Whenever, whatever that mechanism is, when we start to lose that, your body's also conditioned to, you know, your gut biome reflects what you've been eating. And so it's not, it's not like that's irreversible, right? But you, they, we know that our cravings for sugars and things like that are tied somewhat to the gut biome as a byproduct of what you've been eating in general and what it is used to.

So. That is a very accurate, explanation. But added to that is what is the nutrient content of processed or ultra -processed food, which is primarily from complex carbohydrates. Most of them are processed to enhance taste and make you addicted to that wanting. For example, If you routinely eat sausage and biscuits for breakfast, when you wake up in the morning, you're hungry, you're saying, oh, I need sausage and biscuit.

You're conditioned to eat that. So if the ultra -processed foods don't provide all the nutrients your body is looking for, you are going to get hungry within a few hours of... A meal, mid -morning, if you had a high -carbohydrate content breakfast, by mid -morning, you are down in energy.

You are feeling a desire to eat a snack. Why? Because the blood glucose level went up immediately after a meal. Insulin was released, and insulin pushed the glucose down. It went down, and suddenly the brain says, oh, I'm going to starve. Eat. The same thing happens in the afternoon after a high -carbohydrate meal or lunch.

So we go through this yo -yo every day, primarily because we are not eating a balanced diet. We are eating too much compressed carbs. Many of them, processed food, many of these processed foods are low in nutrients, essential nutrients. All of them are. I mean, that's why you get the fortified whatever, fortified X, Y, and Z in there.

We're re -adding all these things that we've stripped out of there to try and supposedly fill these gaps. But there's a lot there. I think definitely I eat pretty clean. It's not that not all the time I let myself have some tastier stuff that I shouldn't be eating.

I exercise a lot and I'm so I'm always hungry. But like if I eat a meal that is crappy food, I'll be hungry within an hour, even if I ate a huge meal. And also exercising wise, I'll get, you know, if I if I'm at a hard jujitsu class and then spar afterwards, like I've gotten to the I mean, I you can feel your blood sugar dump to the pole.

I'll get all sweaty and shaky and like just like sick feeling. I know I'm not the only one that gets that. But I think the other thing. i'm curious what that is the the other side of this is like kids kids do seem to be able to get away with eating like garbage and not have that yeah specifically that age range that we were talking about you know an eight -year -old i feel like can eat whatever garbage they want and they don't seem to get the The same crashes that we do as adults, is there a mechanism that switches at a certain age that drives that?

I mean, that same thing where we see, like, for whatever reason, little kids have all this energy that we lose as we get older. Is this all tied together? Yes, it is. In the sense, you can eat excess as long as you are active and spending it. As you, up to age 35, you are fairly safe.

After that, Well, let me give you my own example. At age 40 or mid -40s, I noticed that I'm gaining weight during the winter months, but during the spring, I lose it. So I said, okay, winter, I'm not going out, doing my exercise. My feeding pattern is the same, but my energy expenditure was going down.

But in the mid -50s, I noticed that what I gained in the winter is not going away. I thought I was eating the same way, I was exercising the same way, but the weight is staying on, one pound a year, another pound the next year. We keep adding on, so most people up to age 35, they are active, they can spend what they are taking in, but by that time they become set on the volume of food they put on the plate.

Once they put on the plate, they are going to finish it. So one time I was counseling 10 adult Americans who are overweight, and I told them, I grew up in India, and certain days I didn't feel hungry. And now I know why. So they asked why. Because you were eating for me for the starving children in India and China, and you were asked to complete your...

Finish your plate. What is on your plate? Clean your plate. Or you'll get punished if you don't kind of thing. Yeah. Yeah. You get conditioned and you have got school. You have got, you're traveling. You don't have time. You eat now. You finish it and then I'll give you the ice cream.

Otherwise, you cannot have it. So this is how you get conditioned. You become an adult. After age 35, it gets magnified because You're adding one or two pounds every year. And pretty soon, by mid -50s, you say, oh, I'm 25, 30 pounds overweight. How did this happen? Yeah, I think most people, I mean, obviously 40 % of Americans are a lot more than 20 or 30 pounds overweight.

I mean, it's a real problem. And I think, you know, some of this is... Some of it is literally a lack of will and discipline to eat. There's a medication for that. Especially now, I think these GLP -1s are probably... I would imagine that a lot of people that are...

I know that it impedes your hunger because it slows down the digestion process and all that stuff. But I would imagine that you still have to fix the behaviors. Otherwise, if that is taken away, you're going to... blow right back up and i i think you know the other side of this is a lack of education i really think a lot of people don't understand these things to the extent of what you should and shouldn't be eating and like really the the impact of these highly processed foods and the facts that They are literally engineered to be addictive and to suck you in and to have these rich flavors that play on your dopamine levels in your brain.

I mean, this is when tobacco companies started getting hit hard. Nabisco was bought up by one of the big tobacco companies. I think there were three of the big ones that all of the scientists that they had engineering cigarettes to be addictive switched over to food. And so this is...

It's the same thing playing out again, except it's not something that we directly recognize as being this, you know, cancer causing thing, even though these foods are full of these highly processed foods are full of things that will play into cancer. And then, you know, cancer feeds on sugar.

And so it's this nasty cycle of everything. I mean, in your experience, is it I saw this because when I when I lost my sight, I was going to school for nursing and I was working at a hospital as a certified nurse's aide. And I was on a cardiac stroke unit.

And, you know, you get a lot of people in there that haven't been eating healthy or some of them were diabetic. And I remember having a patient that was there because this person had to have something amputated as a byproduct of their diabetes. And so had just had this operation done and then was ordering juice, pancakes.

It was everything that you shouldn't be eating, just like no care in the world, legs wrapped up because things just got chopped off and we're still eating the same things that got us in there. And it's like, you just not know. What's your experience with that? My experience, well, in a way, I'm glad you mentioned that.

The reason I started on this journey about questioning diabetes is because My own relative, her husband was a medical college professor. She was taking insulin, or he was giving her insulin to keep her blood sugar down because she was diagnosed with type 2 diabetes. And during my training, I noticed, I found that she had amputation of one leg.

So I thought, okay. No, the doctor knows the insulin is not working. It is keeping the blood sugar down, so he will change the medication, do something else. But no, the doctor not only continued the insulin, but increased it. In two and a half years, her other leg was amputated.

Imagine an elderly gentleman, now having to, almost retiring, having to deal with a physical, emotional... and intellectual problems of a double amputee wife. That shook me. How can this happen? And that is where I started questioning the dogma of insulin resistance. First of all, if you are resistant to an antibiotic, will the doctor treat you with the same antibiotic?

No. No. So if you are here, you say, oh, you have high blood sugar because you are resistant to insulin. Here is a prescription for insulin. Now, how does that work? And we're turning a blind eye to it because you've been saying this for 20 years and now there's been an article published in what journal did you say?

Medical Hypothesis. Okay. And so it is out there. Other doctors and scientists are seeing this and you're getting no response. Well, I'm in some response to write more articles that some of the journals are paying attention to this. I have since published one more article describing all the things that we talked about, the discrepancies in the insulin resistance paradigm, what is wrong with it.

So that it is beginning. It is just starting. i am glad at least i'm making some waves now if i may you mentioned glp one and you mentioned that they are extremely effective right i don't know if i i i know they help people shed weight i don't think it's a good mechanism to do so i know there's a lot of bad side effects from them including loss of bone density and other things i know but yeah That is the side effect part.

My interest is how does GLP -1 work? Do you know how it works? I thought it slows down your digestion and to an extreme extent so that people feel like they're full just because everything is taking so long to move through their gut. Okay, let us look at the effect.

How does a person lose weight? They can lose weight only if you are not eating as much as you were eating before. If a person cuts down the food, what type of food is cut down more than any other type? The healthy food because they don't like it?

No, no, no. What is the type of the... nutrient that is cut down the food group you're saying if these people are less hungry right what what type of food group are they not eating i'm gonna take a wild guess and say vegetables because they're not that tasty no no what what is the percentage of energy coming from carbohydrate, protein, and fat in an average American diet now, currently.

It's definitely mostly carbohydrates and fats. Correct. Carbohydrate provides more than 50%. Okay. And on GLP -1, the first food group that is cut out is the carbohydrate. And what happens is the people suddenly find The fruits have a natural taste. They are more enjoyable than the pasta. So you're just saying behaviorally people tend to cut out the carbs.

Exactly. So the reason you became, you're eating and becoming, became obese is because your brain wiring for natural control. of food intake has been messed up because of the constant intake or indulgence of complex carbohydrate. And how do you correct it back? With GLP -1, you are stopping the food.

Now, let me ask you this. Suppose I boil some rice and give it to you. Will you eat it and enjoy it by itself? No, but I wouldn't put a bunch of crap on it just because that's how I eat. Again, I'm not a good example for that.

What I'm saying is the rice has no taste. So people use rice as a carrier for something. The same with bread. And it is not the bread you are tasting. You are tasting what is in between the two loaves of bread. So the problem is the carrier. not the nutrient.

And suddenly when the carrier is not there, people begin to understand. They enjoy the food, the real food, with the real nutrients. And they find out they don't need to eat as much. They feel satisfied with less intake. And you are retraining your center, control center, back to where it was supposed to be.

And so if we can use the GLP just to train yourself back to the way you should be eating or you did eat when you were a toddler, that's a win -win situation for all. Yeah, and I want to double tap on some of this because I feel like some of what was said may have just contradicted itself.

And just so I think I probably misheard or one of us misspoke. We've been talking about... sugar obviously the blood sugar is i i feel like the problem yes we don't need grains but simple carbohydrates are much more of a problem than complex carbohydrates and so in the just a second just okay you need a simple carbohydrate is much more problematic than complex explain that to me what is my My understanding is that there's more value nutritionally in a natural complex carbohydrate, which would be, my understanding, like a sweet potato, as opposed to you drinking a can of sugar or a can of soda that is literally just sugar water.

Well, any time you put sugar in the content, of a product you're eating is higher than what is in nature, you are in trouble. Sweet potatoes in nature, though. Right. There is no problem, even with rice or anything, there is no issue except the quantity. You can eat any complex carbohydrate, even grains, if you want.

It is not a problem. The problem is the quantity. How do you control the quantity? Suppose I give you a bowl of sugar, natural sugar, which is sucrose, by the way. Blood sugar is glucose, as you know. The word association is what makes people don't enjoy sugar because they think it is going to automatically elevate blood sugar.

Blood sugar is glucose. Natural sugar is sucrose. Why do we have... the enjoyment of sweetness. Why do we have the sweet sensation? I don't know. It releases dopamine in the brain? Yes, it is dopamine. That is a mechanism of creation of enjoyment. The sensation starts in the mouth.

Okay, let me... No, you are... Blind in the sense, I usually tell people, I blindfold you and give you something to drink. How do you know whether it is water or beer or wine or soda? How do you know that? Part of it's the smell. It's the different molecules that are in it, I'm assuming, that add the flavor.

That means in the mouth. Water doesn't have any smell. Once you put it in your mouth, you immediately know all it takes is a couple of drops of, you know, sips. You know immediately what you are drinking. So, the brain knows. Now, let me ask you this question.

Can you tell me, can you predetermine how much water will it take to quench your thirst? and before i have any water at all just hold i'm thirsty and i have a cup of water in front of me like how much do i have to drink to quench my thirst right can you predetermine that uh i don't i don't know i feel like you can kind of ballpark it but is what you're i feel like what you're getting at you know sugar is associated in nature at least with foods that are more calorically dense which would have You know, that's good for us back in times when we're hunter -gatherers, where you're trying to just survive on your caloric intake that you can get every day.

Is that where all this is headed? What we are saying is the sugar has a meaning, the sweetness has a meaning, that energy is going to be absorbed. So the brain reassures you, gives you the feeling of happiness or joy because the brain is expecting that. And it's rewarding your behavior.

When you start something, actually, is there any food or the food ingredient in the nature from which humans can get nutrients from without chewing? Honey. The only thing is honey. How many people have access to honey? Again, even that, it would be in a comb. So nature packaged every nutrient we need in containers that require chewing.

Why? Because as you chew, you are releasing the nutrients into the receptors in the mouth. They are reporting to your brain not only what you are consuming, but how much is going down. They are not only detecting, but also metering. When the deficit is corrected, when you are taking enough to match the deficit that the control center knows, that is when you feel satisfaction with your drinking or that's why you cannot predict the volume it will take, but the brain knows as you are drinking.

Sometimes if you work out, you need 32 ounces. Or right now, you may need a sip. By the time you stop drinking, the water is still in your stomach. It has not been absorbed into the body yet. So are there other less visceral, you know, we have obviously taste buds on our tongue, but then I feel like that's where our reward comes from, other than the dopamine that we get.

Or I guess, is that the means by which the brain is... monitoring this intake and so i also because i shot myself right in between the eyes that's how i i lost my sight so i don't i don't have any sense of smell how does smell affect all of this as well because like my sense of taste is dull compared to what it used to be we if how do you know there is a perfume in the air i don't right yeah before you lost your sense of smell perfumes as this is fat soluble molecule volatile molecules water soluble molecules you cannot smell fat soluble is what floats in the air when you eat something there are some nutrients which are needed in the body but they are fat soluble when you chew them when you agitate them in the mouth the molecules go back into the nose through the back of the throat and inform the brain what are the nutrients coming up the fat soluble nutrients and that is how you get the full flavor of a meal you need both smell and when you get a cold when your nose is blocked the food doesn't taste as good because your smell is not as good and does not inform the brain of what you are thinking So these are the natural control mechanisms.

And the brain will reward you if you take a nutrient, if you consume a nutrient that your body needs. And the intensity of that enjoyment will go down. The first bite you take when you're hungry is so tasty. But after five minutes, a few minutes, the intensity of taste has gone down.

And it is what the toddler uses to stop eating. When you become an adult, you become conditioned to emptying the plate, cleaning the plate, regardless whether you need that much or not. Or you want to please a host, or you are in a party, everybody's eating, or you want to get your money's worth.

So that is where the problem is. The number one cause of unwanted weight gain is eating too fast. You're not taking time to chew and release the nutrients so that the brain can record and give you the pleasure of eating. No, you are in a hurry. You have work to do.

You have phone calls to make. You are under stress. You eat. And we, I think those intense flavors to almost make you not pay attention to the feeling of fullness that you start to get. Now you're talking about processed foods, right? Yes. Yes, of course. That is, as you mentioned correctly, they are engineered to make you want to keep eating regardless of how much.

That is the whole idea of. food marketing and in that in this this detection system that we have and that you know kids haven't been conditioned to ignore by like we have by the time that we're adults i what role does smell play any role in that actual measurement or is it all i know it contributes to taste but it doesn't independently play a role in this mechanism Yes and no.

The intensity of smell, you know, sometimes it wants you. It is too much. You cannot tolerate it. So there is a limit just individually. Each person, some people like certain smells, some people don't. But it's a warning system. If there is something rotten, you can smell it and it's warning.

It's more of a warning mechanism for the brain to keep you safe. Okay. all of this is so that's so fascinating but what you know i mean this is all pretty maybe you know there's a difference between things being simple and things being easy they don't always go hand in hand i think knowledge is power in this and again these are simple choices to make in terms of slowing down but especially just what you're putting into your body is is i think the the biggest battle here and but you know other than people just making the choice because it you know at the end of the day it is the choice as you do it over time that that will get easier and that is kind of how you know part of that is discipline and doing it when it is not easy but what else you know i i think it most reasonable people will at least recognize that like that though these are the key factors right you're not eating well you're eating too much you're not exercising yes there are there's still the science out that insulin is a you know the the factor here but we know that the need for the insulin is still all of these things it's the bad choices that people are making and so what else is this is your whole proposal here is that insulin is a non -factor in this.

It is purely choices that people are making. It is these choices that are elevating the blood sugar. And so we just need to fix the behaviors and the education around this and the food choices that people are making. Insulin is a factor for type 1 diabetes. But for the type 2.

Insulin is a lifesaver for type 1. For type 2, it is a problem. It is not a solution. And so is it accurate to say that you are saying the solution is purely behavioral here, correct? Exactly. That is what brought us into it. As an adult in type 2 diabetes, it is triggered by our food intake behavior and conditioning.

It's oversupply of nutrients or substrate oversupply. primarily driven by complex carbohydrates in the form of processed foods, which are produced and marketed hyper -palatable, hyper -whatever, and you get addicted to that behavior. If you correct that, as GLP -1 is showing, the effectiveness of GLP -1 comes not because of anything, in my opinion, it is because It is allowing you to go back to your natural physiological food intake control mechanisms and pay more attention.

Since people are not eating a whole lot, they pay more attention to what they are eating and they are enjoying it more. And when the intensity of that enjoyment goes down, they are stopping, they are fully satisfied. But... The question then becomes, because that's not an intentional thing, that is a subconscious thing that's happening.

So what is the research showing when people get off of GLP -1s? Unless you train yourself, unless you understand how it works, you go back to the same way as you have done before. Yeah, it's just a band -aid. Well, it is a band -aid unless you pay attention and train yourself.

That is where I'm coming from, that this gives you an opportunity. to retrain your brain, your behavior, food intake behavior. So if you use it in that way, you can use GLP -1. Otherwise, you are adding another drug. You are dependent on a drug for the rest of your life.

Do you want to do that? No, and this is all very straightforward stuff. And again, even if insulin was a factor in type 2 diabetes, that wouldn't matter because again at the end of the day the dietary choices they're getting people there are still the issue which i i don't think you know i don't think anyone was confused by but yeah i i guess i expected there to be a different proposed mechanism of which you know when these bad why these bad choices get to a point to where the body can't counteract to them like why why we get so adjusted to those bad decisions that it becomes dysregulation in the body but very straightforward people do some reading and make some better decisions at the the grocery store stay out of the center aisles and stay on the the the outer stuff where all the good the good foods at You have to take charge.

If you don't put something in your mouth that is absorbed as glucose, your blood sugar cannot go up. And eat. Take time to enjoy what you put in your mouth. Chew it. Enjoy it. And your brain will tell you when to stop. All you have to do is pay attention to what nature puts in your brain.

And just pay attention to that control mechanism, just like a toddler do, just like we all did when we were toddlers. Just reactivate it. Those communication systems and control mechanisms are still there. You can reactivate it as demonstrated by the GLP -1 medication. That's the best that I can say about GLP -1.

It is allowing you to do that. But then you have to get off it. It's like any... Oh, go ahead. Otherwise, you are becoming dependent on another drug. Yeah, I mean, that's the same thing I see with people that are, again, antidepressants, will be on antidepressants but not be doing anything to learn coping skills or, you know, address the things in their lives that made them depressed or, you know, to learn, like...

i've i've got some imbalances in my brain that come along but i've learned the skills to navigate that without needing which it doesn't make the suck go away but it lets you learn how to navigate it until it does eventually go away some months later and it just you know all of this stuff can be If you stop looking at external and that's not to say, you know, I work with professionals, I've got a therapist and stuff like that, but this is the same thing.

You know, maybe you need to start working with a nutritionist for a time to learn these skills and do the right things and make the right decisions. But we don't all sometimes the answer for this stuff is a lot simpler than we make it out to be. Again, maybe not easy, but simple.

Exactly. I agree. You may need help because you have been practicing something bad for years or decades. And it is not easy to change, I understand. And each time you fail, you think, oh, I'm going to give it up because I cannot. You say, oh, I don't have the willpower.

I'm not strong enough. I just have to depend. Don't accept it. because it is natural to fall down when you're trying to learn something, bicycling or whatever. You fall down, you get up and move on then. So again, I agree with you, just a matter of retraining and accepting what he can and what he can't.

Yeah, and I think we, you know, I think the body positivity movement was a horrible thing from the sense of, Yes, we shouldn't just shit on people who are fat. I'm not saying that. But we also shouldn't tell people who are so overweight that it's affecting their other health that that's okay.

No, you don't need to do anything about it. Can I make a comment on that? Yeah. How do you decide a person is fat? I mean, people say the BMI, I know it's not a great representation. Let me clarify it this way. 85 % of people with type 2 diabetes in the United States are obese or overweight.

60 % of type 2 diabetics in India are not obese or overweight, according to the weight tables or BMI charts. EMI is just a, it's a sex height and weight thing, not a, that correct. It's not like a great model. Right. So that being the case, I define obesity in two different ways.

One is, well, let me give you this example. During my practice, I had two patients. Both of them weighed 300 pounds. And they, each of them asked me, doctor, my... Family doctor says, I'm overweight, I should lose weight. So I asked the first person, what is your blood pressure?

Normal. What's your blood sugar? Normal. What's your cholesterol? LDL cholesterol? Normal. I said, you are cosmetically obese, but not medically obese. You look big, but you're healthy. So that is what counts. Whereas the other person, he weighed also 300 pounds. He was already on two different medications to control his blood sugar, and his doctor was asking him to take insulin.

And I told him, you are medically obese. And I took him, I showed him how to eat. We went to a restaurant, he took the food, and I showed him how to eat. What food to select? A year later, he came. I didn't see him for about 15 months.

He came back, and he was smiling all over. He said, Doctor, I want to show you my weight. He stepped on the scale. He had lost 100 pounds. Wow. And his blood sugar was normal, and his blood pressure was normal, his cholesterol was normal. I sent him for a glucose tolerance test.

to make sure, and everything was normal. He did it on his own by just changing his eating habits. Yeah. Oh, go ahead. You finish. No, what I'm saying is just classify. People look at another person and say, oh, he looks big, so he is medically, you know, he's not healthy.

Well, how common is it for someone to be, 300 pounds and actually not be medically obese. That seems like an outlier. No, well, it depends on what your gene genetics are. As long as you keep your fat outside your blood. If you've got a lot, if you have two different refrigerators, one storing 20 cubic feet and the other 10, if you buy the same amount of grocery, the 10 is going to get filled up faster.

And 20 can still hold some more. So it is what you have inherited. What you inherit is your fat storage capacity. But how common did you come across someone like that who is still medically healthy and that large? It is becoming more and more recognized right now. There is healthy obesity right now.

People are talking about it. yeah this is the first i've heard of it that's very interesting it makes sense that there would be genetic outliers i guess but yeah i'm curious to see how much of an anomaly that is or if it's not but yeah and a no you know at a zooming out even more, okay, yes, his markers all came back right.

How comprehensive are the markers and what is he eating? Is he still eating like garbage and it's just not affecting him other than he's eating too much calories, but his body's able to counteract everything else that he's doing to himself? Or what is it? No, again, it depends on what type of food you're eating.

If you have a large storage capacity, that may... influence the volume of food you are eating because there is still extra storage space available. How do you navigate that as long as you are eating a balanced meal? So I tell people, try to eat three different vegetables, three different fruits, three different nuts every day.

The quantity your brain will tell you, but the variety is the key. You cannot survive on one food group or one meal. Why do we feel hungry multiple times a day? Because each meal does not contain all the 50 to 100 nutrients your body needs for healthy living.

Yeah, all very straightforward stuff. I mean, we've learned a lot of good stuff, but also, again, the... the fixes are very very straightforward so i really i'm gonna have to look more into the the taste stuff i think that's very interesting and specifically as the the measurement mechanism that we use for things again that was the first time that i've ever heard that but I had some other things that I wanted to talk to you about, but we're already an hour and a half in here, and I have some stuff to do this evening.

So I do want to start bringing this to a close because I feel like we've done a pretty comprehensive cover of this, unless you feel like I've missed something down this subject. Well, no, we have covered, as you said, a lot of things, much more than what I thought we would because of the time.

It is less than 45 minutes that I get a chance to talk to someone. But you have covered not only that, you have a fundamental grasp of what we are talking about. You yourself being in the medical profession, you can ask the right question and you can understand the answer.

You can question me. So we had, I believe, a very good exchange. Now it is up to the listener. Well, if they want to know about me, my website is drjohnonhealth .com. Okay. And I'll have that linked in the show notes. Do you have anything else? I know.

I'm guessing that's where everyone can find your books and things like that as well. Yes. Okay. Awesome. Yeah. Unless you have something else that you would like to tell everyone to go check out, I will have that linked. But just thank you so much for... diving into this and letting me, you know, really get granular with you on this stuff.

I thank you for having me and I thank the audience and I thank you for asking these very interesting questions because once you start talking about type 2 diabetes, I get very, what should I say, tense. You get fired up. That's not a bad thing. It usually means you're doing it well, you know, because you're not defending something.

That means you're doing it for the right reasons. It's because you care. You're coming from the right place. People like you saying that, that keeps me motivated to keep going because I think about my patients. I think about my relatives. There is no need for them to lose their kidneys, their eyesight, their brain, their heart.

it can be prevented. It is easy to prevent type 2 diabetes than treat it. Yep. And all by choices. So, which is, that's a good news for everybody, right? Like you can, you can defend yourself and insulate yourself against this. So thank you again for being here. Thank you.

I know this was probably a dense episode for some folks, but hopefully it instilled some curiosity and you learned something here. I kind of nerd out on this stuff. I think it's very, very interesting and, again, very, very important. So share this thing around. I think, again, this might be a hard conversation for some people to have to realize that they need to make some changes, but that's not a bad thing, right?

And sharing information like this because you care about someone is a good thing. So also, if you did get something out of that, please leave a rating and review for the show wherever you're listening. Or again, subscribe to the YouTube channel if you're watching. And I will see you guys next time.