T2 DIABETES REMISSION FOREVER

Hi folks, this is Dr. Rob Cyvis. I am the carb addiction doc and I want to welcome uh Shashi Kant umar and he's got a brilliant story that we are going to explore today. If anybody out there has diabetes, you must watch this. You've got to watch this because this is possible. It is feasible. Shashi talks about an N of one, but in my practice, this is absolutely feasible and it is relatively uh sustainable long term and that's what we're going to talk about. A lot of people can get rid of their diabetes, difficult to sustain over time. Shashi, welcome. It's great to have you here.

Um, you, let's let's start with this. You have a very interesting kind of work background and and and background in when I first met you that you started out in pharma selling, if I'm correct, diabetes medications. Can you tell us a bit about that and then tell us how that's evolved and what you're doing now?

Yeah, so uh so I was in pharma for 35 years and interestingly pharma sales, not in any department. So I used to meet doctors for 35 years. Um, the last post I had was as a zonal manager uh taking care of the entire western India. Uh, so I was in Abbott for more than uh 30 years and Pfizer for a couple of years. So it's a uh I was in diabetes and cardiovascular segment for for more than uh three decades, couple of years in neuropsychiatry.

Can I stop? Can I stop you for one second that you just mentioned and I I'll tend to do this when I hear something that just sends a flag up. You were in cardiology and diabetes when you were working on that, when you were talking to doctors about that. Did they make the strong connection between cardiovascular disease and diabetes or do they consider them to be separate diseases?

It is always in silo. It is different.

Isn't that odd? Okay. Because in this country, the commonest cause of cardiac disease right now is diabetes or elevated blood sugar. So and you had that first first experience going to talk to these doctors.

And and the cardiologists were still mostly obsessed with lipids.

Yeah. Yeah. That is always everyone is obsessed with lipids in India. Not only cardiologist but diabetologist also and even the general public. The fear of lipids is very, very big in India.

Well, among you should be you should be dead then. But it it doesn't look that way.

I have promoted atorvastatin for 15 years to doctors actively involved in campaigning that cholesterol is the biggest killer in India. So so now currently I am I I have a venture called Metabolic Health India, which I've been running for 3 years, more than 3 years. So it is health coaching and I help people reverse their diabetes, take control of their blood sugars, blood pressure, weight loss, polycystic ovarian disease, and even in mental health disease also I work in the same space applying ketogenic diet or ketogenic metabolic therapy for uh mental health disease. So this is my change of profession from a full-time pharma seller to a full-time uh metabolic healer.

So without the pharma a lot. Um, so here's uh at the in the show notes, anybody that is interested in reaching out uh to Shashi and to his organization, you need that help. Uh, look in the show notes, the directions will be in there. And is this for anywhere in the world or or specifically for the?

I have mine is mine is global practice. I have quite a lot of clients from from the US, uh from the US, Europe, Australia, but all these are all Indians.

Right, right. And you, you know, we can always expand. This is not limited to Indians, but obviously given some of the religious religious and dietary restrictions, which we're going to talk about, uh, it it it appeals so much to uh folks of Indian genetic descent because diabetes is so prevalent. Uh, the last time we talked, I was just astounded. Um, and you, you gave me the statistic that 200 million people in India are diagnosed with diabetes, type two diabetes, and there's probably half as many that are undiagnosed. The sad part for me is that we're only touching the little snowflake at the tip of that iceberg. I mean, it's and this is not, with all due respect to you, this is not that difficult. It's not that difficult to get rid of your diabetes or put it into remission. Listen up, type 1 diabetics. In my opinion, it is malpractice to promote the consumption of carbohydrates in a type 1 diabetic and then cover it with insulin. The ideal is to stay away from carbohydrates, but even then, you may have problems regulating, especially early on as you convert to a more carnivore-based carbohydrate, low carbohydrate diet. You may still have surges of blood sugar production by the liver and a degree of insulin resistance. Well, one of the best ways to combat that, and it's important to understand the difference, is to use Ketone IQ. This is an exogenous source of ketones that drives you in ketosis. The key thing is this, that it is an alternative fuel source, but it doesn't replace insulin. You want to be using insulin to drive sugar into your bloodstream. If the energy supply is sugar plus ketones, at first from exogenous ketones, you significantly lower your insulin requirement. You treat that early insulin resistance because once you are insulin sensitive as a type one, you need far less, far, far, far less insulin. And using Ketone IQ, an exogenous source of ketones on a regular basis, reduces and stabilizes your blood sugar and makes you more insulin sensitive. Now, be cautious with dosing, but it is a radical way to give you energy when you don't want a bump in sugar and you can tolerate lower blood sugars. You definitely don't want to do this when your blood sugars are super high in lieu of insulin. If you're super high, you're in ketoacidosis. Don't add ketones to that. But if you're in a decent sugar range, but you're requiring a lot of insulin, Ketone IQ will get you to lower your average insulin requirement while still keeping a normal, normal range blood sugar. Try it as part of your therapy, as part of your conversion, as part of getting rid of insulin resistance.

You mentioned to me that you were diagnosed at the age of 49. How were you diagnosed? What, what was the reason you were diagnosed at 49?

Surely you should have known what your blood sugars were working in pharma. Why didn't you know what your with Abbott, Abbott self, why didn't you know?

Yeah. So this will sound funny because we never used to do annual tests and all. So I was not aware much about all this. And once I was I was into my fieldwork meeting doctors. So uh in the in in the doctor's chamber, there was something called as uh diabetes detection camp which was run by my own organization. So so that that lab person was sitting there. So I just asked him to test my blood sugar. So it came high. It was 3 hours after a nice high carbohydrate typical meal and I read, so the reading was around 175 or so.

Wow. So I thought, now this is this is a serious issue and you know, I probably have diabetes. So this was on a Thursday. So I came back on Sunday, went to nearest lab, got my fasting and PP done. It was 153 and 252.

Wow. You have, did you have an A1C done at that time?

Yeah. So then I went to my doctor. He, as usual, prescribed Metformin. And then he told me, you additionally do A1C and thyroid test. Maybe it is due to thyroid. That's what he told.

Right. For it. Yeah.

So when I did this, my thyroid function was normal. Absolutely. All the parameters and HBA1C was a nasty 7.2.

Wow. So this is not just borderline diabetes. This is and it takes a long, takes decades for your A1C to get up to that. Uh, the one little little funny thing, cuz I hear this a lot, especially for my overseas. Oh, it's my thyroid. Well, we can blame the thyroid once you show me videotape of little hands coming out of your neck, picking up cake and putting in your mouth. Then we'll blame your thyroid. It is not a thyroid condition. Type two diabetes is not thyroid. Wrong, wrong uh um hormonal organ, wrong endocrine organ.

So, you're diagnosed at the age of 49. I'm I have an interest though. Um, and I don't know if you want to share this, but do you have any family members prior to this that were diagnosed with diabetes?

Yeah. Everyone is diabetic in my family. My father.

So that's my father didn't go off for you.

Yeah. Yeah. So it was it was see, it I knew that I will get diabetes eventually due to family history. So I am from India. We are all prone to diabetes and I am from south of India who are much more prone to diabetes. So it was obvious that I will get hit one day. So I was a bit depressed for a day or so. But then I eventually had to accept it that I got that I have diabetes.

Right. And and that is a very important consideration because everyone thinks, oh, every doctor thinks, oh, you got diabetes, take this medication. But psychologically, for both type one and type two, it is a devastating diagnosis, particularly because they tell you it's forever.

They tell you that you are going to die of this disease and you're going to have it forever and there's nothing we can do. Take these medications. Is that, is that your experience? That that is the usual experience we all have?

That you have to take now medication for lifetime, Metformin and the simple advice is only three things: stop rice and start eating wheat, no sugar, and no potato. The standard.

But they did give you some low carbohydrate advice though?

No, there was nothing on wheat and other carbohydrates.

No, but what I'm saying is they did, they did at least address some car, I mean, there was a, there was at least a connection when they told you that. What were the medications that, that they typic, what are the medications they typically use in India? So you mentioned Metformin. What else?

Um, widely used Metformin. So they, they gave me Metformin. I took it for only two weeks and then I stopped because I came across low carb. So I'll tell you the story. But typically in India, we, we use a wide variety of medication. Everything is available here. So it is.

But, but put on your pharma hat and tell me what were the, what were and what currently are the most available of the diabetic medications? So Metformin.

So Metformin, we have Metformin and we have sulfonylureas, glimepiride, gliclazide.

Right. And, uh, we have this, uh, alpha-glucosidase inhibitor, voglibose is used very widely.

And then of course, gliptins, sitagliptin, vildagliptin, linagliptin, and the most popular currently is SGLT2 inhibitors.

Well, that was, that's where I was going to, that's where I was going. So, did they ever sell lactose or anything like that? The DPP.

Yeah, yeah, we had vildagliptin. It was used widely earlier. So not as much. So we have pioglitazone is used widely.

Okay. Now, the SGLT2 inhibitors, which are horrific drugs for me, especially on a low carb diet. Um, but those are, that's far in this country. Um, that's what the one of the reasons they like that because it tends to keep LDL levels low.

So it doesn't cause a rise in LDL levels. However, uh, when I see a patient on an SGLT2, I typically stop it right away.

Why? Why SGLT2s?

See, it is, it is, it is used widely because it gives good results.

Well, you pee all the sugar out and.

Oh, that is okay. But people eat a lot of sugar in form of carbohydrates. The results are really good. And then the evidence is supported the, the, the, the benefits on the kidney, kidney part, on the heart, and a lot of these, these are all evidence-based.

But it slows down disease. It doesn't negate the diabetes. That's that's my problem. And it can cause, uh, increase in urinary tract issues, infections, that kind of thing. And then certainly, if you are not eating a lot of carbohydrates, I've had three patients end up in the ICU, um, with diabetic ketoacidosis, especially as they start a ketogenic diet. So I'm not a fan of SGLT2s at all. What about the, the big popular one that one in eight Americans currently are using GLP-1 medications? Uh, either GLP-1 or combinations. How, and it's the majority of them are made in India. What's, what's the Indian prescription rate for?

So the, the use of, of, uh, uh, GLP-1s is definitely increasing, especially in diabetes and in weight loss. It has become, you know, you will not believe this, it has in weight loss, Mounjaro has become the number one pharmaceutical seller of number one brand in the pharmaceutical market.

Well, yeah, in the US, it's exactly the same. I mean, Mounjaro is going through the roof, and obviously it's made in India. Now, is that the Eli Lilly product or is it mostly a local Indian formulation?

No, it is Lilly product only. So the patent still exists, but I think the, the patent of few other, few of the GLP-1s are going to go off and we are expecting it to drop from let us say around 25, 30,000 a month to maybe 3 or 5,000 a month in Indian rupees. And I, I can tell you in my, in my experience now, even though it's not FDA approved yet, Mounjaro and and certainly Ozempic and Wegovy, which are the pure GLP-1s, are going to disappear from the market when the big gun comes along. And I've got several patients now that are using it. It's called Retatrutide or Triple G. And it is working so incredibly well. I, we still have to look at the, at the, I've got some concerns about the side effect profile, but so far, triple, uh, triple G or Retatrutide, which we have a number of clients who have their own supply that I monitor and manage, I don't sell the product, I don't, uh, I can't prescribe it, but that is going to be the big one. And I think Eli Lilly is a little bit slow in rolling it out. I'll tell something interesting. Eli Lilly is slow in rolling it out because they're making so much money off Mounjaro. Why would they, their Mounjaro business with this drug? The other interesting thing, and it's just to my mind, I, I'm worried about this because I don't know if it was a stupid mistake, but this is a smart company or um, whether they found something as a side effect of the drug, but, um, Novo Nordisk has a Triple G. They have the product, but they've they've stopped any research on it. And it doesn't make sense that a company that is losing the battle pharmacologically to Mounjaro has not promoted their Triple G product. So I'm worried. Are they just dumb, which they're not? They're not. Or is there a problem with Triple G? I don't know. I don't have the answer, but I, I'm suspicious of that. Why would a company that has it, that has the product, not be researching it further? Anyway, we, we did, we made the classic mistake, Shashi. We jumped into pharma first, and that is not your story. Your story is one of deep prescription and disease remission.

So, um, you mentioned though that a number of your family members have diabetes, and I think what you bring to the table is you are a very smart, very educated person, strong family history, you work in the field, and yet, and you probably had diabetes for about 10 years before you were diagnosed, and yet the cognitive dissonance was there. That, and I think that's just an important message out there. Anybody watching this who thinks, "Haha, I'm fine." Don't think, prove it. Get tested. Get tested, and then we can work on it. Um, that was your story. Um, originally, after diagnosis, you mentioned you were on Metformin. Were you treated traditionally in an endocrine way, or how did you not get trapped in the traditional diabetes is forever, take Metformin, eat less potatoes? H, how did you ch, what happened initially, and how did you change?

Yeah. Yeah. So, so when I got diagnosed with diabetes, and of course, it's a life sentence with medications. So I, I went to, I went to Dr. Google. I went to the internet, and I started searching for a solution. There could be a solution somewhere. Maybe it is Ayurveda, maybe it is in homeopathy, maybe it is in some other therapy, maybe there is some way I can reverse it totally. So all these things were running in my mind. So I was searching for a lot of options. Many people insisted that I should take some Ayurvedic medicine and all. So all these things are very popular in India. But for me, if I have to take any medication, then what is the point? I may as well take allopathy medicine or modern medicine, which is proven. At least I know this is a, these are the adverse effects with Ayurvedic and all, where I don't know what will be in there. And my contention, why should I take medication? So I want to get control without this. This was my my thought.

Can I, can I stop you for a second? At that time, were you monitoring your blood sugar? How were you doing it? Did you have a CGM, and what medications were you taking? And is a statin part of diabetic therapy, part of the algorithm?

Yeah. Yeah. Now, what happens was, uh, fortunately, my lipids were not haywire. So I was not put on a statin. And though the protocol is that all diabetics should be put on statin, some of my doctors did not put me on it. So I was on Metformin for 2 weeks, but this two weeks did not go like that. I, of course, purchased a blood sugar meter. We did not have CGM that time in India.

Right. You were told, you were told to check your blood sugar, or did they just tell you, take?

They told, no, they told me, you, my doctor told me, you come after 2 months or 3 months, then we will see. But I was a curious person, you know, I immediately purchased a meter. The reason is, back in 1989, '90, I used to actually promote blood sugar meters of my company. So I was used to using blood sugar meters. I used to use those demo pieces for my dad. I used to manage his blood sugar by measuring it very frequently and sending it to doctors. So I.

Let me, let me also stop, just a little plug for Abbott, because now Abbott sells the Libre. It's one of the most popular, uh, CGMs, and also in this country, they've got something called Lingo, which you can now buy as a self-pay. You don't even need a prescription for it. But I love for my patients, diabetic patients, to monitor their own blood sugar. It's crazy that you drive a car if you don't have a speedometer. It's crazy that you have diabetes and you don't monitor your blood sugars, and the CGMs are very easy. So just a little, little point there, and when you know, you know.

Yeah. So I purchased a blood sugar meter and I was a crazy person. I used to test multiple times a day.

That's the way it should be. It's the way it should be.

Test after half an hour, 1 hour, two or three or four. On Sundays, I used to do 10, 10 or 20 readings also. Ever so obsessed with.

Richard Bernstein, did he just pass away? A little bit between 10 and 20 blood sugar checks a day. Uh, now he was a type one, but still, at the same time, if you don't know, you don't know.

Yeah. So I was, various options. And then in on online, I found Mr. Tanop Singh, my guru. So he was promoting low carb diet, LCHF diet. So I found very fascinating. I did a lot of research and found out that, no, this is a good option that can be done. Why not try? Now, this is culturally a totally different thing.

Reduce carbohydrates, eat more protein and fat. So let's stop there. Let's stop there because this is a salient point, and a lot of people in this country won't quite understand it. Obviously, all Indians do. Um, your diet at the time from a religious perspective, you're a Hindu.

Pure vegetarian.

Pure vegetarian diet.

No eggs also.

And so it is pure vegetarian. It is almost, uh, vegan in that regard.

Not almost vegan, it is vegetarian because we eat a lot of dairy.

Okay. So the, so a vegetarian Hindu is a lacto-vegetarian, okay? So it's not a pure vegetarian, but no eggs.

No eggs.

And no meat whatsoever.

No.

So all of your.

I used to eat a lot of rice because I'm.

So your macronutrients were primarily rice and then some wheat or grain products.

Lentils, lentils, vegetables, a lot of vegetables, that's all it is. Just restricted. There's wheat sometimes in form of chapati, roti, sometimes, but primarily.

Non the chapati. So there is, there is a bread base, but you mentioned potatoes earlier on. Are potatoes a significant dominant form of carbohydrate in?

Significant. Significant.

That you see, I, I mostly thought it was rice.

No, it is rice, potato. See, it is split. Let's understand in the northern part of India, it is wheat.

In the southern, it is rice. So ultimately, all are grains. They all raise to the same level.

Right. But, but, uh, one of those three. So it's either rice, grain products, or potatoes. And I always say that the grain products are the worst because the proteins in the grains are as antagonistic as the starch itself. Um, you know, we got gluten, we've got thyroid disease, we've got a number of of autoimmune diseases that are triggered by, um, by grain products. Okay. So, um, you were a, a lacto-vegetarian.

Vegetarian. So I started, I started slowly reducing the, I actually, I actually initially, I reduced the whole calories itself. I used to eat less and stay hungry throughout the day.

Now, let me stop here, one for one other second, cuz this is an important component. Um, what is your highest ever BMI or or your highest ever weight?

I know highest. See, I am 175 cm in height.

Okay.

My highest weight was 69 kg.

At least centrally obese. I'm the typical Indian who is lean, low body mass with central obesity, tummy.

But is that, is that because of the lack of protein in your diet?

Probably. Yes. Yes. Okay. So, it's not just the diabetes, it's the lack of protein in the diet, uh, that that results in that central, the male central obesity with a little pouch of the belly and and the little legs that that are are tiny. Okay. Um.

And so, uh, uh, once I found LCHF, I slowly started adopting to that, slowly increased my protein. So.

So LCHF is two components. It's low carb, which which is easy. I mean, that, that, that everybody can understand. It's lowering your carbohydrates. You can go to any book, any site, find out where the carbohydrates are, and you have to have the integrity to lower it. How do you raise fat on a vegetarian diet?

Yeah. So, so it is not typ, see, this LCHF has a missing component, and that is protein. I always say that that the word term LCHF is not correct. It is only to show the macronutrient composition, but we are missing the key component, that is protein. So.

Well, except, except in the US, the majority of people eat a high fraction of animal product, and they eat lean animal product.

Wow. So, so it's not in there because I think most of it came from the US, the LCHF component, and we didn't put the high protein in there. Plus, also Atkins probably promoted too much protein and too little fat as the kind of the first big guru here, and we wanted to promote the higher fat component. But so there is a little bit of 25 years ago history, which I was part of. But how do you get fat into a vegetarian diet?

Yeah. So, so the, what we added was, I started having a lot of paneer, which is Indian cottage cheese.

Okay.

Very easily we can incorporate in our diet, which is high fat naturally.

Okay. Well, that's what I was going to ask you, because that is not true here in the US. In the US, we take the fat out, and most cottage cheese, uh, is either smooth or crumbly, but it's it's low fat, and you've got to seek out the high fat. What is the fat content by percentage of paneer?

So, so, uh, paneer, paneer, 100 grams paneer will have 30 grams fat and 25 to 30 grams, around 18 grams protein.

Wow. You see, here in the US, we are at four, the best you can buy cottage cheese, 4% fat, 4% fat. So we have both, we have low person, we have low fat and high fat paneer also, which is.

We don't have high fat paneer here. I mean, we don't have high fat cottage cheese here.

So it is called as malai paneer. Malai, malai means that fat. So it is available in India. All people fancy high fat paneer.

So that was my source. I added up a bit of cheese, you know, initially, a bit of lentils and all, and then I found that I couldn't make up to this higher protein level. Then I realized that protein has to be there. We cannot only just eat low carb and just keep gorging on fat. No, protein has to be there. So we realization.

And, and let me stop. So you don't, do you drink milk at all? Do you drink the milk, or mostly just?

I see, earlier I used to drink. Now I don't drink too much milk and all because it has lactose and it, it raises my blood sugar.

Right. But it does have protein in it.

Yeah. But so I'm eating paneer, I'm eating yogurt. Another component is a lot of yogurt. Hung yogurt or Greek yogurt or sky yogurt.

So you know where we drain away that, uh, that lactose, whatever bit is there, that b liquid, and then concentrated form we take. So my primary source was paneer, yogurt, and a bit of cheese. And then I realized that I have to add eggs.

So, but you, you cut back on the carbohydrates.

Yeah, definitely.

That was the first, the first thing you did was cut out onion of rice.

Starchy vegetables and a reduction. We'll talk about the fractions in a second, but you pretty much eliminated or.

Starchy completely. Starchy vegetables, zero. Sugar, zero.

Okay.

Fruit, zero.

Right? That was the other big thing. So no, no fruit at all. No lychees, no mangoes, no nothing.

I eliminated.

Okay. So, um, but then you're still running at, and especially if you, if you eliminate some of the beans, which are high in carbohydrate, they also are the highest in protein. They don't have the full set of protein. But how do you replace the protein in your diet?

See, I added up eggs. So I eliminated all these lentils, beans and all. I do have a small portion now, but in between, I'd eliminated everything.

Are we talking about the early days where you were really trying to get rid of your diabetes?

Uhhuh. So we were just, I was just taking it for some time. And when once I started incorporating eggs, after, uh, after some time, I just thought, okay, uh, let me eliminate most. I was still on the low carb. I was still taking a bit of grains and all, bit of grains, lentils. And then I followed this pattern for 3 months.

And, and when you eat these products, do you eat them individually as they come, or do you tend to incorporate them in other foods?

Okay. So now eggs, how do I eat eggs? It is boiled or omelet. These are the two forms.

Okay. So you're not putting them in a vegetarian food or in a vegetarian dish?

No, no. We keep it separately.

Okay. Oh, okay.

See, in my home, we are vegetarian. So, you know, we have a separate vessels, utensils for for eggs. So, so I.

So the religious, that's a religious separation. Okay. And, and for a, for a religious Hindu, is that religiously acceptable?

It is not acceptable, but I don't have any biases anymore because I think our health is very important.

Mhm. Does, does, just as a question, does the religion make exceptions for to things like diet for health conditions?

See, it is, it is up to us, individual. It is how we adopt.

Right, right.

So, so, so I started eating eggs. And lot of vegetarians in India do eat eggs. A lot of them because it is not seen as something, you know, there is no blood in it, or we, it's not seen as killing something. So eggs are highly acceptable. A lot of lacto-vegetarians, they take eggs. They might take at home, or sometimes they will eat outside.

Yeah. And both eggs and dairy are renewable products. Uh, um, nothing gets harmed in that production, at least by death. Um, good. Okay. So, uh, do you think you could have done as well as you've done without eggs?

I don't think so because it would have been very difficult because the food choices becomes less. With eggs, at least it is very easy. So I.

The average Indian diabetic has to make that decision for themselves. Can I religiously add eggs in or not? I mean, that's a, that is a fundamental, uh, crossroads in your, in a transitional pattern of eating.

Yeah. But I want to mention that a lot of my clients are vegetarians who don't eat eggs.

And they're doing it successfully for many years. In fact, I had a, I had a lady who come to me with high blood sugars, pure vegetarian, no eggs. We eliminated all medications gradually with the help of the doctor, putting her on a low carb diet. And you know, uh, she was only on paneer, yogurt. And then, you know, where, and then she also, uh, conceived. And then in the entire 9 months of pregnancy, she followed my diet where I incorporated back a bit of fruit, a bit of rice, and all, staying in that, in that low carb range. And baby is very healthy and active, and no gestational diabetes. We, she managed with only one tablet of Metformin.

Wow. And that's perfect. Absolutely fine. Yeah.

And she came down from taking a lot of glimepiride, a lot of Metformin, vildagliptin, she was on three drugs.

Wow. So we, so it's so important for the fetus because the, uh, the baby of a diabetic mother who's got gestational diabetes, first of all, there's a 17% uh, infetal mortality rate, and then, uh, a lot of brain development issues, a lot of b. Oh, so that's a, that is excellent. And we have a very high gestational diabetes, uh, rate, both in Africa, where I originally came from, and in India. So let's carry on with your story. So you decide, did you, did you add the eggs in at the beginning, or did you slowly transition? How did that work?

Huh? So, so we, uh, so we just incorporate, I just started having one egg a day.

Okay.

Boiled egg, one, two, three, four. Later on, now I take on an average, four to six.

Okay. Perfect.

A day.

Together with your dairy. So your, your p, your primary nutrition macro and micro comes from dairy and.

I want to add something that, you know, I also take whey protein. I take a scoop of whey protein, whey isolate.

Well, that, that was going to be something that I wanted to ask you. Um.

And I started using it somewhere in 2019.

Okay. So the, the protein is of, and that replaces some of the loss of the starchy, the beans and the lentils, and that kind of thing, which do carry a lot of protein, but not the full range of 20 amino acids. Okay. Next question for you. Um, in India, obviously, you lo, you use, and we've done, we've talked about this before, a lot of spices in your diet. Uh, and spices that we in this country put in capsules and assign medicinal value to. Two questions for you. Number one, do you, apart from the whey protein that you've declared, do you take any other supplements, and do you feel any supplements are necessary? And secondly, do you consider the spices that you put in your food? Is that an important addition, not only for flavor, but also as a supplement? For example, turmeric, that kind of thing. How do you view that?

See, now spices is very, very common in India. Sometime we don't even see them as medicinal. We just use them. Masala, we just use them. And I like a lot of spices.

So I like, we like, you know, I, with me, there will be at least 10 different masalas.

Wow.

In in my kitchen. So we use different masalas for for different dishes. We enjoy that, uh, very much. Now, when it comes to supplement.

Well, let me just ask you, you do, you, with a masala, do you assign a supplement type? Do you add them to your food purely for the flavor, or also because of the potential supplement benefit?

No, only for the flavor. I mean, as I told you, in India, we really don't see them as, you know, that that thought does not come to us that it is medicinal. We are just used to using it.

Yeah. No, but I, you know, in this country, we, we, we use them a lot as a, as a supplement, a pill. I don't know if you changed your thinking as you were working your diabetes, but.

No, we are just, we are just continuing. We use turmeric in everything, every dishes and all. All.

Okay. And now tell me, the supplements that you are taking.

Yeah. So, uh, very early on, I adopted magnesium, magnesium glycinate.

Glycinate. Okay. Glycinate. So I, I felt it was, I read it was lot quite good. And then I adopted it very early back in somewhere in late, as I think within two or two months of diagnosis, I started a magnesium. I also take a good quality omega-3 fatty acid, fish oil. And then, um, off and on, I also supplement vitamin D and B12.

Okay.

So these are the only four supplements I.

B12 is a big one on a vegetarian diet.

Yeah. So even though we take dairy, we take eggs, sometime I find that it doesn't rise optimally. So I, I do what is called as targeted supplementation. So I keep taking it intermittently. And also vitamin D. So even though I was out working there, sometime I find that the levels may tank. So I, I do a cycling of both these vitamins.

Okay. Do you take B1 at all?

No, I don't take that.

Because one of the things, just I've started testing in the last year, and we see profound deficiencies of B1, very tightly tied to neuropathy, diabetic neuropathy, sometimes myocardial neuropathy, but we do see very, very low, I mean, you know, where it's got a less than, in other words, it's unmeasurably low B1. And I've been surprised by how common B1 deficiency is, certainly here in the US. So.

In India, India is not as much as B12.

Yeah, B12 obviously with the vegetarians. Yeah.

Uh, we eat a lot of plants, and also, you know, we are not too much deficient in that. I'm not telling it is not there. It is there, but not too much.

No, I've been surprised at how much of how much B1 deficiency I see. And then, uh, in terms of salt, sodium chloride, or salt, what type of salt do you use, and how heavy?

I, I use, I use plain iodized salt, which is there.

Ah, wait, it's not plain. You said iodized salt.

Iodized salt.

Okay. Because again, here, a lot of our community doesn't use, use a salt that's not iodized, and then we have to use iodine separately. For example, Himalayan salt is very common here, but it doesn't contain iodine, so we add that.

So we, I have seen people who shift to rock salt or pink salt, their TSH goes up, and they themselves come and tell me that since we shifted, this is what is happening. So if you shift them back to iodized salt.

And that's what I use. Maybe a couple of teaspoons a day, throughout the day, in all the.

Okay. But that's a lot. That's 10 grams. That's 5, 10, 5 grams in 11 teaspoon. So that's a. And that again is, is we're pretty heavy on salt. Good. And your blood pressure is pretty good.

Very low.

So there's no, right, there's no correlation between salt and hypertension.

110, 115 by 75, 80 on the lower side. Okay. So we, we, we got ahead of ourselves. We, we talked about the diet. So you get diagnosed at the age of 49. You got an A1C, or it was 72 or 76.

7.2.

7.2. You have, what, one of the, one of the most wonderful track records of your numbers. And first of all, at the time of diagnosis, we know the blood sugar was high. Did you have any comorbidities? Any rectal cardiac, uh, uh, GI neuropathies? Any comorbidities, diabetic comorbidities?

First of all, there were absolutely no symptoms. And whatever I had, whatever I had was, I was comfortable with. For example, you know, uh, brain fog, mild depression, anxiety, good acidity, flatulence. All these were there. But coincidentally, during the, after the diagnosis of diabetes, within 2 months, suddenly my knee started paining, and I was diagnosed with osteoarthritis. I had a wrist pain, which always was there for 2 years. I never understood why it was there. I had a frozen shoulder, which I never understood why. I never did anything.

I, I think one of the things you make a very valid point is that, we've basically had these abnormalities our entire life, and we consider them to be normal.

Normal.

Until they're not there. And I think that is one of the big ones is the acid reflux that people consider reflux to be normal. They may take some Prilosec or some Mopeds, but or even be stranded on that, and literally within a few weeks of changing their diet, those symptoms go away. So it's the absence of what you previously considered to be normal, which is a bizarre state. And no doctor ever told you it was a problem.

No, I see acidity. We just, I had this antacid pills in all my bags, in my work bag, in my purse, in my travel bag, holiday bag, everywhere. I used to have, and I used to think all these masalas are causing it, and I used to curse sometimes very high masala foods. But later on, now I can eat whatever masala I want, nothing happens to me. And it was primarily driven by this high carbohydrate stuff I had.

But isn't that, I mean, that's exact, what you bring out is such an important point as well, because most gastroenterologists are going to tell you, don't eat tomatoes, don't eat spicy food, don't eat masalas, don't eat, uh, you know, especially the spicy side of things. And and don't drink coffee. And nothing changes. But when you cut out the carbohydrates, boom, it's gone. And it's a GLP-1 triggered phenomenon, which, uh, which everybody knows about now. Ain't fascinating. Okay. So, and then also the inflammation, the, the joint. Richard Bernstein said that you diabetics crystallize their ligaments, tendons, and joint capsules. Yeah, if you look at, think about sugar crystallizing on those, and when that goes away, the carpal tunnel, the tendonitis, a lot of that stuff improves, which is a big deal. Um, okay. The next question I have for you, so, okay, you, you embark on this journey, you take your Metformin, you go low carb, you make the dietary adjustments. How, cuz you astoundingly rapidly brought your A1. It was very, it was very rapid. Within two weeks, based on the my home blood sugar meter numbers were down. I just met my doctor, he told, why don't you experiment? Get it off. So I just got off Metformin. And then, you know, I, I was a very data-driven, rigid person. Always being in sales, we are data driven. So here also, I was data driven. And my HbA1c, which was at 7.2 in the time of diagnosis, came to 5.2 to within 3 months.

And there was no blood transf, at least blood donation or anything like that involved. No blood. Very rapid. I mean, that is. And our target is 5.2 because at a, uh, I can't remember the paper, I'll put that in the reference, but there's a paper out there that, uh, for males, a hemoglobin A1C of 5.2%, 2%, which is kind of the blood sugar area under the curve, is non-contributory to cardiovascular risk.

Now, you also, even though you were 49, you did not have, you had a CAC score that was a zero. Is that correct?

That was in 2019. So I was diagnosed in 2015, September.

Four years later.

Ah, so it was in four, five years later. I just got, because I used to read about CAC primarily from our work, commence. So I was very curious and got it done. India, you can do it very easily.

Wow. Yeah. See, I, maybe it's, maybe we need to get, take a holiday to India to get our blood work and our CACs done. But a CAC or just a cardiovascular disease, a heart attack or a stroke, is the commonest cause of death of diabetes. And and yet, uh, we don't do the screening tests because we still believe so inherently on lipid, on managing surrogate markers with with, um, anti-lipid lowering medications. It's, it's quite astounding. Okay. So, within 3 months, you've got an A1C of 5.2. How restrictive did you find the diet? Was it something you adapted to fairly easily, or were you annoyed that you had to be on this diet?

No. So, it is not very easy. It was very restrictive, and I was annoyed, angry. Sometime I used to, you know, I feel I'm cursed, why I'm doing this, that I should be doing all this, you know. I felt so unfortunate. But later on, you know, as, as I kept reading, as I kept understanding, then I realized that this is the only way I have to follow. So I was very rigid for for many, many years. You can imagine, not a single piece of fruit.

Right.

From from September, October 2015 till 2020. And then.

Okay, so you adopted this very strict carbohydrate diet. Can you give me, in the first year or so of you doing this, approximately what your macro ratios were?

So, see, let us say, uh, uh, protein would be around just 1 gram per kg body weight, barely. Okay. It was initially it was difficult. So maybe 60, 65 grams. And, uh, carbohydrate was around 70, 80 grams, less than that, 100 grams initially.

Yeah.

And then fat must be around 100 grams or so. So you were.

120 grams.

How much, how much did you weigh? You weighed.

I was weighing 69 that time. Then I lost lot of kilos. I came.

But let's call it, I just want to do the math here. So you said one, one gram of protein per kilo. So you about 70 grams of. So your, your carbs and your protein were about the same, 70 and 70. And then how much fat?

Fat would have been higher. Yeah, I think it is 120, 130 grams, or sometime 150 or.

Grams. But then it's a lot higher by calorie, cuz it's 9 calories per gram versus four. So you were very rich. How, how do you, is, how do you get that fat in?

See, it comes, see, this paneer and all is high fat, and I used to have additional, I used to have additional butter and all. Earlier, earlier. So you use, you use butter, right? Ghee, all.

Okay. And then what about, what about olive oil or coconut oil or avocado oil?

Yeah, coconut oil, we use. Avocado oil, we don't use olive oil sometimes, but we don't prefer much because of the risk of adulteration or contamination, which is there. Even in US, it is not so pure, we know this. Yeah.

So, so we tend to use, in, in my home, we use only ghee, butter, coconut oil, only these two.

Okay. So you do use coconut oil, which adds in, uh, some of that.

We, I used to use, we used to use sunflower oil earlier.

Okay. Yeah. Seed oils. So you, one of the.

Things you also eradicate, we didn't even mention this, are the seed oils. So I just dumped it. I dumped it in the garbage. When I came to know it's inflammatory, I just stopped using it.

Initially, we shifted to a bit, you know, just to get. We are not used to using coconut oil at home, even though I'm from South of India. We were using a bit of peanut oil, and then one day we decided and got off and then just shifted to these three.

Right. And your whole family is doing this. Is that right?

Yeah. Me, me and wife, we are just two here. So even she's following low carb to a some extent, 50%.

It does. It is a lot easier if those are the ingredients in the house. If you're trying to do this and somebody else is eating all the other garbage, it makes it a lot more difficult. So that synergy, uh, that support and that synergy is very important. And it's always important. I always tell my patients this, thank, thank the people around you. Thank your spouse often for being supportive because it makes it, it makes all the difference in the world. I am fortunate. I've got a very supportive wife as well because sometimes I can't trust myself. And she's always there as, "Hey, be careful, do this, do this." So it's, it's, it's useful in that regard. I, I'm certainly fallible.

Okay, so the other incredible thing that you have is blood parameters. So you've got, you got so much more. What was your starting insulin?

Insulin, see, we measured it up. Fortunately, I met a doctor who also told, "Why don't we measure your insulin level?"

Very unusual.

Uhhuh. Very unusual. So, uh, it was around 7.7 or so.

Not. That was seven, right? But it was. That's the problem.

That was after, after some two, three weeks of, you know what?

Going on a low-calorie diet.

But associated with what? With what? Um, what blood sugar? Said, what was your blood sugar at a seven?

Uhhuh. So that time, my blood sugar has come to some, already it has come to some 105 or so because I was, I was on a, initially I was on a low-calorie diet. I reduced everything. So it actually rapidly brought down my weight and blood sugar also.

So it was. But you started low-cal and then went to low-carb.

Uhhuh. So it is a mismatch. I cannot really say what was the correct blood sugar or what is the correct.

Let me ask you this. Have you ever done an oral glucose tolerance test?

No, never ever.

Because that, what, what's interesting for me, and we, we discussed this before, is what I call peak insulin production capacity. Some people genetically, like myself, can produce massive amounts of insulin. So we can clear blood sugar and I gain weight very easily under that high influence. Even though you're insulin resistant, you turn that sugar into fat. Someone like you has a relatively low peak insulin production capacity. So, you can't clear the sugar to become fat, but your blood sugar builds up. And that's the, the genetic, obviously, it's a bell curve, but there's a genetic difference, um, between folks in your part of the world and kind of where my genetics comes from. I'm a bit of a fruit salad when it comes to genetics, but, um, I'm very obesogenic. So, uh, you call that, uh, let me see my notes here. You, you had a term for it, and it is M O N W.

Metabolically obese normal weight. Metabolically obese normal weight. In this country, we call it TOFI, thin on the outside, fat on the inside. But it's the same. Uh, I call it obesogenic, but sorry, diabogenic, but it's the same arena where you're not able to gain weight, uh, maybe just a little bit, but you become diabetic very rapidly.

As time went on, I started refining it. And then, you know, I'm on, you know, I'm on more than almost 1.8 grams per kg body weight also of protein. So I take. I'm on a high protein, 1.5, 1.8 grams.

Right. So, why, why, what's the purpose of?

So I find that, you know, uh, higher protein, I am able to, you know, initially I lost a lot of weight. I was looking very horrible. Everything was shrunken and everything. And now when I take a lot of protein, I find much more stable and, uh, hunger, you know, no frequent hunger. And then generally I feel very healthy when I do this.

Well, let's talk about the science of that because as you remove carbohydrates, the body doesn't suddenly change from being glucose-requiring in terms of of a fuel source. And we have to have a certain amount of sugar. When your primary substrate is sugar and you reduce the sugar, your body's got to make, uh, uh, uh, sugar from something. And it, the reason it's okay not to eat sugar or to radically lower your sugar and starch your carbohydrate consumption is because the liver is very good at producing sugar. And the primary source of sugar is protein. So as you reduce your carbohydrate consumption, you also want to increase your protein consumption, not just to preserve your muscles, but also now as a fuel source. And we can measure BUN and creatinine and uric acid and look at those metrics to see how much protein is going toward energy versus muscle. But it sounds like you've, you've done well with the muscular side.

Now I have one other question for you. At this time, prior to this, were you doing any exercise? And have you introduced physical activity or exercise into your daily routine?

Yeah. So prior to this, I used to do early morning walks. So maybe four, five kilometers. And I also run for three, four, five kilometers also. So both were there. And, you know, I was running with high blood sugars in the background. I was not knowing. Probably that has led to this, uh, osteoarthritis in my left knee. So I used to do. Then I stopped running and I just started walking. So walking is my routine, four, five kilometers walk. So I, I don't, I have not gone into really gym and resistance training till now.

So. But you are physically active.

Yeah, I'm very much physically active.

And you said till now, are you, are you going to introduce that into your life or?

Yeah, probably I will. I will. I will introduce after some time.

Start resistance training.

For what reason? I think better muscle structure is better for me as a.

Muscle definition. Okay, fair enough. I, but I think the, the key thing there is that exercise does not, or, or intense exercise does not have to be. It's beneficial, but it doesn't have to be part of this journey. It's reforming biologically what you put in your mouth and how your hormonal system works. Um, so I like that a lot.

Are you currently, how do you currently manage your monitor your blood sugars?

So, uh, I, I was also one of the early adopters of CGM back in 2016. So, no, one of the author in this study, Dr. Mahir Rahul. So, I, I used to discuss all my lab reports with him. So there are three, three doctors I always used to discuss my lab reports with them in my professional visit. So I used to take some half an hour, 45 minutes, 10 minutes with them to discuss and they were all very keen supporters of what I do. So he, that time CGM was just introduced. So he told me, "Why don't you try?" So immediately I got one piece from him. And then that time we didn't have readers and all. I only had the sensor and I had to go back after two weeks, hand over the sensor.

Yeah.

So that's how you will do. So meanwhile, I, I made a food log of everything I took throughout the day. Even if it is a small cup of tea, coffee, I'll put everything. And then I used to see that. So then I learned a lot from that CGM graph where what mistakes I used to do, like having too much milk in coffee or something.

Right, right.

So that is how. And then multiple testings throughout the day, I used to do. Now those intensity has reduced, but still now, many, at least two or three times a week, I test. I now use for the last three, four years, I've been using CGM at least three, four times a month.

Year. Three, four times a month, right? Yeah. I use a lot of CGM. The biofeedback every six weeks, I find very useful. It's cumbersome. I'm not diabetic. I've never been, but just to tell me, as you said, "Okay, this is happening, this is happening." It allows you to make objective little changes and to recognize things because we do drift in our diet just a little bit. So the CGM is. And now that certainly, here in this country, you can get Lingo and Stell. Uh, uh, you don't need a prescription for them. They're available and the quality is really good.

So, India, you don't need a prescription. You can go and buy.

Oh, really? Okay. Yeah. Yeah. Yeah. So fantastic. So, uh, you need to, you need to, uh, uh, develop a health tourism industry. Load a bunch of people in the US that are sick on a plane, get them tested in India, and then we can ship it back. And then I used to test myself multiple times initially, two or three times in a year in labs to have this. It was just a fancy. There was no idea of publication that time, but, you know, I was data-driven. I thought I should have some data. Fortunately, I preserved everything.

Well, let's go through, cuz I, I mean, you've got a fantastic log of your own data. Why don't you go through and, and, and we'll try to show this in, in, in slide format, but go through the important markers that you have tracked and the changes in some of those markers that you've tracked over time.

Okay. Now, uh, I will just refer to my, uh, PPT. Okay. So now, uh, uh, HBA1C, my average, see, uh, once I started low carb. Okay. So I also initially shifted to low carb, then I shifted to ketogenic diet. And during that diet, uh, my HBA1C came down from 5.2 to 4.7, 4.9. So my average HBA1C, my average HBA1C is five for all these years.

Wow.

Is only five.

Yeah, but that's still, that's ridiculous. That's crazy. Yeah.

And insulin from that seven and all, 7.7, 7.2 to currently it is around three or four or five over these years. So even the postprandial insulin, postprandial insulin is just around 30 or less. Many times it is 15, sometime it is 20.

That almost puts you in lean mass hyperresponder, almost insulin suppression category. But your blood, the, the big things, you've, you've told us, your blood sugars have been pretty good. The blood glucose have been pretty good. What is your average blood glucose running?

Uh, see, I, I, I know in HBA term, it is five. But if I see on the, on the fasting front, usually I see around 90 to 95.

Yeah. Which is very. Postprandial is on postprandial around currently around 100, but there was a time, 100, 110 now, but there was a time I used to have PP of 95.

Yeah. And that's, and that's kind of the two correlate, but not always. Absolutely. So you are running at that level. Do you ever use Metformin?

I used it in the initial phase, two weeks.

But you don't use Metformin when you see your numbers running a little high. There are some of my tattoos in remission. See, I do attend sometime this events like weddings and all. My blood sugar goes up 160, 170, 180. It's okay. It comes down.

Well, that's because of what you put in your mouth.

Yeah.

Yeah. So, but, but you also have, and that's one of the things that separates you a little bit, is this happened somewhat vicariously to you. It wasn't what we deal with a lot in my world, which is an addiction to carbohydrates, using them as a drug. But there are a lot of people in India who have activated their type two, uh, because they do use carbohydrates, probably processed carbohydrates, as a drug to manage their emotional need. And that, there are, what we're talking about with you is control and a a pragmatic change in your diet. There are people out there, and I can tell you, I'm one of them. There's just no way that I can do that because I can't keep boundaries around something. I've lost the ability to do that. So, a caution there is that we've got to look at our own personalities and say, "Okay, can I do this?" Because I know I can't. I know I cannot. And again, it's, it's, I, I, I'm no carbohydrate in, in my world. I'm more carnivore, but it's because I can't trust myself to have boundaries. But a lot of people can, and I do like that about you.

So what are your current? So if, if, if I could clone you and take you back to 49, just got a diagnosis or a client that looks like you, what would be your current recommendations?

Uh, reduce carbohydrates drastically. Come to, initially come to less than 100 grams. Use a macro tracker, increase protein, increase fat, whatever possible. And then start tracking your numbers, tracking your weight, tracking how you feel, and then gradually adjust. Protein has to be at least one, one and a half grams per kg body weight to start with, is what I will say. Fat, whatever comes, it. I don't, you don't really need to track fat. We don't really need to. But if you feel a little more hungry, maybe it can help. But then I don't, I, we now, I don't take pure fats and all. I depend upon protein food. Eat protein food. Eat paneer, eat yogurt, eat eggs.

But in, in India, your, your protein almost never comes without fat.

It is always with fat.

Right. Except for the whey protein. But other than that, it's always. And that's the big difference here in this country.

You can get a lot of the protein is devoid of fat. And that's a problem. And we've become so used to being a lean protein community. There's nothing that we eat now. I'm talking about animal products. There's nothing we eat where the fat hasn't already been removed. Whether it's yogurt, whether it's cheese, whether it's cottage cheese, whether it is, uh, an animal product. The fat has been removed. And it's a challenge to chase that fat. I, I think once it's back in the, in the shops, when we can buy it, uh, then there'll be a less of a problem. So I think you'll have an advantage in India in that regard.

Coming back to your question, coming back to from, I only told from the perspective of a lacto. But what about for non-vegetarians in India? They can easily add meat, fish, chicken. And earlier on. So another little compromise I was going to catch you on this one. You take fish oil.

H. I do take fish oil. So that's okay. I mean, we don't, we see, we don't cook them at home. I cannot cook them at home. That smell will not be there. Fish oil, I'm okay taking.

So you take the fish, the capsule. But, but on, as a, as a vegetarian Hindu, your fish is so, pesca-vegetarian is not.

Not there, but many of us take.

Even vegetarians do take. And good quality one, you know, I imported from US only.

Because I'll tell you, the, probably the healthiest animal product is marine food, whether it is shellfish, if you do those, or the small fish, the sardines, oysters, clams, mussels, and then the fish. But obviously, from a religious perspective, that's, that's not on there.

Um, so you don't have specific numeric numbers. If, if you came to see yourself the day you were diagnosed, do you have specific recipes, diets, and numeric numbers, or do you just give global reduction?

No, no, I do. I do. I do give. So it is around the same, you know, uh, we have around 60, 65% fat, which comes in terms of calories. And in protein, it will come to around 20, 25. And, uh, and, uh, carbohydrates, it could be anywhere between 50, 20, 25. I keep it very flexible. So it is not very fixed that only this number has to be there. I see the person, what is a dietary habit, and I fix, I fix what they eat, and then try and see what is the chart coming like. So it is not very strict that I have to use only this formula. No, it is highly flexible.

Right. Now, the problem that I have is that, and I know this, your LDL has gone up tremendously. Are you not worried about that? What, how do you correlate a a very high LDL or much higher LDL with your current diet? And how do you reconcile fear of of a heart attack because you're LDL? And how do you talk to clients about that?

Yeah. See, now there are, uh, if you see multiple studies which have compared various risk factors for heart disease, you always find diabetes very high risk. The, the hazard ratio for diabetes will come around 10 or so. And then metabolic syndrome, then smoking, then hypertension. If you see the hazard ratio of lipids, it is just around 1.5 or something, which is even less than two. We have three, four such studies. It is like investing. If you are investing in lipids, it is like investing on something which will give you less than 2% returns. But if you invest on blood sugar, it will give you 10% return. So that's what I've been convincing everyone.

I like that. That is. I like that metric. That's so, uh, investing in lipids is not even beating inflation. I like that. That's. I like that analogy.

So, so I used to read about all these that, you know, there, see, my lipids are not very high. It is around 153 or something. LDL is around 153 milligrams.

You want that below 90, which is.

It is only possible with statin, which I don't want to take. I don't require. And my, my two CAC and my two, my one CT and show zero, zero.

Right. So you've got, with all due respect, at your age, if you've still got a zero, and you've corrected, as you said, the highest hazard ratio disease, which is a diabetes, you're going to die of a lot of things, but it's not going to be a heart attack. Uh, and I think it, but it's so difficult to convince people because their cardiologists and their family doctors are petrified of. They will completely, uh, uh, disregard all the benefits because of that one number. Now, your ApoB, which is the latest sexy number, has also gone up with.

113, 113 milligrams per deciliter.

And, but the problem with ApoB, as we talked about earlier, is that it's an amalgamation of several different lipoprotein factors. And your big fluffy LDL is the one that's gone up, and your small dense oxidized LDL has gone down. So it is again, a very poor surrogate marker. I keep telling everybody, and this is a standard in my practice, is in every risk screening protocol we have, if you can, we always get an image. It's always based on imaging. Whether it's breast, where it's colon, we, we're based on imaging. We've got this wonderful tool called a CAC or CCTA. If you choose, a little bit of higher radical tool, nobody ever uses it. 44% of people in the US are on statins. 162% this is data from the Prevent trial have ever had a CAC score. It is lunacy. And, and I think, do you encourage your clients to get a CAC score? Is that part of.

Yeah, yeah. Wherever people are afraid of lipids and all, ask them to get the CAC score done. So they can do. And there are some people who are still afraid of lipids and they take statin. I'm okay with that because as a health coach, it is not, it is not there. There are certain limits on which I work. So there are some clients who are happy with low numbers and taking statin. It is okay. I mean.

Right. The problem, the conflict though, is between a statin and when a doctor puts you on a statin, they also put you on a low-fat diet. And now, you know, the conflict isn't just the medication, it's the nature of the diet. We having that this year, we turned the so-called food pyramid upside down to favor more fat, to favor more animal product, be that as it may, but the higher fat. And that's difficult to reconcile in an era where everybody's telling you to eat less fat and be on a statin to even further lower your, your fat transport. So there's a lot of conflict there.

What about the other organs? What about, um, any eye issues, heart issues, neuropathy?

For monitor that?

Huh? So fortunately, in the initial phase, I also went for an ophthalmic checkup, just like that. I mean, as a preventive measure. So I have that record with me. And I went to the same doctor after 10 years to do the same test and with much more. No glaucoma, no retinopathy, and optic nerve. Everything is normal except the specs. Everything is normal. Absolutely.

This is, this is old age though.

Yeah. And I used to test everything. My kidney function is healthy. I have all the numbers. My liver function is healthy.

The dialysis rates in India are through the roof for renal failure. Uncontrolled blood sugar coupled with blood pressure will lead to kidney disease and dialysis. Right?

I have seen that in all diabetics who have kidney disease, they should have mandatorily high blood pressure also, uncontrolled. This is the common thing which I've seen. Doesn't mean that others are not there. Yes, some people with high blood sugar do face DKD, but the common is high blood sugar, high blood pressure, and uncontrolled status for multiple years leads to high creatinine and ultimately dialysis.

Yeah. And no neuropathy.

No neuropathy. Absolutely. And even dental checkup, I had no cavities, nothing. So that is also safe. I also did, interestingly, CIMT, carotid intima-media thickness test. Yes.

So blood flow, everything is normal except in my left, uh, carotid, there's a mild thickening of 1 mm. Now, I don't know whether it was there earlier, whether it is recently developed, or is it regressed, or is it stagnant? We don't know. So my plan is, repeat. I will track it after five years. After five years, I'm going to do CIMT again and see what is the status. Is it increased? Is it decreased or same?

Right. The only, the only recommendation, obviously, you want to track it because is your diet impacting on it? But the, having done a number of carotid surgeries myself, until you get to a 70 to 90% stenosis, it's somewhat irrelevant. And if it is elevated and there is a rough surface, you're going to be on an aspirin. But.

I'm much more worried about cardiovascular disease, coronary vascular disease than this. And strokes usually don't come from this. The commonest cause of a stroke in a diabetic is an arrhythmia. Atrial fibrillation and arrhythmia. So checking your heart rate, checking your blood pressure, checking, getting the CAC scores is the screening stuff.

All normal, including echo.

Yeah, stress test, ECG, everything is normal.

The other very interesting thing that I looked at with you, cuz I just did a talk on this a little bit ago, but it's important is your uric acid. And your uric acid has been very stable.

Yeah.

It's been very solid. Um, have you ever looked at your glucagon?

Glucagon? No, we're not measured.

Are you able to? I'm sure you are in India. Get glucagon.

I'll have to find out. I'll have to if you can get it next time. But have, have your insulin and your glucagon done at the same time because it's going to be very, very useful to see where, because you're unusual in that, um, your, you are still eating some carbohydrate that probably your blood sugar is primarily supported by carbohydrate. So you can tolerate a lower protein fraction because most of that gets triaged to your, to your muscles because there is salt. And then the fat is also obviously the ketogenic fuel source makes the dependence on sugar lower. So your uric acid is low. In this country, we're eating a ton of meat, uric acid levels tend to go up fairly easily.

Um, but you.

In India, in India, uric acid, we find hyperurism very common, very, very common. A lot of fabratin, allopurinol is used. When we measure insulin, it is high. You take care of insulin, uric acid car.

Right. And, and you see the uric acid that in India is coming from fructose. So the commonest cause of an elevated.

Is it not due to insulin resistance also?

Two together, right? The two together. But the interesting thing about fructose is it's somewhat insulin independent. So you see very, very high fructose rates and all of the sugar, all of the carbohydrates you're eating in India, except for the, uh, dairy, is one molecule of glucose, one molecule of fructose. So you're seeing that, that combination. And glucose will affect the insulin levels. Fructose doesn't. So in, in my PhD research, the single worst of the sugars was by far fructose, um, cause the highest vascular abnormality, but also does lead to ura, hyperurosismia. And then when your insulin, I mean, the two are parallel because when you stop eating carbohydrates, it's not like you're just getting fructose, you bring those levels down. Um, and then in the patients in this country with very high glucagons, we now see the protein becoming purines and being spilled because it's driven by glucagon. Um, but yeah, I mean, that's just something of interest. That's why I'm interested to see what your glucagon is. And I bet it's.

I'll, I'll get this and do. Now, interesting part on uric acid is when, when clients come to me, put them on a low carb, insulin reduces. I had read that high insulin prevents the normal excretion of uric acid. So when you lower down insulin, increase the protein, still the uric acid comes down.

Right. And, and that's, but the. So whether it's the insulin or whether it's the low reduction in, in fructose, both of those make a difference. Yeah. So, um, and it's, but it's interesting that your uric acid has never been up. It's always been fairly flat. Uh, and I think that's probably because you've got currently a fairly decent fraction of carbohydrates in your diet. And I think you prove that even if you've got low insulin production capacity, if you've got those other two, the high fat and the protein, it modifies the carbohydrates are used for energy, but they're not overwhelming the system.

Do you do any intermittent fasting?

Yeah. So, I am on last seven, eight or nine years, I'm on two meals a day.

It's interesting. Yeah. Go ahead.

So, my, my intermittent fasting is different. So I don't follow the typical 16 or something. So it is, it has always been two meals. Earlier also, I used to have breakfast at home, maybe 8, 8:30. Go out in field work outside. I will not eat anything in the restaurants. My team will eat with me. I mean, I mean, I will, they will all eat. And while I have some lemon water or black tea or black coffee. And then come at night because I was employed, so I used to come very home late at night, 9:00, 8:00, 10:00. So I used to have one meal that day. Now, now that I am home, so I follow two. I still follow two meals a day. For me, breakfast is very important.

So, at 8, 8:30, I do eat my heavy breakfast. And then I have early dinner around 6:30.

You're at about a 12-hour spread, 10, 12 hours separation. So, two, a bit like the way most people feed their dogs in the early in the morning and the evening. But, you know, and I think, but I, I still think that look, um, if you look at most people in Asia and in Africa, where I come from, they are eating typically a meal before they go to work, uh, in rural India, and then a meal afterwards. And they may be eating. I, so this all this information now comes from, I just interviewed my good friend Jason Fung. He's got a new book coming out, Hunger Code. I interviewed him last week. He and I sat and chatted, and he's got a Chinese heritage. And he said, "Look, uh, you know, we asked him about the rice. They're eating 300 grams of rice, but it's twice a day with a long period of time outside of this." And Jason developed, he's a nephrologist, a kidney doctor. For those that don't know Jason Fung, look him up. He's the father of the modern era intermittent fasting movement. Um, but Jason said, you know, he started with a group of, actually, it was more Muslim Indians who wouldn't give up their rice or their papadam or their naan, but they would consider doing Ramadan every day. And that means that they're eating same thing, uh, uh, after sundown and before sunup and not eating during the day. And their diabetes and their kidney disease got better. And that's how intermittent fasting started. It was a group of of Toronto-based, um, Muslim Indians. And then he expanded it. So you are basically following that same paradigm. But I think you bring something very important to the table. It doesn't have to be a, uh, uh, all in the same window. The difference though, is that you're managing your blood sugar. For people trying to manage their weight a little bit, that's where that the narrower intermittent fasting, uh, uh, comes in. That you're distributing that sugar, keeping your baseline sugar, and you don't ever spike high, uh, is coming from your mouth rather than a lot of production. That's why your protein dynamics are good. BUN's good, uric acid is good. So, uh, that is an important consideration. And you are a lean person. The other comment that you made, which I think is so important, is that not for a lot of people, like myself, breakfast is the least important meal of the day, but for you, breakfast is the most important meal of the day. And there's nothing wrong with that. There's nothing wrong.

I feel extremely hungry in the morning. So even, even if I am on, even if I have ketones running, I still feel hungry. I need to eat somehow. That is ingrained for 35 years because we need to eat food and then go out to work because we cannot eat those restaurant crappy foods and all. So we prefer to eat mostly.

And again, it, it's done. There is no harm in my opinion to do that. There's no harm to eating in the beginning of the day in my opinion. There's also no harm to be eating later in the evening. I don't have an issue with either of those.

Um, now you mentioned something. Do you track your ketones at all?

Uh, earlier I used to track ketones. Now sometimes I do track, but now I'm in a little higher carbohydrate range. I may be in 70 grams or so. So ketones, yes, rarely it does happen. But for four, five, six years, I was on very strict ketogenic diet. I used to track ketones also. Primarily, initially I used to track with urine ketones and then I purchased this Keto Mojo and Abbott and Abbit, uh, ketone meters. I have both with me. So I used to track, but not too often. Now I'm not, frankly, I'm not very rigid on the ketogenic part. I'm more into 70 grams or so on, maybe a little bit.

But I think, I think that's important is because you still using your body is fat adapted.

So it's still primarily using fat with a little bit of sugar.

Um, and, uh, so I, I think that the, I have no biologic issue with what you're doing. For a lot of my patients, I have an addiction issue with that. Mhm.

Is, you know, does that make sense? So, we've just got to be very cautious. I mean, you don't have that as a problem. That's the only distinction is not everybody can emulate what you're doing because if you told me to eat 70 grams of carbohydrates, but there's rice in the fridge, I'm going to eat until it's gone. There's no, there's no imposition of limit. You know, if there's chocolates in my house, they're gone. So, they are not there because I can't trust that. So, we've got to take that into account as well. Uh, but I, I, this is brilliant. And now you've published this paper, and the paper will be in the, in the reference as well, in Frontiers. And all of your data is in that paper. Is that correct? All of the numbers, all of the data is in there. So that is available for public reference, but we will, it'll be part of this discussion as well.

Any advice to, I mean, it's just an incredible journey. Um, so I have an interesting question for you. What is going to kill you? How are you going to die?

No idea. Maybe old age, maybe accident. We don't know.

Some. I don't see heart disease at least from whatever test I've done.

No, that's what I'm saying. You're not, you're not going to die of heart disease. I, I'm looking at you and saying, "Okay,

What is going to kill this guy?"

Maybe accident is what I think.

That's. I suspect that it's going to be some, some death in old age. But there's always something that causes that. But isn't that the ideal way to go? To to wake up dead one day when you're old? Because, you know, by the time we're 60, most of us kind of have an idea of why we're going to get killed or why, why are we going to die? Do you ever look at your prostate? Your, your, do you do any cancer surveillance or prostates or?

Uh, no, I have not done any cancer test. But prostate, everything is normal that way. I have, I don't have any issue.

Yeah. So you.

I don't know about cancer. I have not done any cancer testing at all. Maybe I will do it. I was seriously evaluating doing for this 10 year, but somehow I couldn't do.

Yeah, it'll be that for 15.

That'll be the good follow-up. So I, you know, again, brilliantly done. And I love the fact that you have put this with all your data into a paper. And I would urge people to share that document because it's really a lay document. It's not a, it's got a lot of science in it, but it's a lay document of, yes, you can do this. Is it easy? No. But is it, is it better than living with diabetes? And the disease of diabetes, the way I label it, is you're dying in pieces.

You lose your toes, you lose your foot, you lose your kidneys, you have stents in your heart, you lose your eyes, you have your cataracts done. You die in pieces. And you've avoided all of that. It is.

And let me tell you, let me add in something that how I feel. The kind of energy I feel is when I was in college, when I was a teenager, even at the age of nearing 60, I'm 59 and a half. So the kind of energy I have is tremendous. So that is. I advocate this for everyone. Everyone should be doing at least lowering down carbohydrate, getting off all those processed junk. And for diabetes, this is the best treatment. Restricting carbohydrate is the best treatment. No medication, nothing. You can do fasting whenever you want. There is no compulsion to eat carbohydrate to maintain the level. So it doesn't cause hypo. No, all these are all big advantages.

Yeah.

And, and then the other thing you haven't talked about is you mentioned that your anxiety and your depression.

They were all mild, you know, mild anxiety, depression, sleepy after meals, all those things are eliminated. How I'm energetic throughout the day.

Yeah. Very, very, very impressive. But you're, you're absolutely right. I think it's, I'm struggling to find a reason other than a lack of knowledge why anybody from two, why any person with diabetes or pre-diabetes wouldn't do this. But secondly, and here's my real annoyance, why any doctor still follows a medication-first algorithm and tells people they must eat carbohydrates if they take medication. That, I, in my opinion, with stories like yours, has now become malpractice.

Would you agree with that? Have, have any doctors?

See, what happens is, see, let me tell you that I have a different view in the sense that many people are not willing to change the diet.

I agree.

They say, "No, I want to see." In India, the addiction of sugar is not high. Addiction to grain is very high. That's why I coined a term for Indians, that is granitarians. We are all granitarians. We want a lot of grains. So if you tell them, a lot of clients, a lot of prospective clients approach me. When I tell them that this is what you have to do, reduce the grains, they don't come back because, because grains is very emotional.

Now, now they can make a decision based on knowledge. They're choosing to. You know, everybody knows smoking is a bad idea.

So you choose not to change it. Is a historically, a lot of people didn't know that smoking was a bad, bad thing.

So that's the first thing. The second thing though, is that your story, although ridiculously good, is now becoming more and more common. And there's no endocrinologist that hasn't seen somebody with your story, and yet they refuse to adopt this methodology. That was Richard Bernstein that had a whole lifetime. He became a doctor and couldn't convince anybody.

Or anybody in this world of diabetes and endocrinology.

To change their, their management algorithm. And that's the frustration for me.

But fortunately, many doctors in India are now supporting low carb.

Good.

They might not prescribe, but they support. I do get quite a number of doctors, they refer clients to me.

For for better weight loss or even better blood sugar management. In fact, I have a couple of doctors from US who sends me clients. They are all Indian doctors there practicing.

Nice. Fantastic.

And, you know, you'll not believe this, or you'll find it difficult, or you'll believe this also. More than 40 doctors themselves have been my clients for diabetes.

Nice. That. And that is a testament to how well you're doing is when physicians become part of your. It's daunting. It's daunting. But I have a lot of physicians as well that are part of my practice. And it's daunting. But when they give you accolades, there's no better accolade of transforming somebody who's living in a world where the entire industry is against you.

So, last question for you. How do you get the word out? How do we accelerate the exposure and the momentum of what you've done so successfully and sustainably?

So keep, keep posting in social media. And, uh, these sessions, these podcast sessions like yours are bound to spread the message. So we keep doing a lot of educational stuff in, in social media, posting, raising awareness. And we also done three metabolic health conferences, low carb conferences also to raise the awareness. So, so the active education is going on. And I hope that this study will, will gain traction and doctors will realize that it is possible to do. And I have proven with safety methods that, you know, it is cardiovascular is safe also, in spite of having high LDL, higher ApoB. Though it is, anyone, once I may not be able to say that everyone is safe with this, but nevertheless, in my case, it is proven that if you follow this well, the relative safety will be there. And we can always intermittent checks for everything.

I, I'm going to be a little bit stronger than you. I've got the MD and the PhD. There is no doubt that it is safe. There is no doubt that it's safe. And, um, I will categorically state that, uh, having worked with more than 10 thou, well, more than 10,000 patients in my time, it is categorically I'm stating that on a low carb diet, if your LDL goes up, it is 100% safe. It is not a cause of cardiovascular disease. There are other causes of cardiovascular disease, but not elevated LDL. So I will, I will take. I'm very comfortable making that statement.

I cannot make this as a health coach. It is out of my boundaries to.

No, no, no. But that's what I'm saying. I will take. I will take that on anytime. I mean, it says right there.

Got my degrees on my chest. No, but it, and that is not based just on the physiology and the science. It's also based on a lived experience with so many patients.

And, you know, I will ask your help in spreading the, the studies to more in your circle because people should know. Not many people may be knowing that this study is released. And this is the first of its kind documented 10-year diabetes remission study with the safety aspect. This is the first one. There is.

No published data on 10 years. This is the first of its kind. And we have that 10 years ketogenic diet with Andrew Kotnik, who has published it last year. So for type 2 diabetes, this is the first of its kind. And, you know, at this opportunity, I'll take. I, I know I will thank. I will thank Dr. Jasmid Kore, who has taken pains to document everything. So we have worked together. Major part of work is hers. I will thank Anup Singh, from whom I have learned low carb, when initially I was searching for this. And also, Dr. RK Singh, Dr. Shhat Kolk, and Dr. Mihir Rahut, who were part of my journey for almost 10 years. And I used to share my reports, showing them, and they were also incorporating low carb in their own dietary practices to some extent.

Perfect. Perfect. No, I, I really like this. And if people want to know more, go to the show notes. But this is an incredible story. And as you said, I'm astounded that it's the first time that this has actually been published because the anecdotes are out there. I've got the experience. I have these patients. But, uh, if it's not published, it doesn't exist. And especially the, you, you mentioned social media, but AI needs to have more data to counteract the, "Yeah, low carb's good, but your LDL is going to kill you. Don't do it." That's what AI currently says. And we need to, we need to turn that around.

And I have proven that Indian vegetarians can do this. It is not only just meat. They can do it. It is very easy for them. Lot of my meat-eating clients are doing extremely well, but vegetarians always doubt whether I can do. So I have a lot of vegetarian clients who don't eat eggs and are doing extremely well. And, you know, I have handled five pregnancy cases with diabetes.

And whether they are meat-eaters or pure vegetarian, they are doing extremely well. The kids are extremely healthy, cognitively very strong, very good weight.

Absolutely. And it's the, the insulin-driven dynamics that's so important. I, I look at three different types of vegetarians. The worst ones are what I call the junk food vegetarians, which we see in this country. Then you've got the white vegetarians, which are mostly in India, where it's all white foods, the white starches. And then you've got the green vegetarians, and they're okay. And the green and yellow, which is cheese and eggs, that's the, that's the ideal. Good. Well, Shashi, this is very illuminating. I, I sprung on this as soon as you, I saw the P, the you showed us the publication. Congratulations. And let's get this out there. We've got two million or more lives to impact. Thank you.

Take care. Bye-bye.

Thank you. Thank you. Good night.

Good night.