Diabetes Deep Dive with Dr. Mona Morstein – Episode 34

In this episode of Dr. Ruscio Radio, the doc takes a deep dive into the topic of diabetes with Dr. Mona Morstein. Dr. Morstein has been a naturopathic doctor for 24 years and is considered an expert on obesity, pre-diabetes/insulin resistance, and all types of diabetes.

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Dr. R’s Fast Facts

  • Diabetes patients have lost the metabolic capacity to handle carbohydrates.
  • All diabetes specific diets share a commonality in that they are all low carb.
  • Appetite is not a willpower issue but a hormone issue.
  • Some herbal medicines, like berberine, have been shown to be as effective as Metformin in the treatment of diabetes.
  • Other powerful herbs and supplements for treating diabetes: curcumin, bilberry, cinnamon, taurine, n-acetyl cysteine, alpha lipoic acid, gymnema and fiber.
  • Alpha lipoic acid, acetyl l-carnitine, Lion’s Mane and benfotiamine can be used in treating diabetic neuropathy (nerve damage).
  • High blood sugar is what causes all the damage in diabetes patients.
  • Metformin is a very safe and well-tolerated drug treatment for diabetes.
  • A holistic approach that looks at diet, exercise and other health parameters is ideal for diabetes patients.

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Topics:
Dr. Mona Morstein’s credentials and background…..1:34
Diabetes dietary basics…..2:47
Supplementation for diabetes…..15:04
Diabetes medications…..28:10
Episode Wrap Up…..36:25

Links:

  1. (17:16) Efficacy of berberine in patients with type 2 diabetes mellitus http://www.ncbi.nlm.nih.gov/pubmed/18442638 Trusted SourcePubMedGo to source
  2. (38:30) Dr. Morstein’s website http://azimsolutions.com
  3. Hype or Reality: Should Patients with Metabolic Syndrome-related NAFLD be on the Hunter-Gatherer (Paleo) Diet to Decrease Morbidity? http://www.ncbi.nlm.nih.gov/pubmed/26405708 Trusted SourcePubMedGo to source
  4. Metabolic and physiologic effects from consuming a hunter-gatherer (Paleolithic)-type diet in type 2 diabetes http://www.ncbi.nlm.nih.gov/pubmed/25828624 Trusted SourcePubMedGo to source

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Diabetes Deep Dive with Dr. Mona Morstein

Welcome to Dr. Ruscio Radio, discussing the cutting edge of health, nutrition, and functional medicine. To make sure you’re up today on this and other important topics, visit DrRuscio.com and sign up to receive weekly updates. That’s D-R-R-U-S-C-I-O.com.

The following discussion is for educational purposes only, and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking to your doctor.

Now, let’s head to the show!

Dr. Michael Ruscio: Hey, folks. Welcome to Dr. Ruscio Radio. I am with here with Dr. Mona Morstein, and she is a physician who I met actually a number of years ago when I was still a student and I attended one of her lectures on diabetes. I was that wet-behind-the-ears, super-eager student, and I think I probably talked your ear off for a good hour after your lecture. You were probably dying to go home, but I was super-excited about what you were doing, and so we had a nice conversation. We connected at the SIBO Symposium in Portland, and I know you have a lot of great stuff to say about diabetes, so I asked her to come on the show, and she, thankfully, said yes!

Dr. Mona Morstein: Yes! Thank you very much for inviting me. I’m pleased to be here.

Dr. Mona Morstein’s credentials and background

DrMR: Absolutely. I think you’re going to share some really interesting stuff on diabetes, but can you give people just a brief kind of synopsis about your training and what you’re doing right now?

DrMM: Yeah, I’m a naturopathic physician. I’ve been in practice nearly 30 years. I went to National College of Natural Medicine in Portland for four years, and then I did a year of residency after that, went to Montana, where I had a private practice for 13 years, and then became Chair of Nutrition, gastroenterology professor, and a clinical supervisor at Southwest College of Naturopathic Medicine, the ND school in Tempe, Arizona, and I’ve been back in private practice now in Tempe, Arizona, for two years.

DrMR: And you do a lot with diabetes.

DrMM: Yeah.

DrMR: I don’t know if you still are, but you were teaching, I think, a weekend clinical seminar on diabetes for a while also, right?

DrMM: Actually I do that in another three or so weeks up in Portland again.

DrMR: Oh, great. Great. So that’s a topic we’re going to dive into today.

Diabetes dietary basics

DrMR: Gosh, there are so many things we can talk about regarding diabetes, but why don’t we start off with the dietary basics. I know you had sent me a note about the different diets one can do for diabetes, and I thought that was a great starting point: the different diets, maybe the pros, the cons, and kind of how you use them clinically.

DrMM: Yeah, well, there’s one key concept to treating people with diabetes in general, which is being low carbohydrate. If we do a one-sentence definition of diabetes, it’s pretty much very simply these patients have lost the metabolic capacity to handle carbohydrate. And just like people with celiac disease have lost the capacity to process gluten without it causing an autoimmune disease and they have to remove that, people with diabetes, since they can no longer effectively handle carbohydrates, have to limit those.

There are four main diets that fall under the low-carb auspices, and I’m not particularly concerned with which diet people want to use — although most of them use one — but the main options are a vegan diet, a low-carb omnivore diet, an ovolactovegetarian diet, or the low-carb, high-fat ketogenic diet. Those are the four diets that various people use, and I’m happy to work with any of those. They all have some basic restrictions, but then they kind of veer off into how the meals play out.

DrMR: OK, now, one of the things I’d be curious to hear your take more on, because I’m sure some people are wondering about this, the kind of lower-carb vegetarian diet, is that one that you find is harder for people to comply with because — and correct me if I’m wrong — but doesn’t that take a lot of the potential foodstuffs off the table for a vegetarian?

DrMM: Well, starting off with the vegan diet, where I see that to be the most effective is in newly diagnosed type 1 pediatric patients. It has the capacity to most quickly initiate their honeymoon period, and it has the capacity to extend the honeymoon period as long as their own body, their own system can go. We’re talking with some patients years and years in honeymoon.

DrMR: Really? Wow.

DrMM: Now, of course, all diets have pros and cons. The con of this diet is, of course, its low-protein content, kids mainly using nuts and nut flours for their only real source of protein. So I do find some kids don’t grow because they’re not getting any good animal protein in and growth hormone is protein-based. You know, it has a lot of protein in it!

DrMR: Right.

DrMM: So I’ve had to take some kids off of their vegan plan and have them start getting at least some fish in, some eggs, and then they start to grow again, but you have to monitor height as the number-one concern in diabetic kids on this vegan diet.

DrMR: Gotcha. That’s a great point, actually. I didn’t even really think about that, but that’s really, really nice clinical insight.

Two things I want to ask you, based upon what you just said: I’ve recently read a review showing that those with type 1 diabetes have an increased incidence of antiparietal cell antibodies. And the parietal cells, just for the audience, are cells in the stomach that manufacture hydrochloric acid, and of course, if those are compromised, you may also compromise certain vitamin and mineral absorption. With that in mind, have you found that in that population you see any of this parietal cell derangement sequelae, I guess you could say? Do you see malabsorption? Do you see the need for hydrochloric acid? Do you see B vitamin deficiencies more frequent in that population?

DrMM: It’s a good question, and of course, with type 1, it’s associated, of course, with Hashimoto’s disease, which is an autoimmune disease of the thyroid, with celiac disease, which is, as we talked about, an autoimmune disease in the gut. Also Addison’s disease, I’ve definitely seen. And then, yes, parietal cells. The type 1’s, and like any autoimmune patient, if you have one and etiological factors are not uncovered and tried to get under control for why they got the first autoimmune disease, it can spread.

DrMR: Right.

DrMM: Now, the antiparietal antibodies, obviously I see a lot more Hashimoto’s, celiac, and — believe it or not — even Addison’s than I do the antiparietal. But, yes, with all of these, you have to be checking in and following them with a B12 and methylmalonic acid and just, in general, does your protein just sit like a rock in your stomach, signs of low hydrochloric acid production. Every year, you have to do their thyroid, you have to check their celiac, you have to just be checking on making sure you’re picking up the most likely areas in the body the autoimmunity may have spread.

DrMR: Gotcha. That makes sense. It seems pretty logical.

The other question, and this is just more so to play the devil’s advocate because I completely agree with your whole posit about the low carb, but I know the Ornish diet — which would be kind of like your higher-carb, lower-fat — has shown some success with cardiometabolic markers, and there may be someone out there who’s asking this question, so for them, what would you say?

DrMM: Look, I am not an Ornish fan. I sat next to him at an ACAM conference. I mean, his whole logo was a big bowl of white pasta.

DrMR: Right.

DrMM: That was what he put up. No, there’s no way that’s going to work, and people are like, “Well, what about beans? They’re so high in fiber.” It doesn’t work. Just give your diabetic patients those foods. Just give it them and see. The ADA diet, because they’re concerned about fat — or have been historically; in their 2013 guidelines, they do validate low-carb diets, although their own website doesn’t promote it — but you just give the patients the oatmeal that they tell everybody to have for breakfast, and I’ve seen all these patients coming in. They wake up, their blood sugar is maybe 120 and then it’s 240 after the bowl of oatmeal.

DrMR: Right.

DrMM: It just can’t be played out in any way. However, my “however” is if a patient goes on any healthy diet, at least they’re not having the Coca-Cola.

DrMR: Right. Relative to the Standard American Diet, yeah.

DrMM: Just getting rid of all the junk food and saying, “I’m gonna do Ornish,” you’ll probably have a little improvement, but there’s no way — in any way — you can eat an Ornish diet and get your A1c down and get your blood sugars under control. I’ve never seen it.

DrMR: Yeah, it makes sense to me. I just was curious to hear your take on that.

OK, so I think that you’ve given people a pretty simple overview of diets. There are multiple diets one can choose. There’s that reoccurring theme of low carb. Is there anything else regarding diet that you think is important to mention?

DrMM: Well, I think one of the things is also, obviously, portion control. The regularity of eating, especially if people are on insulin, eating breakfast at a certain time, lunch at a certain time, dinner at a certain time. I’m an advocate of very modified intermittent fasting. I like people to eat dinner and then have, like, a 12-hour fast to breakfast. Just working very simply with just some other aspects of… You know, people have lost ideas of portion control, but the good thing is that when you get on a low-carb diet, within the first week… people don’t understand that insulin resistance, which drives type 2 diabetes, and type 1 is affected by it if the blood sugar is too high, like over 170, or if they’re injecting more than 40 units total of insulin a day, they’re initiating insulin resistance, but their disease isn’t formed by it. But insulin resistance in the physical body means your blood sugar stays high because your physical cells are refusing to take it in. Insulin resistance in the brain makes your brain not acknowledge you’ve eaten enough food and you’re full.

DrMR: Right. Good point.

DrMM: So you still have this driving appetite. When people get on a low-carb diet, within a week they’re like, “Wow! This isn’t so bad! I am just full if I have some chicken and some veggies and maybe an almond flour little muffin. That’s all I need,” because they’re resetting appetite control.

DrMR: Mona, this might be something people are wondering. Do you think this is because the brain is trying to utilize more relative ketones than it is blood sugar and they’re not necessarily ketone resistant as they might be insulin resistant?

DrMM: I just know that appetite control is not a willpower thing, like patients should feel bad or guilty. Appetite control is really a bunch of hormones and chemicals getting your brain to say, “I’m full.”

DrMR: Right.

DrMM: And if there’s resistance to those signals, the brain is going to say, “Yeah, I do need another chicken breast,” or “I ate dinner and now I’m hungry again.”

DrMR: Right.

DrMM: That gets under control so quickly when people engage in any one of those four low-carb diets.

DrMR: OK. And I think most people probably get that. Most people listening probably get the importance of these kinds of basic dietary principles, this sort of ancestral lower-carb sort of approach.

Supplementation for diabetes

DrMR: The thing that, I guess, I’d like to get more of your weigh-in on would be the supplements and the medications. These are two of the other things that we talked before the call about discussing, so I’d love to hear more on the supplements you use, which ones you find to be more effective, maybe a little bit about dosing, maybe a little bit about expectations or reactions, just for someone who’s maybe needing more. You know, they’re doing the diet, and they’re not getting to where they need to be. I’m assuming next you do supplementation and then followed by drug therapy, but I would love to get more about that from you.

DrMM: Yeah, I mean, I do put all my patients on some supplements, and of course, there’s a little variance, but I am putting everybody on a good multiple vitamin, and I am putting everybody on fish oils at at least a starting dose of 1000 mg EPA and 750 mg DHA a day. A lot of people think of fish oils as, “Oh, but there’s 1000 mg of fish oil.” Well, that’s meaningless to us. We want to quantify the EPA and DHA anti-inflammatory, anti-insulin-resistant components of the fish oil. So everybody starts with that. Obviously since we’re checking vitamin D in everybody, if there’s a deficiency in that, then I want to treat that. I treat vitamin D by making sure they also get A and K in at the same time and calcium/magnesium, but that’s in the multiple.

Then we have the diabetic-type supplements. Now, I’m going to say I have a proprietary formula out there that I made with a company that I think is the best one out there, and it’s called Diamend, but if you’re not using that, that’s fine. Here are the best supplements to be considering at the top of the list: The first, especially with type 2 diabetics, is berberine. The study (1a Trusted SourcePubMedGo to source) used berberine hydrochloride in terms of equaling metformin in its effectiveness in the body at 1500 mg a day, but berberine, as naturopathic physicians know, also is very healing towards the liver. It’s also good at controlling dysbiosis in the gut, and of course, one of the etiological risk factors for both type 1 and type 2 diabetes is gut dysbiosis and also other autoimmune diseases in the type 1 patients. You know, the main problem with berberine is that at higher doses it can upset the stomach, so I just have people eat and then take the supplement after instead of some people sometimes taking the supplement and then eating. If you put a meal in your gut and take the supplements, they work a lot better.

I think turmeric is another important herb, or really I should say curcumin made from the spice turmeric. Curcumin is anti-inflammatory. Most overweight type 2 diabetic patients have fatty liver. That makes them insulin resistant. Turmeric is good at helping to reduce the inflammation in the liver. It also is very anti-insulin resistant. It’s been shown in studies to decrease Alzheimer’s onset in type 2 diabetes. And of course, in type 1 diabetes… you know, diabetic damage causing complications is an oxidative process, and so any kind of antioxidant-type herbs, like turmeric, are very protective.

I like the proanthocyanidins, like a bilberry or blueberry, obviously specific to the eyes, but just in general around the body a very good antioxidant.

There’s cinnamon that has been shown… actually the initial studies were OK. Follow-up studies have been good or bad, but they have accumulated enough studies with cinnamon, particularly cassia, to show that it could be beneficial for people just obviously to include in their diet, which is nice because it’s fall and we like to use a lot of cinnamon then, but also in concentrated doses as well.

I mean, you have so many — taurine, NAC. You have your fiber products, very helpful at slowing down glucose excursion after they eat and also rebuilding the microbiome. I mean, you can go… I don’t know. I’ll pause here and…

DrMR: Yeah, there’s actually a few things I wanted to ask on that. Actually, one, I want to give you a compliment because I really enjoy it when people are constantly following the literature, as I, of course, know you are, but also updating their recommendations based upon the literature. I don’t know how I remember this, but I remember from when I sat in at your lecture — it must have been eight years ago or more now — that you were not super on board with cinnamon because of the results from the preliminary studies, but it’s nice to hear that you’ve been following the research and, as we have more data and better findings, that you’ve kind of evolved your position on that.

DrMM: Thanks.

DrMR: Not everyone does that, so I appreciate it!

And with berberine, do you ever find or do you have any concerns about long-term use and the antimicrobial effects maybe having a deleterious effect on killing some of the good guys if use is prolonged?

DrMM: Well, you know, it’s certainly a good consideration. On the other hand, we have no studies showing, you know, “Well, let’s treat diabetic patients with 1500 mg of berberine, and check their microbiome before and after.” It would be a great study if someone wanted to spend a couple of million dollars or probably more doing that!

It’s interesting, but if you look at herbs, for example, like garlic. Nigel Plummer — he’s a researcher in England — he’s done some really great studies on, in fact, the most antimicrobial herbs and found actually that garlic and cinnamon were the two most effective natural medications for antimicrobial help in the gut and also clearly showed that they had really no effect on the microbiome. I mean, look at Italians. For all the garlic people eat every day in the world, who could possibly say these people have a worse microbiome because they are every day eating cloves of garlic in their food, right? I think sometimes we narrow our minds into kind of micromanaging the gut and then realize that the rosemary, the thyme, the garlic, the onions — I mean, we’ve used them as spices for their antimicrobial aspects, and every day we’re eating these, and everybody seems healthier as a result.

So in that regard, I’m going to say it’s safe until it’s shown to be otherwise because it seems to have some good effect on people, and I know from my patients taking it I haven’t seen any diarrhea or gastric upset developing over time because they’ve been on a product with a fairly good dose of berberine in it.

DrMR: Sure, and I totally agree with your position on the herbs tending to have a health benefit, especially when used as condiments. I do think the game changes when we get up to pharmacological doses. However, that being said, there has been some preliminary evidence published that, for example, in the treatment of SIBO, we see improvements in blood sugar levels and cholesterol levels, and I know that patients with diabetes may have a higher incidence of SIBO due to any sort of enteric neuropathy, so what we may be getting here is a side benefit, where the berberine, for example, may be helping with insulin sensitivity and at the same time it may be pruning back an excessive bacterial growth in the small intestine, which may be causing over-absorption of calories from food and seeing kind of a secondary benefit.

DrMM: That’s great. That’s excellent.

DrMR: Yeah. We’re speculating right now because we don’t really know, but sometimes it’s fun to speculate!

Now, another one I wanted to get your take on was, I believe the herb you had referenced was thunder god vine, I think. Or, no, I’m sorry. It was lion’s mane, I believe.

DrMM: Oh, lion’s mane, yeah, yeah.

DrMR: And you use that for, I believe, neuropathy seen in more progressed diabetes. Do you have anything to say on that?

DrMM: Well, actually that was at the SIBO conference, where I decided if I’m treating all of these diabetic patients with neuropathy, why is no one addressing that we have nerve damage in the interstitial cells of Cajal causing SIBO? I like to pat myself on the back that I’m the first one to bring up that conversation.

In terms of diabetic supplements, I should have said alpha-lipoic acid because I will always put all diabetics on alpha-lipoic acid because it protects the pancreas, it protects the liver, it’s an insulin resistance reducer. Same with gymnema. I would always someone on gymnema. But anyway, alpha-lipoic acid, acetyl-L-carnitine, and lion’s mane, as well as benfotiamine, which has to be used quite a bit in diabetics with any kind of complication — these are my four main for diabetic neuropathy. These seem to be the best studied, they’re easy on patients, and they work really well. So I’m not putting patients on benfotiamine or on acetyl-L-carnitine or lion’s mane. I’m putting all patients on alpha-lipoic acid, but if they start having neuropathy or others — if they have retinopathy or kidney failure — then I’m going to start adding the acetyl-L and certainly the benfotiamine. Lion’s mane seems to be specific to the nerves.

DrMR: Gotcha.

DrMM: Paul Stamets at the American Association of Naturopathic Physicians conference this year in Oakland, in his discussion of many herbs, also brought up lion’s mane and confirmed its nerve protection and regeneration capacity.

DrMR: Interesting. I’m curious to see, and I’ve been dabbling with the idea of maybe using that with some patients that seem to have really recalcitrant SIBO to see if we might be able to regenerate some of the interstitial cells of Cajal with it. Gosh, I hope you’re on to something with that, and I hope that that really works because that could be a huge benefit to those patients.

DrMM: Well, definitely my SIBO patients wind up on acetyl-L-carnitine and lion’s mane. I put all of them on those products, and I think it really helps them. I really do. I think that it just gets things kicking in better for them quicker than not using it, so I do that with all of them. I feel very comfortable with that.

DrMR: Sure, OK.

Diabetes medications

DrMR: Now, what about the medications? And there are…

DrMM: Many!

DrMR: Yeah, there are many! And I do have one question, but let me hold that until you give your narrative on this, and then I have one or two that I think might be interesting to discuss.

DrMM: You want me to give a narrative on diabetic medications?!

DrMR: Well, I guess maybe your short narrative. I’m sure you could probably go for five hours.

DrMM: I think it’s important for doctors to have certain attitudes when working with patients. I am a naturopathic physician, and obviously I first love trying to get people to heal their own bodies and have them work on their own with maybe gentle support, etc. However, people don’t always come in the door like that. They come in the door with advanced disease. They can’t really change the diet. They’re not going to exercise. They don’t want to do a detox program. They use their CPAP but not when they travel. I mean, people are people! And so what I teach in my courses and what I firmly believe is that we cannot consider drugs a bad thing. We have to consider drugs to be just another way — The bad thing in diabetes in high blood sugars. That’s the disease. That’s what causes all the damage. It’s not metformin. It’s not Lantus. It’s high blood sugars. So right from the get-go, we have to talk to patients that, “We’re going to do everything we can naturally, and if it works, great. But if your blood sugars are still really high, you may need medication. And the good news is that we have some good medications that we can work with to get your blood sugars down.”

Like, metformin — that’s a fairly good drug. Now, metformin has the capacity to block B12 because it interferes with the enzyme in the terminal ileum that absorbs B12 from the gut. Now, that enzyme is calcium dependent, so if a person is either just taking B12 in a supplement or taking some extra calcium, that can overshadow the metformin. Go back 10 years, I thought, “Oh, people on metformin have to get a B12 shot every month.” That’s not the case. Just taking my multiple, people on metformin are fine. They’re not getting B12 or folic acid deficient. So, it’s just that, of course, patients come in on metformin for a decade from their MDs and they’re not taking a multiple or anything. Those are the people that we might want to be concerned about and really check their B12. But metformin, otherwise, aside from the gut problem, which affects about 33 percent of people, but usually if you switch them to an extended-release metformin, over, I think, 98 percent of patients will have no problem with the gut if you go on extended release. It’s a good drug. It’s safe. It doesn’t cause problems. You have to be careful if they’re having some kidney failure — significant kidney failure — but, you know, that’s why everybody across the world is recommended to start with metformin in type 2 diabetics or pre-diabetics or PCOS patients, because it’s a fairly good drug.

DrMR: Now, there was a book written, and I can’t recall the name of it, but one of the opinions this author put forth was that insulin might be a better front-line therapy for diabetes. You know, when you’re going to use a medication, it may be a better front-line medication than we have considered it to be because it’s the natural hormone that the body is producing and it’s not a drug, which can cause other problems and have other side effects. I found that very interesting from the perspective of, I mean, it’s using a hormone, which I kind of get that, but I also had some reservations about that. What are your thoughts on that?

DrMM: Well, here’s the deal with that. One, the studies are pretty clear that if you have a person with type 2 diabetes say — of course, type 1 diabetes, duh. You’re putting them on insulin unless you can get —

DrMR: Sure.

DrMM: But if we’re talking type 2, which is 95 percent of diabetics, if they come in the door and they have an A1c of 9 or so, initiating insulin is the quickest, most effective way to get their blood sugar down. It preserves the most pancreas support so that you get your blood sugar down, and then you wean people off of insulin, and they can be good for months and months and months and months and months, up to a year or so, especially if they’re making changes that they need to make.

So, yeah, the studies are very good with that, but nobody is doing it. Why? Because patients don’t want to be on insulin. Doctors hate having patients on insulin. Most doctors are clueless with prescribing insulin. They don’t want to deal with the hypoglycemia. They don’t want to deal with being in touch with them about what’s going on with this or that. There are huge blocks with patients and huge blocks with physicians to initiating insulin right away in that regard.

DrMR: Right, and I can definitely see the potential hypoglycemic effects. I mean, if you’re not paying attention and you overdose yourself and you have a hypoglycemic event, that can be scary, even life threatening, so I get that perspective. But, yeah, it also seems like there’s some utility there that’s not really being fully used, but I guess, rightfully so. The downside risk seems substantial.

DrMM: Right, and remember the other thing is that insulin has plenty of side effects, right? For this person to say that, “Oh, insulin has less side effects than metformin,” that’s completely not accurate. I mean, with insulin, you have weight gain, you have water retention, you have hypoglycemia, you have bruising where they inject, you have lipodystrophy. I mean, there’s a significant amount of problems with insulin. You have expense. Metformin is a $4 medication at every pharmacy. Insulin, each bottle a month is $230.

DrMR: Wow. I didn’t know that.

DrMM: Yeah, let alone you need your syringes or you’re going to get pens. There are big differences in affordability among these two, say, medications.

DrMR: Sure. Well, you did a good job of answering that one.

DrMM: And look, I feel super-confident using insulin, as you know. I teach a two-day insulin intensive seminar, but it is a much more serious affair. You can never get into a hypoglycemic state on metformin.

DrMR: Exactly.

DrMM: It’s impossible. And all patients need is one hypoglycemic effect on insulin and they are pretty traumatized by it.

DrMR: Yeah, I definitely would not want to have that myself, so I totally get it.

Episode wrap-up

DrMR: All right, Mona, well, to kind of bring things to a close, are there any thoughts that you want to leave people with?

DrMM: Yeah, I would say, look, I’m a naturopathic physician. I think diabetes does best through alternative-based naturopathic or maybe integrative MD physicians because we spend the time. Having diabetes means looking at your diet, your exercise, your detoxification, your sleep, your stress, your nutrients. It takes time to spend with patients to really do it well and do it safely, and unfortunately, in standard care, these five- or eight-minute office visits, it doesn’t work! Or if they do a team approach, here’s the classic team approach in standard care: The physician does the insulin. He has no idea what the person eats. The registered dietician works with the patient on what they eat but has no way to change the insulin, and so, of course, the outcomes are usually not very good. So having a physician who does the diet and the insulin and talks about the stresses and the exercise — that’s alternative care. That’s naturopathic care. My one little smarmy phrase is that we own diabetes in terms of being the physicians that can give the most comprehensive, safest, and most effective care, and a lot of it is how we schedule office visits and giving the time and having the broader-based vision of what causes it and what needs to be addressed to best get it under control.

DrMR: I agree a hundred percent. This is known to be a predominately lifestyle-related disease, and so, of course, if you don’t really address the lifestyle, how can you expect to have a very efficacious treatment? Absolutely.

So, Mona, where can people track you down or get a hold of you if they are wanting to find out more?

DrMM: Thanks. Well, my website is (2b). I’m in Tempe, Arizona, (480) 284-8155.

DrMR: Awesome. Well, thank you so much for being on. I think people are going to get a lot out of this call, so thanks again for taking the time.

DrMM: You were great! Thanks very much. I really appreciate it.

DrMR: My pleasure, Mona. Take care.

DrMM: OK.

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Discussion

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14 thoughts on “Diabetes Deep Dive with Dr. Mona Morstein – Episode 34

    1. Charles,

      This is a good question. I specifically asked this question to Dr. Morstein in the interview because I am aware of these data. Did you read/listen to this part? She provides her thoughts. My thinking is no one marco-nutrient diet/ratio is right for everyone. Again, good question – always good to look at both sides of an issue.

  1. Excellent interview Dr. R.. Thank you so much for conducting it. I find you to be quite honest and trustworthy. Trying not to put you on the spot – what is your opinion about ketogenic diets for.

    1) People with insulin resistance. (Pre diabetes)

    2) Type 2 diabetics.

    3) Healthy people.

    4)Healthy active people (Slow aerobic joggers less than 30 – miles per week.)

    Best Regards,

    Jim

    1. Hey Jim,
      Thank you, I really appreciate that.
      1) and 2) certainly a primary consideration
      3) and 4) could be helpful but not always
      In the book I will detail a process through which people can help determine what their ideal carb intake should be. The hard part is often times people can’t get a good read on what level of carbs they feel best on until their gut is healthy. So we have a sort of 2 step processes. 1st fix the gut, 2nd empirically determine what the ideal carb intake is. Hope this helps!

  2. One more follow up question. Have you ever tested a 55 year old male who was not insulin resistant (pre-diabetic)?

    Best Regards.

  3. One more follow up question. Have you ever tested a 55 year old male who was not insulin resistant (pre-diabetic)?

    Best Regards.

  4. Excellent interview Dr. R.. Thank you so much for conducting it. I find you to be quite honest and trustworthy. Trying not to put you on the spot – what is your opinion about ketogenic diets for.

    1) People with insulin resistance. (Pre diabetes)

    2) Type 2 diabetics.

    3) Healthy people.

    4)Healthy active people (Slow aerobic joggers less than 30 – miles per week.)

    Best Regards,

    Jim

    1. Hey Jim,
      Thank you, I really appreciate that.
      1) and 2) certainly a primary consideration
      3) and 4) could be helpful but not always
      In the book I will detail a process through which people can help determine what their ideal carb intake should be. The hard part is often times people can’t get a good read on what level of carbs they feel best on until their gut is healthy. So we have a sort of 2 step processes. 1st fix the gut, 2nd empirically determine what the ideal carb intake is. Hope this helps!

    1. Charles,

      This is a good question. I specifically asked this question to Dr. Morstein in the interview because I am aware of these data. Did you read/listen to this part? She provides her thoughts. My thinking is no one marco-nutrient diet/ratio is right for everyone. Again, good question – always good to look at both sides of an issue.

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