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2009-08-20 John McDougall MD Diabetes Reversal With The McDougal Program

KIRK HAMILTON: Welcome to Staying Healthy Today, a health-oriented radio show committed to bringing you key experts in the fields of nutrition, prevention and integrative medicine.

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Today's show topic is "How to Prevent and Reverse Diabetes Following the McDougall Program." Our guest today is Dr. John McDougall, a board-certified internist and nutrition expert who teaches better health through vegetarian cuisine. Dr. McDougall has been studying, writing and speaking out about the effects of nutrition on disease for more than thirty years. Dr. McDougall is founder and medical director of the nationally renown McDougall Program, a ten-day residential program in Santa Rosa, California, where proper diet and lifestyle changes can lead to dramatic health improvement. Dr. McDougall is the author of several national best-selling books and his latest ground-breaking book "The McDougall Program for a Healthy Heart." A graduate of Michigan State University College of Human Medicine he performed his internship at Queen's Medical Center in Honolulu, Hawaii and his medical residency at the University of Hawaii.

Welcome Dr. McDougall and thank you for taking the time out today in your very, very busy
schedule to share your wealth of experience about diet and lifestyle, and in particular today on preventing and reversing diabetes. So thank you for coming.

DR. JOHN MCDOUGALL: Well it's just a pleasure. Of course we have to define what kind of diabetes we're talking about.

KIRK HAMILTON: That's true. So if you look at the last time I was on the CDC website they'll say approximately 8% of the U.S. population has diabetes and another 19% is prediabetic. So that's a quarter of the U.S. population has some type of blood sugar issue and my understanding is 90 to 95% is type 2 diabetes and I think that's what - well, your program addresses both but that's the one that you see the dramatic changes in. Is that correct?

DR. JOHN MCDOUGALL: Yes, it is correct in a way. I mean this is the one, type 2 diabetes, that you cure. But for type ,1 and type 1½, or however you want to define everything in between, the results are quite dramatic also. I think people should understand when we're talking about diabetes we're generally talking about diabetes mellitus, meaning elevated blood sugar. There are generally two categories. At least that's the way it was traditionally thought of. One is type 1 which was previously referred to as childhood diabetes and that's where you have inadequate production of insulin from the pancreas and that's due to diet also. It's an autoimmune disease primarily resulting from cow's milk consumption. That's a completely separate issue and discussion from type 2 diabetes which is the kind where the pancreas is working to it's full capacity. In fact, sometimes it's producing twice as much insulin as somebody without diabetes. It's just that the body has developed resistance to that insulin. You hear about insulin-resistance, and that's sort of type 2 diabetics traditionally, and so by definition if you can stop the cause of the insulin resistance since there's plenty of insulin being produced, then you can cure all of these people which is the case. If you have true type 2 diabetics just by removing the cause, which is the diet and associated excess weight, then essentially all these people would be cured of their diabetes. I mean that's the proper word - they're cured of the problem. Now the thing is that you've got a spectrum of people between insulin insufficiency and insulin resistance and some people refer to these types of diabetics as type 1½. I think what needs to be conveyed is that these people can produce enough insulin to keep themselves out of serious trouble which we call ketoacidosis. But they don't produce enough insulin to keep their blood sugars normal or in time to keep their weight on and so these people are insulin insufficient. With a change in diet they will improve a lot, but they still may end up, because they don't make enough insulin, with elevated blood sugars and other problems associated with diabetes. That doesn't take away from the fact that these people need to be treated just as aggressively.

KIRK HAMILTON: Let me ask you then about what might be the causes in the last 50 to 100 years in the American diet, or the industrialized world's diet, that might have led to this issue of diabetes.

DR. JOHN MCDOUGALL: You're talking about type 1 or type 2?

KIRK HAMILTON: Well either one. I mean I know you talk about...

DR. JOHN MCDOUGALL: You really have to separate them. You can't talk about them... together.

KIRK HAMILTON: Let's talk about type 2 then.

DR. JOHN MCDOUGALL: Type 2 diabetes is a natural response to overnutrition. There's no disease involved here. The body is doing what it's supposed to do. It's an adjustment to overnutrition. What happens is as we have excess calories available which is, you know, something that's only been available to common people since the industrial revolution and more so as the years go by. People can live and eat like kings and queens. Prior to that, there was just a few people who could indulge in that kind of excess. When you have excess calories what happens is the body does what it does normally and naturally for survival, it stores some of these calories which is good. I mean you can store an extra 10, 20, 30, 40 pounds and the body claims this as an advantage for survival when the famine comes along or the winter comes along. So this is a proper thing for the body to do, to store an extra say 30, 40 pounds. Then you get to a point where you're still taking in excess calories and the body says, "You know, I really don't need any more to store because if I store any more pretty soon I'm not going to be able to climb a tree and get away from an enemy." And in modern times you're not going to be able to get out of bed or get through the door. I mean it's just getting to the point where it's contrary to survival. And then what the body does is it makes a normal natural adaptation. And what it does is it becomes resistant to the effects of insulin. Insulin produced by the pancreas. Its job is to allow sugar to get into regular cells and allow fat to get into fat cells. Well you've already accumulated enough fat. You don't need to accumulate any more so what the body says is okay, that's enough. Now I will become less sensitive to insulin so I don't keep storing fat and become 150 pounds overweight. That's insulin resistance and it occurs at all kinds of levels. It occurs at the cellular level. It occurs in the blood stream. It occurs in many places we know about and don't know about. But the important thing is the body makes a proper normal adjustment.

KIRK HAMILTON: Let me ask you where the diet changes have occurred? I know we have excess calories, but what are the diet changes specifically that you see in the last 50 to 100 years that have related to this excess calories?

DR. JOHN MCDOUGALL: You know again it depends on what we're trying to define. We're trying to define the disease problem or are you just trying to define...you're putting yourself into a state of adaption of insulin resistance. The major change that has been is the consumption of more animal products, more free oils. Those are the primary things. And then you get to some very secondary things which are sugar and refined flours. But it's the fats and oils that are the primary problem particularly when they're bound up in animal foods. But the thing is the underlying mechanisms I tried to explain to you is one of normal adaption. It's not a disease. The body's not doing something wrong. It's just being burdened.

KIRK HAMILTON: If everybody was lean irregardless of the quality of food they ate, would diabetes be dramatically less?

DR. JOHN MCDOUGALL: Yes. Even if they ate the Atkins diet, an all meat diet. Diabetes would be - type 2 diabetes would be dramatically less. You can correct type 2 diabetes by eating a diet exactly the opposite of what I recommend.

KIRK HAMILTON: So tell me about the diet that you recommend because you've been so successful with it and I know you emphasize the starch based diet and we have a carb phobia still in this country somewhat. Can you elaborate on that?

DR. JOHN MCDOUGALL: Yes. The diet that I recommend is the diet that most people that have ever walked this earth have consumed. It's the diet of all successful populations throughout all of recordable history. There are no exceptions. And unfortunately science or historians or the general population has a hard time recalling history. If they did for a moment they'd figure out what the human diet really is. In recordable history - I'm talking about times where we really have adequate information about how people ate, and that dates back to 13,000 years ago, maybe 24,000 years ago. We really have good records from camp sites and writings and all kinds of things as to what people ate. And if you just stop for a minute you realize that people are starch eaters. All successful populations of people have lived on starch. For example, the Mayans and the Aztecs. They were known as ‘People of the Corn'. So was the American Indian, native American. They lived on corn and squash and beans. That was their diet. As a matter of fact there's a new dollar out called the "Three Sisters" which represents those crops. If you think about Asians for at least 5,000 years their primary calorie intake has been rice. But it's been other things. It's been sojourn and buckwheat and sweet potatoes, but rice is classically the diet of most Asian populations. In the Middle East, five, eight, 10,000 years ago it was millet and wheat. If you look at South America and you look at the people of the Andes. They live on potatoes, still do today, potato based diets. And there are populations that lived on sweet potatoes like those in New Guinea and those in the Caribbean. So wherever you look the primary source of calories for human beings has been starch and when they've consumed those calories, they've had no type 1 or type 2 diabetes. They've had no multiple sclerosis, heart disease as far as we know. Well we have examples of these people living on starch based diets up until recently, and in fact there are a few isolated populations that haven't been touched by the American diet and we can still see that they don't have type 2 diabetes. They don't have coronary artery disease. They don't have multiple sclerosis, rheumatoid arthritis, etc.

KIRK HAMILTON: Tell me about the type of starch. When you say starch, we talk about refined grains and whole grains. Can you elaborate on that a little bit?

DR. JOHN MCDOUGALL: Well starch is a scientific term. Starch refers to plants that have high content of starch granules. You know that's what starch is. And unfortunately the American public is unfamiliar with that term or if they have emotions that are improperly placed on that term, but there's actually a journal, scientific journal called ‘Starch.' Because that's what the food is. And rather than try and work my way around it and call it things like plant food based or high carbohydrate or you know other words that have been used, vegetarian or vegan or whatever, I try and identify for people exactly what they need to focus on . Because until they do they can't get it figured out and they can't do it. People need to understand that the human being is a starch eater and you live on a starch based diet that's the natural diet. You can talk about refining and adding things to the starch, but that's not what I'm talking about. What I'm talking about is the native plants. They're called starches which are rice, corn, wheat, potatoes, sweet potatoes, winter squashes. There are various kinds of starches. They're high calorie, not too high in calorie. They're high calorie foods that are based on the starch granule.

KIRK HAMILTON: Take us through the beginning of let's say your program. A ten-day residential program where someone comes in. In fact, I know one of your clients who came in very overweight, big milk drinker, on multiple diabetic medications. Take us through what you would tell that person. This is a type 2 diabetic with severe neuropathy. How would you approach him?

DR. JOHN MCDOUGALL: Well I would assume the person is there under their own volition, but not always. Sometimes they're sent there by well-meaning relatives. But say the person came there fully knowledgeable about what they're getting involved in and what I do and very much wanting my services. The first thing I do is I do a history and physical because I am an internist, a practicing medical doctor. And so I sit down and talk with the folks. Find out what - how they're feeling, what their problems are, what medications they're on, and so on. And that's day one. Day one, in general for the type 2 diabetic, I stop all of their diabetic medication. That includes insulin. That includes all their diabetic pills for a type 2 diabetic. I hope I said type 2, type 2 diabetic. I stop all of their medications generally on day one. Now sometimes they're a little frightened about that kind of aggressive recommendation. And so I will tell them I may compromise. I tell them to stop the pills. Maybe I'll leave them on, a third or half or quarter of their insulin until they get a little bit more comfortable with what's going on. But generally after a day or two they're off of all the medications. And their blood sugars are as good, if not better, than when they were on a bagful of drugs. And the other thing I do is I take them, they usually just don't just have type 2 diabetes, they also have high blood pressure, they also have indigestion so they're on antacids. They also have high cholesterol so they're on statin drugs. So I rearrange these medications generally reducing them or stopping them also. And then what I do is I monitor them over the next 10 days and generally what I find is that their numbers are better, much better than when they started. They lose weight and they feel better almost immediately. It's a very good way to practice medicine. Your patients are happy and they quickly get out of trouble and so it eliminates a lot of problems once you make these adjustments in their medication.

KIRK HAMILTON: What do they start eating when they come in to your program?

DR. JOHN MCDOUGALL: As far as....what do you mean?

KIRK HAMILTON: Well, is it eat as much as you want of this good healthy food that you have there? There's not a limit on the food, is what I'm trying to get at.

DR. JOHN MCDOUGALL: No. There's not portion control. It's served buffet style. So when people come in they often eat a lot because they're used to eating a lot and they're scared. They are afraid that the food may taste good, that meal, but they may not like the next meal, and yes they eat a lot of food. It's a starch based meal plan. We serve them some salads, but that's a minor part of the diet. We serve them some green and yellow vegetables, but that's a minor part of the diet. The main part of the diet is as I mentioned . It's starchy foods. It's potatoes, rice, corn, beans, lasagna, pastas, those kinds of foods, corn tortillas.

KIRK HAMILTON: Now it's a no-fat or relatively no-fat regimen, and is there any limit on fruit intake?

DR. JOHN MCDOUGALL: Yes there is. It's not really well guarded, the fruit intake, but generally I recommend people eat one to three fruits a day and as far as added fats there are no added fats in the program. In other words, we add no free oils to any of the foods. None of the foods are cooked in an oiled pan or anything that would add any free oil.

KIRK HAMILTON: Is it nut and seed free, or is...?

DR. JOHN MCDOUGALL: Well that would be mixed up in the plant. The nuts and seeds would be...but they don't get many nuts and seeds or avocados at the program. It's a pretty rare treat.

KIRK HAMILTON: So what kinds of things do you see dramatically improve? We know lipids go down. We know blood sugars go down. How about things like diabetic neuropathy, sexual - erectile dysfunction?

DR. JOHN MCDOUGALL: These things take time. There's a study published from Weimar. It's a case report study where 17 of 21 people were able to resolve their diabetic neuropathy with the kind of diet that I serve and they serve, and that lasted for four years. I see some benefits. I see some improvements in people with diabetic neuropathy, but it's a tough thing. There's a lot of permanent damage going on when you have diabetic neuropathy. Also, I see the protein go away in the urine from diabetic nephropathy. In other words kidney disease, and it's been reported as long ago as the 1930s and early 1940s that diabetic retinopathy, the eye disease, on this kind of diet will dramatically improve. Exudates will disappear. The whole eye ground becomes much better looking and so all those things take place. I take care of them for 10 days and even though there may be some pretty dramatic changes in terms of how people feel and what their numbers look like, some of this serious damage that goes on with the nerves and the blood vessels may be permanent, or may take a long time to reverse.

KIRK HAMILTON: Do you recommend any supplements like basic B12 or vitamin D and a basic multi?

DR. JOHN MCDOUGALL: Well I haven't gotten around to recommending vitamin D yet. I think - I worry about possible adverse effects like prostate cancer and heart disease and we really don't know what's going to happen when we add in the concentrated vitamin D to people in pills. I recommend what they really need, which is sunshine. I do recommend B12 as a supplement, and that's a pretty innocuous vitamin. Multivitamins I don't recommend. Multivitamins are associated with worse outcome. More heart disease, more cancer, earlier death. Combinations of vitamins are dangerous and the reason is they're isolated concentrated nutrients that the body was never intended to be exposed to and it creates serious nutritional imbalances. So vitamin B12 is about the only supplement that I recommend.

KIRK HAMILTON: How about exercising during your program?

DR. JOHN MCDOUGALL: It's done carefully and well managed. Like the man you just mentioned. Very overweight type 2 diabetic. You've got to be very careful about that because they come enthused. They want to do everything. They want to do everything everybody else can do and so they get out there and they start pounding the pavement and before you know it they've damaged an ankle or a knee or a hip. So our exercise program is very individualized and very carefully prescribed so that we don't end up doing more damage than when they came in.

KIRK HAMILTON: So using the word control versus reverse. How would you term type 2 diabetes? As a reversible condition?

DR. JOHN MCDOUGALL: Oh, I think you should use the word cure. I don't think you should use the word reverse or in remission or you know - I mean it's cured. It just like if you take somebody who's a cigarette smoker and you have them, and they have a terrible cough and you tell them to quit smoking cigarettes. Are they in remission? Well only if you believe smoking cigarettes is normal behavior. Have you cured them? Well of course you've cured them. If you believe eating the American diet is normal behavior then people are only in remission when they go on the eating plan that I recommend. If you believe the American diet is an aberrant thing to do, something that's only in large numbers, only in this time period and you believe it's an incorrect diet for people when you correct that diet, and you put them on a starch based diet then the term you have to use is cured. They're cured.

KIRK HAMILTON: Can you drop someone's blood sugar too fast? Let's say they go on your diet regimen. Because I've heard people when they're on medication, you can drop their blood sugar too fast. In fact there was an article just about it. Is there a problem with dropping blood sugar too fast on your approach?

DR. JOHN MCDOUGALL: Well I think we have to - I have to understand what you're saying. I think what you're trying to ask me is if intensive therapy with lots of pill and lots of insulin shots, is it harmful to the patient? Clearly it's harmful to the patient to aggressively treat them. You increase their risk of death and heart disease .You double their weight gain. You cause serious hypoglycemic reactions. There were three major studies published last year in the New England Journal of Medicine that all showed this. And there were three published prior to that. So there's six major studies that show you hurt people when you aggressively treat their blood sugar and make it look more like normal. The standard that's used there is hemoglobin A1c. You try and make it look like normal. In other words 6%, as opposed to say 7 ½ or 8%. You increase the risk of death and heart disease in these people. It's a terrible thing to do and hopefully this will be corrected through legislation because education hasn't fixed doctors as far as their prescribing habits. As far as doing it with diet no you cannot. There's no such thing as too intensive diet therapy. If you have them off the medications you'll never run into a problem of a negative effect. It's all positive because you fixed the problem. But you do have to be careful about reducing the medications in a timely manner.

KIRK HAMILTON: Okay. That was what I was wondering. I knew the medication part. I was just wondering if there was too fast a drop if you just do it by diet?

DR. JOHN MCDOUGALL: I have people who come in with blood sugars of 200 on 120 units of insulin and I take them off the insulin and their diabetic pills, and within a day or two their blood sugars are close to normal. As long as you manage the pills, the pills are the problem. The body takes care of itself. But when you introduce the factor of medication which is working against what the body is trying to do then what happens is you run into problems with the drugs. You can get somebody in severe to serious trouble real fast if you change their diet, or exercise them more, and you don't deal with the medications properly and timely.

KIRK HAMILTON: A model patient that does everything you ask them to do, and I know it's hard because everybody comes in different states, but is a six month program reasonable that they could be nondiabetic, or three months or a year?

DR. JOHN MCDOUGALL: Well I think the way you have to look at it is the way we started this conversation. Do they have the potential to become cured? Do they, in other words, do they have a fully functional pancreas making plenty of insulin? If they do I would use another standard to say when we could just say cure or not, and that is when they hit trim body weight. I mean that could take a year. That could take three months. That could take a year and a half. So I would not give up on a patient's final outcome until they've hit trim body weight and that happens sometimes. I will get people who are 80 pounds overweight and they'll lose 80 pounds and their blood sugars are still 180. Well I think you've pretty much declared the fact that they're insulin insufficient and you're not going to be able to reverse that permanent damage to the pancreas, and so what happens is they hit trim body weight, so you have to just at that point keep them from losing more weight, and you have to add insulin to their program. So I generally put them on a long-acting insulin, then their weight loss stops and that's just the way it is. You know if you cut off your arm it doesn't grow back. You destroy your pancreas and it just doesn't grow back.

KIRK HAMILTON: Let's talk about type 1 diabetes as we close. Your treatment of that is similar I take it and you have dramatic results and let's talk about prevention a little bit.

DR. JOHN MCDOUGALL: Well type 1 is a whole different problem. You have dramatic results but in a different way. Type 1 diabetics have had their pancreas, their insulin producing cells of the pancreas destroyed, and they've been destroyed by an autoimmune reaction and that autoimmune reaction in most cases is caused by cow's milk protein. And so once you cause this autoimmune reaction where the body is out there destroying the beta cells, the insulin producing cells, those cells won't grow back and if that person doesn't get medical help they're likely to die. And that medical help is supplementation with insulin. That's the way it's been for almost 100 years and will always remain that way unless we have some miracle like a pancreas transplant. So you have to have different goals. These people are not going to get off their insulin. These people will reduce their insulin a little bit, maybe by about a third. They will become much less brittle. In other words they will be much smoother in their control. But the important thing for a type 1 diabetic as well as a type 2 is that they can prevent complications. The typical diabetic is fed the same diet that causes heart disease and blindness and kidney failure in people without diabetes. The high fat, high cholesterol American diet. So it makes no sense to feed a dangerous diet to a handicapped person, and that's the person with type 1 diabetes. They fall apart at a very rapid rate. So if you want this person with type 1 diabetes to live long with all the parts working then you must take very good care of them and that involves feeding them a healthy diet. I've seen diabetics live 40, 50 years with their eyes working and their kidneys normal, and so on who have been cared for by the kind of eating practices I recommend. So again, you have different goals.

KIRK HAMILTON: What are your blood sugar targets that you shoot for in someone that's lean? Is it below 100? It is below 90? Is it - what is it?

DR. JOHN MCDOUGALL: You know I don't get as fixated on numbers as you would expect I might. Normal blood sugar, in say somebody who eats really really well and is very active maybe as low as 45. In the typical healthy American person you may be looking at levels of 75 to 85. Somebody who is a bit overweight, say eating the American diet maybe looking at 90 to 100, 110. Again I just don't - the numbers trouble me less in those ranges than say a change of 100 points or 150 points. I can't give you a goal number because there's so much more going on that just that number is in terms of how that patient's doing.

KIRK HAMILTON: Okay. And the same with the hemoglobin A1c? If someone was lean and they are between 6 and 7?

DR. JOHN MCDOUGALL: Yes. You know, a normal hemoglobin A1c is below 6%. But if I get them to that hemoglobin A1c by using the drug then I've increased their risk of dying and having heart disease so you know you've got to be careful about what you use as normal and how you get there. So a hemoglobin A1c of 7% or 7 ½ or 8%. That may be okay as long as that's the best the patient can do especially when you realize your alternative is to give aggressive treatment of diabetes which has been proven to kill diabetics.

KIRK HAMILTON: I guess my question was more in a type 2. You have a successful type 2 person that's leaned himself out and is running 110, let's say. Would you put him on a little insulin or not?

DR. JOHN MCDOUGALL: Absolutely not. This is the craziness of the drug industry these days. They treat people with what we call prediabetes. As I just explained, if you aggressively treat a diabetic and you make them with medication normal, you're gonna kill them. You increase their risk of dying of having heart attacks. So if they start at 110 you try and make them whatever you define normal by aggressive treatment. You're gonna do the same thing as if they started at 210 and unfortunately that's where the business has gone. It's called disease mongering. It's how to make people, patients and how to create a huge market, and the way you do that is you change your definition as to what is normal or abnormal. If you say an abnormal blood sugar is 200 your market's small. If you say anything over 150 is abnormal then it gets bigger. If you say anything over 100 is abnormal, which a lot of doctors are doing these days courtesy of the drug industries, then almost everybody's sick and worthy of treatment.

KIRK HAMILTON: Well I'd like to close if I can, by asking you the question. I saw in the (Sacramento) News and Review, you had an article about you, because you're putting a bill in Congress about nutrition consulting or - can you go over that for me?

DR. JOHN MCDOUGALL: Yes, it's Assembly Bill 1478 in California. It includes the two top diseases in California and the United States. These are the big money-makers. And that's why we started with these two, and they are coronary artery disease and heart surgery and they are treating type 2 diabetics with drugs. And what this bill 1478 will require, it will require all doctors taking care of patients with either coronary artery disease, or type 2 diabetes in the chronic forms, to inform their patients that the current therapies don't work. The current therapies hurt the patient and they will be required to tell the patients that both these diseases are caused by the rich Western diet, and that both these diseases if you change to a healthy diet, and hopefully I get to define what a healthy diet is in the assembly bill. If you change to a healthy diet that both of these diseases will be dramatically improved as well as the overall health of the patient. Now the reason we need legislation is because doctors are not responsible people. That's the excuse the California Medical Association will give as to why we don't need it. They'll tell you that doctors are responsible people and don't need to be legislated. Well history says otherwise. They're not responsible people. They need to be legislated whether it's out of ignorance or greed they need to be legislated.

KIRK HAMILTON: You know I want to close, but can you tell people how to get ahold of you - go to your website, because you have some great stuff on your website a lot of education material.

DR. JOHN MCDOUGALL: Yes. Everything that you need to know about type 2 diabetes, coronary artery disease or other things, you can get there in a very organized manner and it will take you a little bit of work, but it's all there very accessible and that website is drmcdougall.com.

KIRK HAMILTON: Well I'm really thankful that I finally got a chance to talk to you and interview you, and I learned some ‘pearls' here on diabetic management, especially type 2. So thank you again for coming on the show today.

DR. JOHN MCDOUGALL: You're welcome. Thank you.

KIRK HAMILTON: So in closing I want to thank Dr. McDougall for his great dedication and work over the years, and I want to thank you, the audience, for listening today on this edition of Staying Healthy Today Radio. And remember until next time, Stay and Be Well.

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