Chuck: Oftentimes on theexam room podcast, we talk about the role that nutritionand a healthy nutrition can play with type two diabetes. We’ve heard all of the researchthere and the incredible things that it can do, but we haven’ttalked much about the role of nutrition and type one diabetes. What is the relationship there? Well, that is what we willbe exploring today when we are joined I’m so thrilledthat she’s back on the register. She is the director ofclinical research now at the Physicians Committee. She’s the director of theuniverse and she’s delivering you new health for a new year. Dr. Hana Kahleova. Welcome back to the Exam Room. Hana: Thanks forhaving me Chuck. you are well aware, it’s, it’s sucha delight to, to talk about diabetes and nutrition. And as you spoke about, mostof the time, when we think about diabetes, we, we talkabout type two diabetes.By what about if you have typeone diabetes, is there a persona of nutrition, you know, is there, is there something that you could do with nutrition thatwill influence your diabetes? So let me pull up myslides and I’ll prove you what we know so far. The number of studies on therole of nutrition in type one, diabetes is much more limited.But at least we have a glimpseand we also need to more studies and that’s exactly what, whywe’re doing the podcast today. Uh, so the type onetype one diabetes is an auto immune disease. That’s characterized by betacell dysfunction where the beta cadres in your pancreaswill not produce enough insulin for, for the body’s needs. So these people need to injectinsulin for the rest of their life, but there’s also a secondcomponent to the disease and then that’s insulin resistance.And when I say insulinresistance, most of you are probably like what I thoughtthat would be a mechanism that’s included in type two diabetes. Which is true. It frisks a more importantrole in nature two diabetes, but it’s also present in type onediabetes to a certain degree. And insulin opposition isbasically, the inability to have the cells to respond toinsulin as much as we’d like.So insulin is like a key thatopens the door for a glucose to come into the cells. And if the door lock isjammed, that would be insulin resistance, all ofthe sudden there’s insulin, but it’s just not workingand it cannot open the door. And the glucose cannotcome into the cells. And so you know, affectingthe beta cadres in the pancreas is much morechallenging than affecting the insulin fighting. So we are trying to target theinsulin resistance of the com as a component of type onediabetes through nutrition. And now with the, withthe limited amount of studies, and that has beenpublished on the role of diet in type one diabetes. We realize that there is abig need for new studies. And I got to tell you, uh, wecame up with a research study that you can participate in, or your friends with type one, diabetes can participate in.The study is a randomizedclinical visitation, where people who are interested in participatingwill be like with a fling of a coin, randomized to eitherfollow a portion controlled carbohydrate, watching nutrition, where you need to count your carbs And uh, um, youneed to watch your parcels, or to a low fat vegan dietconsisted of fruits and grains and legumes and veggies. Now, how are theseapproaches different? They’re very different. The fraction controlled diet isrelatively low in carbohydrates, and it’s basically limitingthe amount of glucose that we. And that comes intoyour bloodstream. So that’s the sugar that’sinside the blood cell and we just limit the amount of glucosethat’s inside the blood vessels.And that’s how we can regulatethe level of blood sugar. The low fat vegan diet is ahigh carbohydrate diet, right. There’s fruits andthere’s grains, there’s legumes and veggies. All of these are sourcesof carbohydrates and it deals with principally the, uh, the insulin resist. The suggestion behind is that theinsulin resistance is eventually caused by overweight that’s storedinside the cells, inside the muscle cadres and liver cellswhere it doesn’t belong to.So if we can get rid of this, this additional fat, the insulin defiance will improve. And since the, this low fatvegan diet is very low in overweight the relevant recommendations behind is that we willmobilize the intracellular overweight, the overweight stored inside the cells. Now, If if you’d like toparticipate in studies and research, then you what, what the hell is you get? You will get weekly categorizes onWednesday nights over zoom. You will, you will geta Dexcom G6 perpetual glucose monitoring work. So on your phone, you will seecontinually how your blood sugar looks like, but you, we willask you to give us access to your data so that we can alsohelp you if, if there is any adjustments that are needed. You will too, uh, get ascale and a digital flake. Vitamin B1 2, um, That’s essential for people on vegan foods. Uh, we give it to allparticipants in both groups. Some prescriptions also decreasethe absorption of vitamin B12. And generally speaking, aswe age, the absorption of vitamin B12 is lower and lower.So you will benefit from takingthe vitamin B12 supplement. If “youre in” the portioncontrolled food, you will get some resources. You will get the book, Think Like a Pancreas. I wish all of us couldthink like a pancreas. I, you are well aware, I wasreally inspired by this. I was like, you know, this is a great book. I entail, uh, I wish allof us could envision like a pancreas and too a cookbook. Uh, but if you are on alow fat vegan diet, don’t worry, you are able to, youwill get other resources.You will likewise get a cookbookand a record, uh, from Mastering Diabetes and alsoa con attendant bible that will help you keep the fatcontent of the nutrition low-spirited. Now we start in late Januarywith this study, or maybe even early February inthe first week, this is the only way varied the breakfasts. Then in the second week wechange the lunches likewise. And then in the third week, ultimately, we too deepen the dinners and snacks, which means that all the menu is already checked. Now you can probablyimagine how the parcel assured diet looks a lot like. But “youre supposed to” don’t knowexactly what it means to be on a low fat vegan diet. So for the, for the lowfat vegan diet, the food is vegan, which makes noanimal products , no meat , no cheese , no dairy , no eggs. Uh, it’s low fat. That means that the solid contentis up to 20 to 30 grams per day.And we likewise keep theglycemic index low-pitched. Uh, you know, when you lookat the strength sheet, uh, the diet consists of fruitsand grains and legumes and vegetables, uh, and how tokeep the fat material low. You may be thinking, well, ifI saute my onions I need oil. But you can also replacethe petroleum with soy sauce or vegetable broth, oryou can use some spray. You will be asked towatch the, the fat content of the packaged menus. Like for example, beansare excellent because they’re the upper limit for thefat material is two to three grams per serving. And this particular can of beansdoesn’t have any solid in their own homes. So it’s model. And you may realize that someof the, the vegan menus will not be compliant to the dietaryrecommendations on the study. So for example, Amy’sBlack Bean Burrito. When you look at thefat material, it’s eight grams per serving. So this would not meetthe study criteria. Now, uh, we know thatglycaemic index is important for people with diabetes. It cures with glycaemiccontrol too with blood lipids and with figure weightand with inflammation.And so when we look at ourfood radicals: fresh fruit and grains, and legumes and veggies, we can create lists. The low-glycemic index foodswould be lower than 55, medium up to 69 and high glycemicindex menus, at least 70. When we look at nonstarchy veggies, all of them are, are wonderful. You don’t need to limitthe intake of non starchy veggies at all. When we look atbeans, it’s the same. All of them are great. Your, your beans and separate peasand your lentils, uh , no restraint on the intake of those. The same is true for mostof the results, except for watermelon, where, um, youwill, you may need to be more careful with the fractions, uh, or with other juicy result, like mango and pineapple.For cereals, all the oldfashioned particles are in barley and bulgur and corn, corntortilla, and millet and quinoa and buckwheat and rolled oats. All of these arecompletely compliant. Uh, the same with ri rice branand spaghetti and mad rice. Where it gets a little bittrickier is sweet potatoes and lily-white rice and cous cous. You need to be more carefulwith the components and this, and, uh, there’s also high glycemicindex menus in, in particles and starches cooked potatoesand instantaneou oatmeal and light bread, for example, or a bagel. Now, does it mean thatyou will not be able to eat any of those on. Uh , no, if you want to havea big potato, you, you still can, you can just load upon veggies, uh, and have let’s say nut chili with it. Uh, and that course you willlower the overall glycemic index of the, of the banquet. And the same applies whenyou want to eat a bagel. It’s a high glycemic index food.Um, but if you have just asmall piece and have a lot of veggies and low fathummus, you can still eat it and you will be compliantwith the study requirements. So to summarize, the vegetablesand the legumes are all low-glycemic index and thereis no thoughts needed. Uh, for returns. Most of them will be compliant. There’s just a few kindswhere you, you may need to be a little bit more careful. And with specks, thereare some added regards that are needed. Now I need to let you know, ifyou want to participate in the study, there might be some upand downs in your blood sugar. If your blood sugar is going toohigh, you may need to include more veggies and more andmore beans with your meals. If it’s running too low, we may need to adjust your insulin and lessen thedose before the meal so that you don’t get too low. The next time. There’s also somedigital aids. You can download the, the2 1 Day Kickstart program on our on your phone. And if you’re interestedin participating, I like to encourage you to contactour study coordinator, Tati, here’s her contact, emailaddress and her phone number.And we also have a studywebsite and that one will be posted below. So which diet is bestfor type one diabetes? The refute is we don’tknow hitherto, and we need your help to to sort this out. Is it the carbohydrate watchingportion control diet that limits the uptake of carbohydrateor is it a high carbohydrate, low fat vegan diet? So I, we would greatlyappreciate your help in answering this questionin helping us with the recruitment for this study.So if you have type onediabetes, or if you know someone with type one diabetes, orif you’re a doctor and you have cases with type onediabetes, please let us know. Chuck: Yeah. And you interpret therecruitment webpage right there on your screen. So pcrm.org/ recruitment, and as Dr. Kahleova said, the authorities concerned will made alink in the chapter mentions below. Um, really importantresearch because very often, and I was talking aboutthis recently with Dr. Dean Ornish, as well as likeso much of this, um, center with diabetes is on type two. Um, but now here weare with type one. And I are of the view that that’sreally, you’re going to be unlocking some answershopefully for a lot of people.And I noticed that theMastering Diabetes book was included in this study. And, um, anecdotallyhere you know, Dr. Cyrus Khambatta and RobbyBarbaro who put those two together, both of them have typeone diabetes and, and, you are well aware have realized pretty good results. So we, you know, that’s just two parties. We need a lot more thanthat to be able to have a definitive answer. And that’s why you’redoing this study. And I think that it’s fantastic. So when does, whendoes the study begin? Hana: The study willstart at the end of January or early February. So we have enough time. You have enough time to thinkabout it, sign up, then enjoy our vacations and start withthe diet after new time. Chuck: I like that start withthe diet after new times. How many people say that? everybody, right. Um, so, okay, well listen, – well with studies and research. Uh, I hope to keep tabs withyou to see how things are going and then, when it’s throughand, and you guys are ready to publish, I would cherish Dr.Kahleova over for you tocome back on and share your conclusions with us. Hana: Thank you so much, Chuck. Chuck: All title, Dr. Hana Kahleova. Thank you so very much. If your state IQ is acouple of points higher than it was a few minutes ago. Go onward and like this videoor subscribe to the YouTube channel and to take it evenhigher, principal over to Apple Podcast or wherever youget your favorite shows. Look for the Exam Room bythe Physician’s Committee. 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