There has been a fundamental shift in understanding metabolic health and chronic disease, particularly Type 2 diabetes, challenging long-standing dietary dogma by emphasizing that insulin resistance is largely driven by overconsumption of refined carbohydrates, not dietary fat or red meat. While highlighting the success of carbohydrate restriction and ketogenic approaches, nutrition is being seen as a powerful tool for reversing diabetes—often more effective and sustainable than conventional medication. The implications are far-reaching, not only for individual health outcomes, but also for reshaping public health strategies in addressing today’s chronic disease epidemic. In this episode, I speak with Gary Taubes, Sami Inkinen, and Dr. Greeshma Shetty about an approach to treating Type 2 Diabetes that works. I also discuss how red meat is not to blame, but we should be looking at high sugar and starch diets. Gary Taubes is an award-winning science and health journalist, and co-founder and director of the Nutrition Science Initiative (NuSI). He is the author of The Case Against Sugar, Why We Get Fat, Good Calories, Bad Calories, and, most recently, The Case for Keto. Gary is a former staff writer for Discover and correspondent for Science. He has written three cover articles on nutrition and health for The New York Times Magazine, and his writing has also appeared in The Atlantic, Esquire, and numerous "best of" anthologies, including The Best of the Best American Science Writing (2010). He has received three Science in Society Journalism Awards from the National Association of Science Writers, and is also the recipient of a Robert Wood Johnson Foundation Investigator Award in Health Policy Research. He lives in Oakland, CA. Sami Inkinen is the CEO and Co-Founder of Virta Health, a pioneer in reversing diseases like obesity and type 2 diabetes through a nutrition-first approach. Sami's personal connection to diabetes and passion to advance global health was the motivation behind Virta and its innovative care model. Previously, Inkinen was the co-founder of the leading online real estate marketplace Trulia, serving as its COO and president and board member until its IPO and eventual sale to Zillow Group. Dr. Greeshma Shetty, board certified in Internal Medicine and Endocrinology, currently serves as a Lead Clinician in the Virta Medical Group and the Director of Quality and Safety at Virta Health. Prior to joining Virta, she was clinical physician educator at Harvard Medical School, where she directed the combined Joslin - Beth Israel Deaconess Endocrine Fellowship program and Co-Directed the Asian American Diabetes Initiative. She is dedicated to clinical excellence, leveraging health technology, transforming healthcare delivery, driving health equity and building high performing teams. This episode is brought to you by BIOptimizers. Head to bioptimizers.com/hyman and use code HYMAN10 to save 10%. Full-length episodes can be found here: The Evolution of Diabetes Treatment How to Reverse Diabetes Naturally Does Red Meat Cause Type II Diabetes?
Chapter 1: What is the foundational cause of Type 2 diabetes?
Patients do well if you don't feed them carbs. How weird is that? It's a disorder of carbamiger metabolism. Exactly. Tell them not to eat it, they do fine.
If you don't take the toxin, you don't need the antinode.
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Go to bioptimizers.com slash hymen and use code hymen10 for 10% off your order. Now, before we jump into today's episode, I'd like to note that while I wish I could help everyone by my personal practice, there's simply not enough time for me to do this at scale. And that's why I've been busy building several passion projects to help you better understand, well, you.
If you're looking for data about your biology, check out Function Health for real-time lab insights. And if you're in need of deepening your knowledge around your health journey, check out my membership community, the Hyman Hive.
And if you're looking for curated and trusted supplements and health products for your health journey, visit my website at drhyman.com for my website store for a summary of my favorite and thoroughly tested products. There are essential fatty acids. There are essential amino acids. There are no essential carbohydrates.
So the body actually does not need them biologically to thrive even though it's our main fuel source. So historically we've been adapted to a whole range of diets from the Inuits and the basic ketogenic diet to the Pima Indians who were 80% carbohydrates but it was all high fiber plant-based carbohydrates that were really nutrient dense.
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Chapter 2: How did conventional diabetes treatments evolve and what are their limitations?
No, they lost weight and they didn't get better. The idea was you lose weight, you'll have fewer complications, you'll reduce heart disease, you'll reduce strokes, you'll reduce mortality from this disease. It didn't make any difference.
Was it because of how they lost weight?
Well, it could have been because of how they lost weight. And in fact, back around 2003, when I first heard about this trial from one of the principal investigators, I was in a conference, he invited me to talk in Houston. I remember saying to him, look, are you doing a low carb arm? Just do a low-carb arm. Make it not just low-calorie, low-fat, fruits, vegetables, whole grains, the usual story.
Mediterranean diet, right. Well, this was pre-Mediterranean. I mean, this was just classic low-fat. But in low-fat, they're also saying you're eating fruits, vegetables, whole grains, cut back on meat, exercise. No, they never crossed their mind to do a low-carb diet because that was still considered quackish.
As the diabetes community keeps learning about how ineffective their treatments are and how their belief system is falling apart on top of them and not having an adult conversation about it, which is maybe we're making some mistakes here.
Other physicians coping with this increased obesity in their patients are confronted with patients who don't take their advice and instead like buy Atkins Diet Revolution book and lose 40 pounds on Atkins. Yeah. And a few of these doctors are open-minded enough, Eric Westman and David Ludwig, they say, I'm going to look into this. I'm going to actually do a clinical trial.
So they start doing clinical trials. There's a big study at the Philadelphia VA. And there, the woman named Linda Stern is frustrated by how much, her inability to help her patients. So she literally goes to like a Brentano's bookstore and she sits down in the diet section, starts reading diets.
The doctor's going to the bookstore to read self-help books because it's not in the textbooks.
You know, it's not, not, not, not. They definitely don't get grades, good grades for this in med school. Anyways, I think she found protein power. Yeah, that's right. The Eads, Michael Eads.
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Chapter 3: What is the history and impact of Virta Health in diabetes reversal?
Yeah, because you're going to have to adjust medication. If you stop eating the toxin, you're going to have to lower the dose of the antidote. And it's either that or the American Diabetes Association standard of care which is drug therapy. And they do the trial and after a few years they report one-year results and after three years they report two-year results.
And for patients who comply with the diet they seem to put this progressive chronic disease into remission. So it's not a progressive chronic disease. No. It's only a progressive chronic disease if you're eating the toxin.
Yeah.
If you're not eating the toxin, you don't manifest the symptoms. And it's not the ideal clinical trial. Yeah. There's all kinds of problems with it. it wasn't randomized, actually I probably said randomized and I should not, they let patients choose whether they wanted the diet or the ADA standard of care.
But even with those constraints it demonstrated beyond a shadow of a doubt that a disorder which is considered chronic and progressive is not necessarily chronic and progressive and that the defining factor is the diet, again whether you eat the toxin.
That's true. I mean, our practice at the Ultra Wellness Center, I've seen that over and over again. People just don't, on insulin, get off insulin, on meds, get off meds, normalize their weight, normalize their metabolism. Then once he goes down, they went from 11 to five and a half in a few months. I mean, it's quite remarkable. It's quite remarkable.
And so by the end of the book, I mean, again, this book does not advocate. It's a dense, historical, critical... Yeah, it's like a mystery novel. And a mystery novel.
Who done it and who didn't do it?
I think it's a very good book. The question is imagine a scenario where everybody, every physician was taught not just the proper drug therapy but how effective this dietary therapy was. Because there have always been two levers to pull to keep blood sugar under control. There's diet or drugs. Until 1921 we only had diet and for patients with type 2 diabetes it was effective. Yeah.
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Chapter 4: How does carbohydrate restriction and ketogenic diet reverse diabetes biologically?
And I hear you saying the same thing about the GLP-1. So I'd love for you to share from an endocrinologist's perspective what your thinking is about this, where they play a role. And actually, is this approach of very aggressive nutritional intervention with the continuous care model of lifestyle support and behavioral change actually better? And how do we think about that?
Yeah, no, I think that's a great question. And it kind of hits on something we spoke about earlier during this call with insulin and how we sort of, I think we missed an opportunity of marrying some of the nutritional sciences to patients who were able to receive insulin. And when you think of like Even type 1 diabetes, of course, insulin was life-saving.
But because we didn't really invest in figuring out the right nutritional, now we have a lot of folks with type 1 diabetes who we say they have double diabetes, which is type 1 with insulin resistance. Because we've just let people eat whatever they want, even if it doesn't work for their body. So I like to think of that as an analogy for GLP-1s.
You just can't eat whatever you want just because there's a new medication. Because guess what? Again, the energy homeostasis is super complex. There's no silver bullet. Like you actually have to eat right for your body. And there's so many, like I said, the genome wide studies have shown that there's a lot of different types of type 2 diabetes.
And if we can get to the root cause, we can help a lot of folks and not look at one target molecule that we're using today, which is the GLP-1 therapy and that. So I think really thinking more holistically about our patients that these are not magic bullets.
Look, they're great medications for patients with diabetes and other non-glycemic indications like reasons outside of blood sugar control, such as heart disease, heart failure, kidney disease. There's mortality and there's outcomes data to support their use. But what about like,
the millions of people who have not yet developed those complications who have diabetes and the folks who have prediabetes and obesity. And this is, you know, diabetes is the tip of the iceberg, right? We have a whole society below that where we need to drive impact because we can't just medicate everybody in the country.
So really thinking about the root cause and finding the right nutrition for the individual patient. And this is part of precision medicine, right? Personalizing your diet to what works for you. And it's hard work. I mean,
What our coaches and clinicians do at Virta, it's a daily, again, like a white glove experience where we're getting that data, we're doing that positive feedback to make those changes, to learn and course correct when things aren't going well, to celebrate when we get those lab reviews. So really, it has to be a very patient-centric, holistic approach.
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Chapter 5: What are the clinical results and patient outcomes of a ketogenic/low-carb approach?
Well, you eliminate ultra-processed food, processed grains, refined grains and starches, sweets, sugar, sweetened beverages especially, and that improves your blood sugar balance and your insulin sensitivity. And what should you be eating then? Good quality protein, and it can be meat.
That's my view of the literature, not my opinion, but it's pretty much evidenced by the randomized control trials. Fiber, fruits, vegetables, nuts, seeds, sometimes whole grains. If you're not fully blown diabetic, healthy fats, olive oil, avocado oil, macadamia oil, none of these will affect your blood sugar.
And then you want to use testing to test your fasting glucose, your fasting insulin, your A1C, triglycerides, and other markers to understand of your insulin resistance. Now, I co-founded a company called Function Health. You can go to functionhealth.com. We've created an initial test of over 110 biomarkers. It's $4.99 a year membership and includes testing twice a year.
And you get all the metabolic markers you need. You get insulin, which your doctor almost never tests, A1C, your blood sugar, but you also look at lipid particle size. We call it lipoprotein fractionation. Not just your regular cholesterol profile, but whether or not you have small particles, dense particles, large or small triglycerides or HDL.
All these will tell you about your cardiometabolic health. We also measure inflammatory markers like C-reactive protein and others. So you get a really good understanding of where you're at. So go and check it out. Go to functionhealth.com. You can use the code YOUNGFOREVER if you want to jump the wait list.
But it's really a way to get testing to see what's going on with you and what's going on with your diet. So again, test, don't guess. Now, it's no secret that navigating the realm of nutrition has become a challenge for the general public and even for people like me and health professionals who've been studying this for 30 years. One week, eggs are good for us.
Only to be vilified for allegedly raising cholesterol levels the next week. The narrative on dietary fats is no less tumultuous. And I wrote a whole book on this called E-Fat Can't Get In. Some experts say that it's the chief culprit behind heart disease. Others say it's critical for overall health and well-being.
Well, more recently, a study made headlines linking red beet consumption to an increased risk for type 2 diabetes, leaving the public once again confused and understandably so. And that's why in today's Health Bytes episode, we're diving deep into the findings from this paper and unpacking the study's design flaws. It's inaccuracies. And where the researchers got it straight up wrong.
The study was entitled Red Meat Intake and the Risk of Type 2 Diabetes in a Prospective Cohort Study of United States Females and Males, published in October of 2023. Now, this was a type of study design. It's important to understand study design because you have to understand science before you can interpret science.
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Chapter 6: How does diet influence hormones like GLP-1 compared to diabetes drugs like Ozempic?
Chapter 7: What role does food addiction and cravings play in diabetes and obesity?
Chapter 8: How can personalized nutrition be optimized for different metabolic types?
So the body can survive and thrive on many different things and the quality of the calories matter, which is really the thesis of your book, Good Calories, Bad Calories. And I think most people don't understand that they actually can regulate their biology if they figure out what their particular metabolic type is, because everybody's different.
And for example, I need a little more carbohydrates because I'm kind of thin and if I don't eat them and I go keto, I'll lose too much weight. But if I take a patient who's overweight and type 2 diabetic, they're going to do really well if I do that.
And a little bit of carbohydrates might prevent them from doing really well. Yeah. I think one of the points that I've made in my other books is everybody is different.
and we definitely evolved to cope with the proteins and fats in our diet that the idea that the foods that we didn't the new foods of modern life ultra processed food that's not even food yeah i'm not wild about the term ultra processed because it's sort of like a miasma of theory of all these kind of vague things that we're going to throw in. Michael Pollan called them food-like substances.
I prefer that. It's more to the point.
But they don't meet the actual criteria of the definition of food.
But we didn't have time to adapt to high levels of sugar in our diet and sugary beverages in our diet. These things didn't exist. We didn't have time. I mean, I'm... diagnostic about the seed oil issue, I don't find the evidence. I mean, I can easily believe that these things are toxic, but I... The evidence is confusing for sure. There's a certain absence of human clinical trial evidence.
Just like sugar, when you think about sugar, we never had exposure to the amount of sugar we're eating now historically as species. We never had 10% of our diet being refined soybean oil before. It's a new phenomena for humanity. And maybe it's okay, maybe it's not, but I think it should be questioned.
Yeah, it certainly should be questioned. And that's the thing, so you can propose that those are... And with the sugar and refined grains, you could see what happens when you take them out of people's lives. And we have clinical trials.
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