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​The Melanie Avalon Podcast Episode #44- Cyrus Khambatta, PHD and Robby Barbaro, MPH

Cyrus Khambatta, PhD, and Robby Barbaro, MPH, are the team behind masteringdiabetes.org, an online coaching platform for people living with all forms of diabetes that focuses on low-fat, plant-based, whole-food nutrition.

They are also co-authors of the New York Times bestselling book, Mastering Diabetes​.

Khambatta has a PhD in nutritional biochemistry from the University of California at Berkeley and a Bachelor of Science Degree in Mechanical Engineering from Stanford University. He has been living with type 1 diabetes since 2002. 

Barbaro has a Master's Degree in Public Health, and spent six years helping build the revolutionary Forks Over Knives empire. He was diagnosed with type 1 diabetes in 2000.

Khambatta and Barbaro have been featured in media outlets such as The Doctors, NPR, CNBC, Healthline, VICE, Fast Company, WIRED, KQED, The Rich Roll Podcast and Plant Based News. They have spoken at major medical conferences including the International Plant-Based Nutrition Healthcare Conference (PBNHC), the American College of Lifestyle Medicine (ACLM) Conference, Plant-Stock, and VegFest LA.


Website: https://www.masteringdiabetes.org/
YouTube: https://www.youtube.com/user/mindfuldiabeticrobby
Instagram: https://www.instagram.com/masteringdiabetes/
Robby Instagram: https://www.instagram.com/mindfuldiabeticrobby/
Cyrus Instagram: https://www.instagram.com/mangomannutrition/
Facebook: https://www.facebook.com/masteringdiabetes.org
Twitter: https://twitter.com/masteringdib


Mastering Diabetes: The Revolutionary Method to Reverse Insulin Resistance Permanently in Type 1, Type 1.5, Type 2, Prediabetes, and Gestational Diabetes

2:05 - IF Biohackers: Intermittent Fasting + Real Foods + Life: Join Melanie's Facebook Group For A Weekly Episode GIVEAWAY, And To Discuss And Learn About All Things Biohacking! All Conversations Welcome!

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7:15 - Cherry Picking Diets

9:30 - Cyrus' Story: Type 2 Diabetes, Low Carb, And Less Insulin With High Carb Low Fat

17:40 - Classifying "Low Carb" 

21:15 - Robby's History: Type 2 Diabetes, High Fat Plant-Based Keto, And Less Insulin With High Carb Low Fat

24:30 - Natural Cures "They" Don't Want You To Know About

26:15 - Plant Based Keto

30:15 - Common Insulin And Diabetes Misconceptions 

34:00 - Picking Fats Vs. Carbs

36:15 - BIOPTIMIZERS: Full Spectrum Magnesium Supplement To Fix Your Magnesium Status, Containing All 7 Versions Of Magnesium! Get 10% Off At www.magbreakthrough.com/melanieavalon With The Code Melanie10

38:35 - The Metabolism Of A Meal: Fatty Acids, Chylomicrons, And Carbs

41:50 - How To Safely Store Fatty Acids 

44:00 - How Excess Fat Creates Insulin Resistance 

46:00 - How Low Carb Makes You Intolerant Of Carbs

49:45 - The Effects Of A High Fat Meal: Can A Healthy Person Eat A High Fat Meal?

53:00 - The Implications And Problems Of Mixed Meals 

54:55 - Insulin Resistance From Fasting, The Ordering Of Carbs Vs. Fats, And The Delayed Glycemic Response Of Fat And Protein

1:00:35 - Should You Mitigate The Insulin Spike?

1:02:00 - How To Transition From LCHF To HCLF

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1:06:20 - How Fast Do Enzymatic Pathways And Fuel Preferences Change? How Fast Does Glycogen Storage Potential Change?

1:08:50 - Ray Peat And The Role Of Polyunsaturated Fatty Acids

1:13:20 - Free Mastering Diabetes Quiz

1:14:00 - Addressing Hunger Issues When Transitioning To High Carb: Comparison To The Keto Flu


Melanie Avalon:           Hi friends. Welcome back to the show. I have been waiting for this episode. I cannot even describe how long I’m so excited about this moment. I feel like I should give you guys a little bit about my background, so you'll know where I'm coming from, but for listeners, I am here with Cyrus Khambatta and Robby Barbaro. They are the authors of an incredible book that the second I read it, I knew I had to track them down. They are the authors of Mastering Diabetes, the revolutionary method to reverse insulin resistance permanently in type one type 1.5, type two, prediabetes and gestational diabetes. For listeners, the reason I am absolutely thrilled about this book and it has been on my mind so much is that as you guys know, I am historically from the paleo world, I started with the whole low carb thing, the whole paleo diet. I've been interested in the carnivore diet, but all of that said, I become increasingly fascinated by the flip side of the spectrum, the seeming flip side, which is an extremely high carb, extremely low fat diet to do- and we can talk about this- do potentially similar health benefits that people seem to experience on ketogenic diets. 

I personally, it seems like there's almost this magical thing that can happen when you go on either side of the spectrum. I would love to get both of your thoughts on this Cyrus and Robby. I feel like in this macronutrient war, people think that either it's low carb, high fat, or high carb, low fat, and that one is right. The other is wrong. When I think maybe its more nuanced and maybe they actually both work as long as they're not practicing together. I would love to get your thoughts on that. Thank you so much for being here.

Cyrus Khambatta:         Thank you so much for having us here. We really appreciate it, Melanie. We love talking not only about the benefits of a low fat plant based whole food diet, I will say, or know regimen, but we also have done a ton of digging deep into the research to try and find what really happens to people who are eating low carbohydrate diets and trying to do it from an unbiased perspective. You probably know when you get, when you zone in on one dietary style, it's easy to cherry pick evidence and say, okay, this is why I do it. This is why I teach it. You sort of, I don't pay attention to the information that is on the opposite side. We have spent countless hours trying to be as unbiased as possible in the search for information. We can talk all about that today for sure. 

Melanie Avalon:           No, I’m so glad you brought that up. That is one of the things that I found so refreshing in your book and your approach is exactly what you just said, because I think there is- it drives me crazy, the overwhelming amount of cherry picking that happens in evaluating dietary approaches. It sense. I think what happens so often is people, you know, they might have a health issue that they want to address.

                        Then they find a diet that works for them. They think it's the cure all and they think it's automatically going to work for everybody. Then they look for the research that supports that and there is research to support that. Then there's no reason for them to look at the other side or consider the other side. Then also I think cherry picking comes in. Even if you try not to, I don't know. I was just so thrilled to read your book and I could really sense that you guys were not trying to cherry pick that, you were doing the research doing the science and this is what you were finding. I'm really excited. I have a lot of questions. 

Robby Barbaro: I agree. We're excited as well. I love when we get on a show or somebody, the host says my audience is technical and understand the nuances because like you said, there are a lot of details. There are a lot of, you know, granular things to look at to really understand what's going on. The fact that we can dive deep into that today is a lot of fun and really exciting.

Melanie Avalon:           So excited. I guess to start things off before we do get into the details, would you like to both tell listeners briefly about your own story and how you, both came to where you are with this dietary approach for mastering diabetes? 

Cyrus Khambatta:         For sure. I was diagnosed with type one diabetes at the age of 22. I was going to Stanford University. I was a senior and I was just trying to graduate and move on with my life about halfway through, as I was studying for finals in December, I started to feel very thirsty, like extremely thirsty to the point where I was drinking about a gallon between one and two gallons per of water per day. It seemed like no matter how much water I drank, I got thirstier and thirstier and thirstier. In addition to that, because I was drinking so much water, I would end up going to the bathroom and urinating about 17 to 20 times a day, like clockwork, every 30 minutes when I would go to sleep, I would cramp up because I was electrolyte depleted having flushed so many fluids, I would go to sleep. You know that feeling where your calf muscle cramps up and then you try and stretch it. Then all of a sudden your opposite hamstring cramps up and then your abdomen cramps up. There were moments where I was lying in bed and I was almost in full body rigormortis because there were three, four, five, six different muscle groups that were all cramping at the same time. I picked up the phone; I called my sister, who's a doctor of osteopathy.

                        I said, Hey, Shanice, help me. What are all these symptoms? Why am I experiencing them? She’s a pretty cool cucumber. She’s very smart. She started crying immediately and said, Cyrus, everything you're saying is that you have type one diabetes, go straight to the health center drop everything you're doing right now. I didn't know anything about diabetes at that time, nothing about human health. Because I was just studying mechanical engineering. I turned to her and I was like, Shanice stop. I don't have diabetes. Diabetes is only about old people and cake. That's literally what I thought it was. She said, “Cyrus, I don't have time to explain, go right now.” I dropped everything, went straight to the health center. They checked my blood glucose while I was there.

                        My blood glucose was in the six hundreds. Now just for the context here, your average blood glucose, normal physiological blood glucose is between about 80 and 130 on a daily basis. If we were to check your blood glucose, Melanie, at any point in time in a non-diabetic setting, because you're non-diabetic, you would be within that range. I was about six times higher than I should have been. They took me to the hospital. They gave me fluids in one arm, insulin and the other, and they started to control my blood glucose over the course of 24 hours. When I got discharged from the hospital 24 hours later, not only was I diagnosed with type one diabetes which is an autoimmune version of diabetes, but I also was diagnosed with two other autoimmune conditions. It became conclusive that I was now living with three autoimmune conditions. The first one that I had developed was about six months prior.

                        That one is Hashimoto's hypothyroidism. The second one is called alopecia universalis. That basically is just a code for total hair loss. I don't have any hair. I have no eyebrows, no eyelashes, no ear hair. No, nose hair no chest hair, no leg hair, nothing I used to, but then I lost it all. That happened at about the same time as hypothyroidism. Then the third one was type one diabetes and all three of those set in within a six month period at the age of 22. I was very scared. The doctors had no idea. They said, you have this thing called a polyglandular autoimmune syndrome. We've literally never seen anybody with this combination of auto immune conditions. We don't know what to tell you. I was like, that's not very promising. I get discharged from the hospital 24 hours after entering with a blood glucose meter, test strips, two tier prescriptions for two different types of insulin syringes, a carbohydrate counting guide and a life alert bracelet that says, hey, in case you find me passed out on the sidewalk, call 911.

I went back to my normal life and I was terrified and confused and I had no idea what to do. The doctors did tell me at that time, they said, hey, listen, if you eat a low carbohydrate diet, that's the best thing that you can do to control your blood glucose because it controls your glucose very well. It prevents you from using more insulin over the course of time. Do that. I said, okay, great. That sounds like a plan. I followed their recommendations and that was to eat things like lean meat, whether it was red meat or white meat, to eat fish to eat eggs.

                        To have dairy products in my diet to try and limit my intake of things like potatoes and rice and corn and fruits and breads and cereals and pasta. I understood the philosophy. The more carbohydrate, rich food that you eat, the higher your blood glucose could go and the more insulin you might need. I said, okay, great. I tried to keep my carbohydrate intake very low. Now my glucose was supposed to become very controllable, but my glucose became a complete roller coaster, a disaster. As a result of that, I started using more insulin and more insulin and more insulin. When I first got diagnosed, I was on about 25 units of insulin per day. Within a three month period, I was using 45 units of insulin per day. Somehow, even though despite I was eating the fact that I was eating a low carbohydrate diet, my insulin use was climbing and my blood glucose was a joke and I just could not figure out what was going wrong.

                        I started looking for more information and I had no idea what I was looking for. All I knew was that I was literally just looking for a way to feel better, to have more controllable blood glucose, to have more energy; two have less achy joints and less achy muscles. I stumbled across this idea of eating a plant based diet. I said, okay, great. I'll give it a try, no problem. Under the guidance of a doctor named Dr. Doug Graham who went on to write a book called the 80 10, 10 book, he basically taught me how to eat a plant based diet. That was 100% plant based. He taught me how to eat lots of fruits and lots of vegetables. It was literally that simple from the get go and under his supervision. He showed me how I could dramatically reduce my total fat intake and increase my carbohydrate intake and get better control of my blood glucose, even though it was counterintuitive and it didn't seem to make sense.

                        My willing suspension of disbelief said, okay, great. I'll try this out. If it works cool, if it doesn't work well, then I'll try something different. I can't even tell you, Melanie, within the first 24 hours of doing this approach for, low fat plant-based whole food, my blood glucose fell so quickly. It kept on falling and kept on coming in low. I had to back off on the amount of insulin I was using very quickly. Within a seven day window, my glucose went from being an average of like 180, maybe 200 or so on a daily basis to an average of like 80, like pegged flat. The beauty was that I was consuming 600 grams of carbohydrate per day. I went from eating a hundred grams of carbohydrate to 600 grams of carbohydrate.

                        My insulin use fell. They went from 45 units back down to 25 units. I was effectively eating six times as much carbohydrate for 40% less insulin. In that minute that that happened to me. I knew something interesting was happening so long story short, I went back to graduate school. I enrolled in a PhD program at UC Berkeley because I wanted to understand what the heck was happening inside of me. I want to be able to put some science on it, and while I was there. I learned that not only is there a whole collection of studies that perfectly describe the biological mechanisms that I experienced in my own body, but that a lot of those mechanisms apply to people living with all other forms of diabetes, whether type 1.5 prediabetes type two diabetes, gestational diabetes, you name it. As a result of learning that information, Robby and I ended up meeting each other, we teamed up and we created mastering diabetes to teach people living all around the world, regardless of the type of diabetes you're living with, how to transition to a plant based diet to get very similar results and even better.

                        Here we are, you know, three, four years after starting mastering diabetes we've changed the lives of more than a hundred thousand people. We're very happy and only really getting started.

Melanie Avalon:           That is so incredible. I bet listeners ears are really perking up because people just don't anticipate, especially in the, like the paleo sphere and the low carb world. This idea that a high carb, low fat plant based diet could have those results. Do you mind if I ask you a really, quick question, when you first went low carb to address that the insulin issues, because you mentioned reducing rice or reducing carbs, were you still including them at all, but just like less of them or where they cut out completely. The reason I'm wondering is something you talk about in the book is how a lot of the problems with studies on low fat diets are that they're not low-fat enough. I could not agree more because it's like, it just drives me crazy that there are a lot of studies that are quote, low fat, but they're not looked at enough.

                        Once you have that fat in there, it's going to be messing with the mechanisms, at least I think so you might not get the outcomes that you would get if it were low fat enough. I think that the same could also apply some times to low carb studies that they're not low carb enough. I'm just wondering, like in your personal experience, doing low carb, if it was like low carb ketogenic or was it just lower carb, higher fat?

Cyrus Khambatta:         I'm actually really glad you asked that question. The answer is I was not eating a ketogenic diet because a ketogenic diet didn't exist in 2003. I mean the philosophy did, it was just called something different. It was called the Atkins diet, I believe at that time. No, I was not consuming 30 grams of net carbohydrate maximum and eating the rest and protein and fat.

                        I was eating on average about a hundred grams of carbohydrate per day. What's interesting is that if you go into the literature to look at what is the actual classification of a low carbohydrate diet, there's no general consensus for the number of grams per day or the percentage of your diet per day. That is technically low carb. The number 100 grams falls well within the range of what's considered a low carb diet. Some studies go all the way upwards of including about 150 grams of carbohydrate. Some of them go it's about 120. Some of them go even lower at 75 or as low as 30. Point being is, you know, technically speaking; I was following a low carbohydrate diet because that's the information that was presented to me at that time. 

Melanie Avalon:           That's so interesting to hear that clarification. I do wonder like you guys talk about, like I said, with the low fat side of things, you know, for low carb, how low carb would it need to be in order to have the effects? Cause I, I think it might be so delicate to the point where that if it's low carbon enough, there's some sort of magic that happens. Then if it's just, just over by just a tiny bit, I think it could very quickly actually be detrimental because it's like you're having enough carbs in to mess with the signaling and, everything. Then you have a high fat intake. I feel like it can go pretty bad pretty quick. Even if it's still low carb.

Cyrus Khambatta:         You're totally right. We can get into more and more details about the actual numbers. When we talk more about ketogenic diets, because you hit it on the head, there's like a magic. As far as blood glucose control is concerned. If you get below a particular threshold, which is somewhere around about 30 grams of net carbohydrate per day, then your blood glucose becomes very flat light. We know this and we've talked to lots of people who are eating ketogenic diets and we've seen this, but despite the fact that your blood glucose becomes much more controllable, there are longer term effects, which are very important to pay attention to. Even though the short term control of blood glucose becomes fantastic, there are sometimes some very detrimental long-term effects that we can't not pay attention to. Those are the things that we can talk about men a little bit. 

Melanie Avalon:           Awesome teaser, so how about for you, Robby? What was your history coming to this? 

Robby Barbaro: I was diagnosed with type one diabetes when I was 12. Just about to turn 13. I've been living with type one now for over 20 years. My older brother was diagnosed eight years prior to me. I was familiar with the condition. I was familiar with the symptoms and I actually went to my mom and said, mom, I've gone to the bathroom all the time. I'm thirsty all the time. I think I have diabetes just like Steve. She’s like, no, don't be silly. You don't have to have diabetes. I listened to her and then eventually she was out of town in Florida looking at homes because we were going to move to Florida.

                        I was at home with my brother and she called the check in and say, hey, how are things going at home? I said, mom, I couldn't sleep last night. I was cramping the whole night. She said, okay, go upstairs user brother's blood glucose meter and test yourself. I was well over 400. Like Cyrus said, you're supposed to be far lower than that. Somewhere between 80 and 130. My brother said right then and there, yup. You have type one diabetes, pack your bag. You're going to be in the hospital for a few nights. We went to the general doctor and we have the official diagnosis there and then went to the hospital for a few nights. My dad flew back. Both of my parents flew back the next day. I just remember him saying just an inconvenience. Don't worry about it.

                        You can just do whatever you want in life. It's all good. That was kind of the way we looked at it. My parents wanted to make sure that my brother and I had the best medical care we could possibly have. We went to the Mayo clinic in Rochester, Minnesota, and I had an endocrinologist. I have a psychologist, I had a dietician. We did our best to follow all the guidelines. I would follow the food pyramid and mom made sure I had fruit had dinner every night. My fruit would be canned oranges, Mandarin oranges with all that syrupy stuff in there. It tasted amazing. I never had strawberries. I would certainly put powered sugar on top. Just a very standard American diet growing up. I ended up with some standard American symptoms. I ended up having cystic acne in high school, which was very frustrating.

                        I did everything you possibly could. I did the microdermabrasion treatments. I did laser treatments, pills, creams, everything. Eventually they put me on Accutane, which is one of the most serious drugs you can take for acne. Your parents have to sign a waiver because some people have he committed suicide on that drug. I felt like that's what I had to do. 

Melanie Avalon:           I did that too, by the way, Accutane it's intense. It's like fill out the forms and it's crazy. 

Robby Barbaro: Absolutely, yeah. You totally understand. I also had plantar fasciitis, which was a really frustrating, painful condition in the arches of my feet. As a competitive tennis player, I did everything I could to try and treat that. I wore big blue boots at nights for passive stretching. I would get sick every year, even though I took [00:18:47 inaudible] and Claritin D, I’d still get sick, I have warts on my feet. Just some frustrating symptoms eventually I just started to learn about eating a healthy diet. My dad was sort of an entry point because he sold supplements. That was the beginning of me learning that, wait a minute, there's something I can do to actually impact my health. Like what goes in my body actually matters. That was just the beginning. Well, I was in high school in Sarasota, Florida. I went to Barnes and Noble to get some SparkNotes, like a high school student does. A book fell off the shelf. This is not a book I'm recommending. It's called Kevin Trudeau's Natural Cures They Don't Want You To Know About. This guy had infomercials all over the place. The guy sold millions of books. Eventually he went to jail for some fraud. Like I said, I'm not recommending it, but the book planted a seed in my mind that maybe it's possible to reverse type one diabetes.

                        If I do everything I possibly can to be as healthy as humanly possible, maybe my body can generate some new beta cells. Like why not? Like what's going on here. Somebody has to be the first to do it. Roger Bannister was the first one to run a four minute mile. All the smartest people in the world told him that's not possible. Once he did it, a bunch of other people have done it since. I'm like, okay, I'm going to do anything and everything. That just sent me on this journey to learn and learn and learn and apply everything that made sense to me. Over time I try the Western price foundation diet. I was eating a lot of grass fed beef drank raw milk. I would go to the local farmer's market and buy milk for cats because you can't sell raw milk to humans.

                        I followed the guidelines. I didn't see any really major transformation in my diabetes health. I did feel a little better, you know, getting rid of a lot of junk food, but nothing major happened. I was continuing my mission to learn and learn. Eventually I came across what is now would be considered a plant based ketogenic diet. This was Gabriel Cousins teaching at a phase one diet where I would eat plenty of olive oil, lots of nuts and seeds and a lot of greens and vegetables. Even some foods like, you know, bell peppers, you had to be careful with because they had a little bit too much sugar. Then, you know, it's too sweet and fruits were definitely out in the phase one program. I followed this diligently and I'm going to usually I don't go into so much granular detail here about the numbers, but since you said your listeners are interested, I'm going to go very granular on the numbers here.

                        As a person living with type one diabetes, we are all fascinating test subjects of insulin sensitivity, because I have a C-PAP type of less than 0.01. Meaning it's basically undetectable, meaning my pancreas is producing no insulin, whatever I inject that's what's working. I know how much insulin I'm injecting. We count our carbohydrate content that we consume and we measure our blood glucose all the time, which back then there were not continuous glucose monitors. I was doing finger sticks. Now I have a CGM. When I started following this plant based keto diet, my total carbohydrates were 70 grams of carbohydrate per day. That was my total, but the net was 30. I did follow a truly low, you know, plant-based ketogenic, low carbohydrate diet. While doing this, as, at this point, I'm a freshman at the university of Florida.

                        I took the least amount of insulin I've ever taken. My total insulin per day. It was about 10 units per day. I was taking only fast acting insulin. I don't use any basil. I literally would wake up in the middle of the night, every so like, I don't know, three or four hours or so to inject a small amount. I was basically using an insulin pump with multiple daily injections. That's a very small amount of insulin to use. If you do the ratio there, you want to do total carbohydrate? That's going to be seven to one. If you want to- then the other way to look at is glucose. We'll get there in a second. Fast forward, I start to learn about the low fat plant-based whole food diet. I actually heard Doug Graham on a podcast and this guy, Doug Graham has a book called the 80 10, 10 diet.

                        It's the same person that Cyrus learned from. The podcast blows me away. I'm like, wait a minute. I can eat all this fruit and this guy is saying like, I can cleanse heavy metals. This is like a big deal. Let me, let me just give this a shot. I, this was in September of 2006. The book comes out in December of 2006 and Cyrus is one of the testimonials in the back. I'm like, wait a minute. This is interesting. Another type one doing this program that instilled even more confidence in me. I look Cyrus up and I'm like, this guy's fed. He's active. Like this is great. I'm going to keep going. I signed up for a coaching program with Doug Graham. It was a 90 day program online. I emailed him every single day, he emailed me back every single day.

                        I learned how to do this low fat planted based whole food diet. I'm eating tons of fruit. I start eating 600, 700 more grams of carbohydrate per day. My total insulin intake, goes up, but my insulin sensitivity is going to like through the roof in the sense of like how much insulin I need for how many grams of carbohydrate I'm consuming. is shockingly low. I'm having lots of low blood because readings I'm like what is going on? I have to keep on changing my dosage. Now when I go back and look at the data I use average of 27 total units of insulin per day. Now I take long acting insulin and short acting. You combine the two about 27 units, total per day, a normal, healthy human pancreas is going to secrete somewhere between 25 and 50 units of insulin.

                        If you're a person, a really confusing thing that happens in the world of diabetes health for type ones is people think taking less and less insulin is the goal that's success. That would only be success. If you knew at the same time, you were also starting to produce more and more of your own insulin. That would be amazing. Really the goal for people living with type one diabetes or any form of insulin dependent diabetes is to use the same amount of insulin you would have, a physiological, normal amount of insulin you would have used before your pancreas was damaged. This is a healthy amount of insulin. What I realized looking at the numbers. Is if I'm eating, you know, 750 grams of carbohydrate per day using 27 units, we're talking about the 27 to one ratio. Seven to one.

                        When you look at total carbohydrates, seven to one on a plant based keto diet, 70 divided by 10 versus 750 divided by 27. Now where it gets interesting is if you start to look at just glucose, so let's say you people argue, well, you know what? You're just eating a lot of fiber and you are eating a lot of fructose and fructose doesn't require insulin. That’s why your ratios look so good. If you use a nutrition app like chronometer you can actually see the exact amount of glucose you're consuming. You go to the carbohydrate section, you break it down you're going to add up starches. You're going to add up glucose and you're going to add, and then sucrose, you take one half of that. You can see your total glucose. When doing the plant-based ketogenic diet, I was consuming about 10 grams of glucose per day.

                        You take 10 units of insulin, 10 grams of glucose. We're talking a one to one ratio. When you're looking at the glucose. Now on a low fat plant-based whole food diet, I'm consuming about 270 grams of glucose per day divided by 27. Now we're talking about a 10 to one ratio. When you're looking at just the glucose, that's a 900% change in insulin sensitivity. This is really what our entire book is about. This is what our methodology is about is really this understanding, the concept of what lifestyle habits can you employ to increase your insulin sensitivity, your body's ability to take glucose, out of your bloodstream into yourself. That was really the life changing experience and insight that I have. Being a student at the university of Florida at the time, I was able to access, really high quality journals and find out that yeah, topic has literally been documented for almost 100 years of people showing as you decrease fat intake and increase carbohydrate intake, you actually see an improvement in insulin sensitivity.

                        You realize, Hey, that's actually the cause of prediabetes and the cause of type two diabetes. Therefore we know how to actually solve those conditions. Then for type one type 1.5 and some dependent type two, if we maximize the insulin sensitivity, we reduce long-term chronic disease risk, give people more energy, help them reach their ideal body weight and help them have predictable blood glucose control. It's like, we got to get this out to more people. We created the mastering diabetes method. We put it in a book here we are today. 

Melanie Avalon:           I’m so fascinated by all of this. For listeners, even if you don't have, you know, type one diabetes or diabetes, I think the information that you're going through and what we could learn from it is so valuable to anybody looking to, address their blood sugar levels and their insulin sensitivity. I would love to go deeper into the science of what's actually happening. I have a quick question. It’s so fascinating to me that, you started eating way more carbs. I mean, yes, it required more insulin, but the ratio, it was a much better ratio in favor of the insulin required for the carbs. Is that a situation where, because you were choosing to be metabolically fueled on carbs in that quote extreme situation where if you were to add in fat that you would be less tolerant of the fat. Like the flip side situation would be, if a person is on a low carb diet and then they bring in carbs and they have this seeming insulin resistance, or they can't quite tolerate, a small amount of carbs. Is it a situation where a person kind of has to choose to be fueling on fat or fueling on carbs? Then when they're in that situation, they have to be very careful adding in that other macronutrient. 

Robby Barbaro: You’re bringing up a fascinating point. It's like, you like stole the words out of my mouth. That's exactly what we'll say. You have to pick one, you cannot be in the middle. That is a true disaster. Once you pick one, I mean, our mission here is literally just to educate people. Like we always say, we're not the food police. We're just going to give you the information you get to decide, you know, which path you want to go on and take the risk that you want to take. We are just going to enlighten people on the consequences that we see and the research that we're aware of. Pick one then we always like to say how much we respect people who do, a truly low carbohydrate diet, just like you were saying, you're defining what the difference earlier between like doing a truly low carbohydrate diet. We talk with doing a truly low fat diet and not getting confused about the research that actually isn't doing that. Anybody who really is doing it, like we have so much more in common than we don't have in common. All these people doing these, different diets and really there's part of the solution. The real problem we have in this country is the apathy is the people who are doing nothing. On both sides, it's just a, it shouldn't be a lot of respect and acknowledgement. Then just sharing information so people can decide where they want to go. 

Melanie Avalon:           I love this so much. My next book, I actually want to be something where it's like, why they both work. It's like pick which one you want to do. Diving into what's actually going on. When a person eats a meal and let's say that is mixed macro, so it has protein fats and carbs. What happens is it's. What is the order of insulin release? What is the order of the fuel processing when it is a mixed macro meal and what is the effect on the body? 

Cyrus Khambatta:         Yeah, that's a great question. Let's go hardcore. Some biochemistry here. Think about it this way. When, you're consuming a low carbohydrate diet, low carbohydrate diet whether you slice it as 30 grams of net carbohydrate or 75 grams of net carbohydrate, or a hundred grams of net carbohydrate, the idea here is that the total carbohydrate value of the food that you're eating is quite low. In that situation the two predominant macronutrients are dietary fat and dietary protein. Protein is basically just a collection of amino acid sequences and dietary fat comes in predominantly as this molecule called triglyceride. Triglyceride is basically, that's a macro molecule that is a glycerol backbone with three fatty acid residues attached to it. You can sort of think of it as basically having a backbone with three fatty acids that all right are attached to one unit. Now, you consume the triglyceride in food and triglyceride comes in the form of, and again, you get it from foods that are fat rich, whether those are dairy products, red meat, white meat, chicken, fish, poultry. It could even be things like peanut butter and olive oil and olives, and coconuts from the plant there's world. Regardless triglyceride is sort of the main mechanism or the main storage form that both animals and plants use triglyceride gets inside of your mouth. It travels down your esophagus, it gets inside of your stomach. It starts to get very sort of like partially torn apart in a very weak way then eventually it gets inside of your small intestine. 

                        Inside of your small intestine. You can think of it as basically being like a bio-reactor in which there are multiple organs that are manufacturing, digestive enzymes, and placing them into that space. One of those organs is your liver. Your liver manufacturers and secretes digestive enzymes, and puts them into your small intestine. Your small intestine itself creates its own digestive enzymes. Your pancreas itself creates other digestive enzymes. The combination of the three of these organs are putting digestive juices inside of your small intestine. Inside of your small intestine was where the bulk of nutrients extraction and nutrient digestion occurs. The triglyceride molecule at this point gets, broken apart. The three fatty acids end up getting pulled off of the glycerol backbone. Those three fatty acids also get absorbed through the walls of your small intestine.

                        Think of it as like a hose. You have water flowing on the inside of the hose. If you sort of poke holes on the outside of the hose then the water that's on the inside can basically escape through the walls of the hose and get on the outside. That’s kind of what's happening inside of your small intestine, the fatty acids end up going inside of the lymph system and inside of your lymph system, and then circulated into your blood. Once they're inside of your blood, they get packaged inside of these things called chylonmicron particles and the chylomicron particles circulate and their job, their role is to distribute fatty acids, to tissues all throughout your body. A simple way to think about this would be if the fatty acids that came in your diet ended up getting inside of these chylonmicron particles, and then those chylonmicron delivered the fatty acids.

                        To only your adipose tissue, then diabetes itself as a condition wouldn't be that big of a deal. Diabetes would probably still exist, but it wouldn't be as prevalent as it is in today's world. The reason for that is because your adipose tissue is a safe place to store fatty acids, it's mechanically and enzymatically designed to be able to uptake large amounts of fatty acids when present inside of your diet. It’s designed to hold onto those fatty acids for a significant period of time, and then release those fatty acids when the time is right. The problem happens when those chylonmicron particles distribute those fatty acids to your adipose tissue, but then they also distributed to your liver and to your muscle because your liver and muscle are two other organs that are capable of absorbing and up taking fatty acids for energy, except they are designed differently than your adipose tissue.

                        They're designed to store small amounts of fatty acids, but not necessarily large amounts of fatty acids. How do we know this to be true? The reason we know this to be true is because the glycolysis pathway, which is basically the pathway that's responsible for degrading a glucose molecule and extracting energy out of it to create ATP. The glycolysis pathway is extremely active inside of your muscle and extremely active inside of your liver. There are many processes that stem off of the glycolysis pathway and the glycolysis pathway is sort of like a central biochemical pathway that's present in both of those tissues. In your adipose tissue, your adipose tissue can also perform glycolsis but to a much smaller extent because it's fuel supply is different. Its fuel supply is fatty acids. Not only can it hold onto and store fatty acids for a long period of time and then release them to other tissues when the time is right, the fatty acids also run off of predominantly fatty acids because that's where they're storing.

                        They can do glycolysis, but to a much smaller extent. To a certain extent you can sort of think about the tissues is burning and have a different engine, a different fuel utilization. as a result of that, when you take fatty acids and you shunt them towards the liver and towards, the muscle, the liver and muscle are capable of storing it, but it's not necessarily the way that they were designed. Over the course of time, if you're consuming a diet, that's rich in fat, and there's a constant supply of fatty acids that are coming in through your small intestine, through chylonmicron and getting inside of your liver and muscle, your liver and muscle basically absorb those fatty acids because they're present. Because they also don't really have very good mechanisms to block those fatty acids from coming in.

                        If you take a look at the actual, like fatty acid transport mechanisms on the cell surface to try and understand like, well, if a liver cell doesn't really want more fatty acids, or it's not designed to store fatty acids, why doesn't it just turn it off and shut them down? The answer is the fatty acid transport proteins on the surface and the fatty acid transport sort of mechanisms are not highly regulated mechanisms, which means that when there's a significant amount of lipid inside of your blood, that lipid can get inside of your liver and muscle without too much complication. Your liver and muscle end up accumulating fatty acids over the course of time. Once they've accumulated a significant amount of fatty acids, there's some very fascinating research that actually shows the direct mechanism by which an accumulation of excess fatty acids, particularly saturated fatty acids.

                        It starts to antagonize the function of the insulin receptor and the proteins inside of the cell downstream from the insulin receptor. Now, why the heck would this be the case? Just simple way to think about it would be when a cell is basically increasing in its fatty acid supply. Fatty acid is just a form of energy. The cell is generally responding to the amount of energy present inside of it in a low energy environment. There's an entire cascade of biochemical activity that occurs in a high energy environment. There's a different cascade of biochemical pathways that occur. When you're constantly putting fatty acids inside of a cell, it's a high energy signal and it's equivalent to more than twice as much energy as you'd get from glucose or protein. The amount of energy inside of a cell goes up and it goes up relatively quickly.

                        The cell goes into a sort of like high energy fed state in a short period of time. In that particular situation, what the cell is actually trying to do is say, look, I don't want more energy. How can I block more energy from coming inside of me? Again, if it had an ability to say, hey, stop coming in here, fatty acids, it would do so. Again, the mechanisms are not very sophisticated. What it does is it says, okay, what if we were to block insulin from signaling, if we were to block insulin from signaling, we could slow down the rate at which these fatty acids are coming in. In addition to that, we can also block another fuel, which is called glucose. These cells go into a self protective mechanism or self protective mode in which they basically say, hey, if we just play this insulin resistance game and make ourselves resistant to insulin or reject insulin or tell insulin to go away, then we can slow down the rate of fatty acid coming in and we can block glucose almost entirely.

                        That's what they do. They go into this self protective mode. As a result of that self protective mode, when there's carbohydrate present in your diet, whether you eat a banana or a bowl of keenwah, or maybe some beans, the carbohydrate energy, it gets broken down into glucose, the glucose is trying to get inside of the cells. The glucose comes accompanied by insulin. Insulin knocks on the door, says, knock-knock liver cell knock-knock muscle cell, there's glucose in the blood. Do you want to take it up? Go right now. If you do, and the liver and muscle respond by saying, , remember we're playing this insulin resistance thing we don't necessarily have a biological need for, that fuel right now go away. 

As a result of that, the glucose ends up sitting trapped inside of the blood, can't get inside of liver and muscle very effectively. Insulin also gets trapped inside of your blood because it cannot communicate with the liver and cannot communicate with the muscle very effectively. In this particular situation, the liver and muscle have made themselves insulin resistant, which then causes a traffic jam inside of your blood that forces glucose and insulin to accumulate in higher concentrations, which is exactly why in a typical diabetic patient, a prediabetic patient, someone who is on their way to type two diabetes.

                        When they present at the doctor, they present with high blood glucose and high insulin at the same time. In most cases, a lot of these patients also test with high lipids, they're hyperinsulinemic, they're hyperglycemic and they're hyperlipidemic at the same time. A simple way to reverse this problem, actually, before we even get to the reversal, the important takeaway message here is that people in the low carbohydrate world, will often report the same thing. They'll say, Hey, I ate one banana and my blood glucose went up and it went up very high. I ate one peach and I checked my blood glucose two hours later and it was 175, I ate a small bowl of rice and my blood glucose went up to 220. I told you carbohydrates are bad for me. I shouldn't eat carbohydrates. Have you heard people say that before in the low carbohydrate world?

Melanie Avalon:           Yeah, 100%. It does seem that when you are following a low carb diet for an extended period of time, then you bring in the carbs that it's like you just don't have a tolerance of them is what it seems like. 

Cyrus Khambatta:         Exactly right. From a biochemical perspective, you don’t.

Melanie Avalon:           Like going back to what you said at the beginning about fat cells are great for storing fat, liver and muscle, you know, not ideal. Say that these lipid droplets aren't filled with fat in your muscle and liver and you have room to store fat in your fat cells. Does it vary by person? Like what a normal healthy person, if they eat a really high fat meal, will it preferentially first go to fat cells and then muscle and liver or is it really individual? Could a person eat a high fat meal and one person, the fat preferentially goes into their fat cells so they don't get issues of fat building up in the liver or fat building up the muscles and causing these insulin issues. Whereas another person that eats a high fat meal and the fat preferentially stores in the liver and the muscle and then they are more likely to experience issues with carbohydrate tolerance?

Cyrus Khambatta:         In order to answer that question, what we would do is have to go into research and try find out what happens to people in randomized control trials that are fed either a single high fat meal or that are fed a high fat meal over the course of time. Over the course of weeks to two weeks to a month, there's a number of papers that actually clearly demonstrate how even a single high fat meal, literally one high fat meal, can increase postprandial glycemia and increased postprandial insulinemia by as much as 65% in the subsequent five hours. These studies were done in individuals who were living with type one diabetes because people with type one diabetes as Robby alluded to earlier, are excellent test subjects that can be used in research because you can fully control the amount of insulin that goes into their body.

                        These are healthy lean individuals that have no, that are well controlled and their blood glucose. I'll quote from the paper here that says the addition of 30 grams of fat, to 30 grams of carbohydrate increased glycemia by two millimoles per liter at five hours and similarly the addition of 40 grams of protein to the same amount of carbohydrate which is 30 grams of carbohydrate increased glycemia by 2.4 millimoles at five hours. When both nutrients, both the fat and the protein were added to the meal, the postprandial glycemic response was increased by 5.4 millimoles per liter. The sum of the effects are the two nutrients individually, so effectively what they're saying to answer your question is these individuals were fed 30 grams of carbohydrate in a single meal and then they were either given 30 grams of carbohydrate with 30 grams of fat or 30 grams of carbohydrate with 40 grams of protein, and in both of those two separate scenarios, they experienced higher glycemic excursions and a high up to a 65% increased insulin.

                        The requirement after the meal and the effects were additive in the sense that if you took third meal and created 30 grams of carbohydrate plus 30 grams of flat plus 40 grams of protein together, then they have the highest glycemic excursion with the highest insulin response in the postprandial state. 

Melanie Avalon:           What I wonder though about that situation is speaking what we were talking about in the beginning about having a cap of carbs to qualify as low carb and still achieve the benefits. I wonder, so if they were doing 30 grams of carbs, and this is the first time hearing this study, so I'm just thinking out loud, so if they were doing 30 grams of carbs in a single meal, do you think that you could make the same extrapolations of that in a high fat context compared to having that amount of fat and carbs or that amount of carbs at least spread throughout the day? I just wonder if the meal had been-.

Cyrus Khambatta:         10 grams of carbohydrate. 

Melanie Avalon:           Yeah, or just the protein and the fat. 

Cyrus Khambatta:         What you're getting at is actually a very true statement, which is that if you're consuming a meal that is a mixed meal, you have some carbohydrates, some fats, some protein and if they're in like kind of relatively equivalent amounts than like biochemistry becomes very complicated and things like insulin resistance, the whole mechanism can get set into play relatively quickly. That’s why I refer to that as sort of like the middle ground. It's like it's the place where you don't necessarily want to be as a standard American diet where you're eating like 40, 40 20 carbohydrate fat protein or 30, 30, 30 something like that. Carbohydrate, fat protein, that's like a, that's a disaster zone and we know through plenty of randomized control trials that that is a recipe for chronic disease.

                        If you split to one side, you can either go to the left hand side which is ketogenetic low super low carbohydrate or you can go to mastering diabetes, which is super low fat, plant based, whole food nutrition. In either direction, no matter which direction you go, you will absolutely get better blood glucose control. The dynamics of insulin and glucose and fatty acids and amino acids will change and they change differently. Whether you go into the low carbohydrate zone or they change differently if you go into the high carbohydrate zone or the low fat zone I will say.

Melanie Avalon:           Here's another nuance I wonder, say you have a person, there's also a caveat because you talk about in your book the study by Sweeney where he compared a patient's eating carbs, patients eating high-protein, patient, fasting and patients eating a high fat diet and then measured their insulin sensitivity on a meal after and the patient's fasting and the patients actually with the fat had the worst insulin sensitivity.

Robby Barbaro: I remember the Sweeney site, that's the 1927 study archives of internal medicine. Yes. 

Melanie Avalon:           Yeah. The reason I'm like wondering about this is I was so intrigued that fasting. What you think would be a calorie deficit that would prime yourselves for properly responding to fuel? Like what can we take from that? Seeing seemingly insulin resistance or carbohydrate intolerance. On paper it looks like they didn't have a favorable response, but we know or I don't want to say that we know, but we see so many benefits from fasting. It makes me wonder how we qualify the response of the cells in that state. The thing that I was wondering also is the order of meals. Like say that you're in a calorie depleted state, your cells are presumably not filled up with fat. Say that you can eat a large amount of just fat and a large amount of just carbs.

                        If you ate the carbs first and completely processed them, would they feel glucose stores and then you ate the fat with the fat safely enter cells compared to if you ate the fat first, would that instigate all of the problems with shutting off the- properly working with insulin so then the glucose would actually stay in the bloodstream? Like is it a where you could eat the exact same meal, the exact same macronutrients, but order the macronutrients differently and it would affect-.

Cyrus Khambatta:         - and space them out in time? 

Melanie Avalon:           Yeah with the order change, things like eating the fat before the carbs compared to the carbs before the fat. 

Cyrus Khambatta:         I mean I think in theory the answer is probably yes, it would have an effect. The difficult thing about that actual scenario is that when you're eating food, you don't really like eat one macronutrient at a time.

                        You could eat a food that is predominantly as it is higher in one micronutrient and lower and another macronutrient. Then it becomes a question of timing. Like here's an example. Suppose I were to eat a meal that contained cheese and chicken. Just as an example of like a food that's higher in fat and protein or a collection of foods that is high in fat and protein and effectively devoted carbohydrate energy. Then an hour later I were to go eat a banana. That’s scenario number one. Or we could flip flop it or I eat a banana and then an hour later I eat the plate of cheese and chicken. The question is, is one scenario safer than the other? Is one scenario, does it occur where the fatty acids end up getting know positioned inside of liver and muscle and then they create insulin resistance or is there another situation whereby they came in after the fact and the carbohydrate got in first so everything is fine.

                        I mean if you ate cheese and chicken first and then you waited for some period of time, call it one hour, two hours, three hours, four hours, five hours, you would get the exact response that I just we talked about earlier, which is that a, the presence of a significant amount of saturated fat then creates a traffic jam that blocks glucose and insulin from entering- blocks glucose from entering cells and insulin from communicating with cells. In the same subjects that I just spoke about here, living with type one diabetes, that's exactly what was happening to them. The presence of the fat blocked the glucose from entering cells and block the insulin from communicating and they ended up with delayed hyperglycemia three to five hours after the meal was over. I can guarantee you this. If you were to separate it out and they were to eat the cheese and chicken first and then an hour later they would eat the carbohydrate meal, they would get a very similar response because the biochemical, the partitioning of fuels occurs exactly the way that I just described, but if you flip flopped it and you ate the carbohydrate first and the carbohydrate went in and the insulin was able to shuttle glucose inside of cells without a significant saturated fat amino acid roadblock, then great.

                        Now the carbohydrate energy gets stored, it gets positioned inside of liver and muscle appropriately. Glucose stays low, insulin stays low, everything's fine. If you follow that meal an hour or two hours or three hours or five hours later with a high fat meal, your glucose would not budge. That is an absolute true statement. Here's the thing, if I were to eat a carbohydrate rich meal at noon and then I were to eat a fat rich meal at 3:00 PM just like we're talking about, your glucose would likely not budge and your insulin levels will not budge. That three o'clock meal is going to have a lasting effect and that's what we see in people that we've been working with. That’s what a lot of the research is now beginning to show is that fat and protein have a delayed glycaemic response. The delayed glycaemic response is something that you can't necessarily, you can't just track what's going to happen over the course of the next two hours when you meet a meal because yes, you will see some aberrant blood glucose excursions and some abberant insulin excursions, but you also have to take into account what's happening six hours down the road and 12 hours down the road and 24 hours down the road.

                        Some of the research that actually goes into detail about what happens in that delayed postprandial period is now showing that glucose metabolism gets altered in a negative way over the course of time. 

Melanie Avalon:           That's something I've wondered. Because a lot of times people will say that you should eat mixed macro nutrient meals because it, you know, will mitigate the insulin release so you won't have this huge spike. When I often wonder if it's better to, , have the carbs have the spike, have it taken care of compared to an elongated insulin response that is, continuing to happen maybe at a slower or at a lower level, but for a longer period of time. I know that seems like a really specific question about the ordering of meals, but people on the intermittent fasting podcast, especially because people are eating in a smaller time window, they ask us all the time about the order of, you know, should they eat fats first? Should they eat carbs first, like what order? I do think there is something to it. 

Cyrus Khambatta:         I always say eat the carbohydrate first if you want. 

Melanie Avalon:           That's what I've always, because people will say you should eat fat, so fill yourself up. Then I'm like, but then if you eat carbs after, I just feel like you're not in a state to use them. 

Cyrus Khambatta:         From a biological perspective, if you're going to eat a meal that is high in fat and or high in protein, if you choose to do that, which is totally fine, I would highly recommend eating a carbohydrate meal first before that so that you won't, I ended up with a high blood glucose or high insulin response as a result of eating this fat and protein. In other words, eating the fat and protein causes and immediate as well as a delayed carbohydrate metabolism problem. Eat the carbohydrates first and then eat the fat in protein afterwards and that shouldn't keep your blood glucose and insulin more control for sure. 

Melanie Avalon:           Some other questions for you. Say a person has been on a low carb diet for a while and they want to give a high carb, low fat diet a try about transitioning over. One question I had was, because in your book you talk about starting with, like one meal at a time, are you not worried that if a person's been doing a high fat, low carb diet for a long period of time, it could be potentially dangerous to start with? You know, one meal at a time, like what do they sort of have to just jump all in and commit right at the beginning or like clear out the cells from fat first? Like do calorie restriction first?

Robby Barbaro: That's a fascinating question and we did make sure to put in a specific sentence in the book, which basically said, look, this is the after working with thousands of clients; the slow transition is the best way to do this for long term success. It might be bumpy in the beginning, but don't worry about that. Especially, you know, you're trying to like reverse type two diabetes, reverse pre-diabetes, seeing some elevated readings in the beginning. It's not that big of a deal yet. As long as people understand those are, that's just the symptom. What you're doing is you're treating the cause of prediabetes and type two diabetes, which is insulin resistance. Let the road be bumpy, work on a solution that's going to last in the long term. That's the way to do this. It's really, it's kind of like a, it's more of like a mental thing and a little bit of how you got what response?

                        Some people can't handle so much fiber right away, but we also say, look, yes you are following this protocol and you're seeing higher readings than you want to and you're motivated to make these changes that you absolutely can. We also both acknowledged that in our own personal stories we did both change overnight. It’s kind of like a nuanced situation that everybody can sort of look themselves in the mirror and decide what's best for me, which option am I going to choose? They have an option. 

Melanie Avalon:           Do you know how fast, like the enzymatic changes are that the fuel preferences in the cells for using carbs versus fats, like how fast that actually happens and also glycogen storage potential? Like does that actually rapidly grow the more carbs that you eat? 

Cyrus Khambatta:         Yeah, very good questions. The question is how quickly can you alter the glucose enzymatic machinery when you start eating a higher carbohydrate diet? Is that right?

Melanie Avalon:           Yes.

Cyrus Khambatta:         The answer is it depends. It depends on a number of things. Number one, it depends on how low carbohydrate of a diet you have been eating, how long you have been eating a low carbohydrate diet. Are you significantly overweight, yes or no? Are you active, yes or no? Those are the four sort of main variables. Let’s take somebody who is 30 pounds overweight, relatively sedentary, has been eating a low carbohydrate diet, like a ketogenic diet for a year. In that situation you can certainly see changes in your, in the enzymatic response to carbohydrate an increased carbohydrate load and that usually will happen within the first week. It could take as long as a week for you to see significant changes in your blood glucose values. If you're using insulin and oral medication, you might take upwards of a week to recognize those changes.

                        In somebody who is normal weight has been eating a low carbohydrate diet for six months and is very active. They're likely going to see changes in their blood glucose response and or insulin use within 24 hours. Just like Robby did, just like I did. From an enzymatic perspective, the answer is the changes happen relatively quickly from a whole body perspective and from an entire blood glucose regulation perspective, it usually is a little bit slower, but the answer is it can happen as quickly as 24 hours and it can happen as long as about a week, maybe 10 days at the very maximum. Truth be told, Robby and I are flabbergasted at how quickly people change and when we first started this process we used to think like, somebody has been 60 70 pounds overweight, it's going to take them months to see changes in their blood glucose and they'll see it significantly faster than that.

                        It's a nice thing. It's just, it seems counterintuitive that you know, you can alter the enzymatic machinery in multiple tissues as well as your blood in a short period of time. That’s what we find to be true and that's what a lot of the research also shows. 

Melanie Avalon:           How do you feel about, are you guys, you probably are familiar with Ray Pete?

Cyrus Khambatta:         I’m familiar with him. I haven't read his stuff recently, but I definitely know what you're talking about. 

Melanie Avalon:           His diet really resonates with me because it's high carb. He loves fruit. It's actually high protein though specifically like not muscle meats but like fish gelatin. He's really about optimizing thyroid, optimizing metabolism. One of the main things of his diet is actually PUFA depletion. How do you guys feel about polyunsaturated fats and do you think there's a benefit to the whole PUFA of depletion protocols?

Robby Barbaro: Okay, so in general there's this big concern. I think when people start following a low fat plant based whole food diet, they're like, am I going to be able to consume enough essential fatty acids? I think that question comes into play and then it's all this conversation and I guess it's just important for people to know that when you follow the mastering diabetes method, the way we've put it together, we have made it so there's an insurance policy for essential fatty acids. The basically our breakfast meals. We're encouraging people to, once they gain insulin sensitivity to focus on having, you know, their favorite fruits. You know about four servings of fruit, some greens and vegetables in there, and then a tablespoon of either ground chia seeds or ground flax seeds. Right then and there people are consuming enough essential fatty acids on the omega-3 side right then and there just with that.

                        Then when you're eating whole foods, right? The lettuce, bananas, mangoes, potatoes, all whole foods actually contain small amounts of essential fatty acids on the Omega three and Omega six side. You are actually getting given extra. The biggest problem that we find is people are consuming too many Omega six fats in their diet in general. Then there's this whole, this all this conversation, well people should increase their Omega three is like just eat more Omega three. When they're really not addressing the core problem here, which is the same enzyme that's responsible for converting on the omega-3 side, omega six side delta 60 saturates. It’s one enzyme that does the conversion process on both sides. When you're consuming too many Omega six fats, the pathway prefers that side that goes and deals with the Omega Six. There's not enough enzymes on the Omega three side to do the conversion and then to get enough EPA and DHA.

                        I mean in our program, our, big focus is optimizing that ratio of Omega six to Omega three. It's somewhere between four to one and one-to-one. When you do that, then you optimize your conversion. Again, just in our program in general, consuming enough essential fatty acids is not difficult. I'm not actually know this guy as well as maybe Cyrus does. This whole, this whole conversation in general, you, you need all these extra fats, rallies, great things to happen and it's so important and necessary. In my opinion, it's, it's oftentimes blown out of a lot of perspective. I mean, it's making a way bigger deal out of the need for a essential fatty acids, how to get them, how to make sure that you do the conversions and all that. It’s just a misguided conversation when really the true root of the issue is the conversation that gets all messed up with the whacked out ratio.

.                       The standard American diet is like 30 to one. I mean it's really, really bad way off. Focusing on whole natural foods, and we outline in our program which is you know, just a lot of plants, whole plants and optimizing that ratio. It is a big deal. I don't know if that answers your question or not, but it's an important tenet of our program. 

Melanie Avalon:           Yeah, no it does. One thing about Ray Pete and I actually, I think you guys would be really fascinated by his work. He actually is all about really like reducing those polyunsaturated fats as much as possible. It’s kind of like the flip side of what most people seem to be trying to do, even Omega threes. In any case, I have so many more questions, but you guys have been absolutely amazing and I really want to be respectful of your time.

                        Everything that you're doing is just so incredible. Listeners, you've got to check out mastering diabetes. It has so much information, so much science. We didn't even really go into like the practical application of it, but it’s all there. It's got recipes, it's got everything and Cyrus and Robby are as well offering our listeners a free quiz to figure out if this is a good approach for you. I'll put a link to that in the show notes like in the show notes will be at melanie avalon.com/diabetes.

Robby Barbaro: The quiz is very interesting. It's, it's a fascinating tool to go and see how insulin resistant are you right now you get to know, you answer a few questions and then you know quiz on the back end, ties up a bunch of numbers and you can find out, hey wait a minute, am I following a lifestyle that leads me to be quite insulin resistant or am I doing things that make me quite insulin sensitive? Definitely check that out. 

Melanie Avalon:           I have one quick question because a lot of my listeners are low carb and a lot of them have been doing that whole world and they might be intrigued by this, what I hear a lot is that when they try to do, you know, change up these macros that they find themselves starving, they feel like all of a sudden they're slave to blood sugar. Do you believe if a person sticks it out long enough that that will resolve? It's just a matter of transitioning to basically running on carbs again?

Cyrus Khambatta:         Yeah so you're saying if they were to make a quicker transition to a higher carbohydrate diet, they notice, what did you say? Their blood glucose goes a little bit out of whack?

Melanie Avalon:           Yeah. A lot of people say that if they, especially if you've been low carb for a long time, that when they try to bring them back carbs, they feel like they lose all control. Like, it's like on low carb they didn't have to worry about blood sugar swings and appetite and when they bring back carbs, all of a sudden carb cravings are back and it doesn't feel like a change that they want. I just wonder if maybe it's a matter of needing to stick it out longer?

Robby Barbaro: Just like we were talking about carbohydrate metabolism is quite changeable. Even if you don't see changes right off of the bat-. Let's put it this way. Let's back up here. If you do the opposite, if you go from eating a higher carbohydrate diet to ketogenic diet, as you know, and as your listeners probably know, there's this thing called the keto flu and the keto flu is anywhere from, a two day period upwards of us five to seven day period at the very longest in which people feel not so awesome. Part of the reason why they don't feel awesome is because they're forcing their liver and their muscles and in particular their brain to adapt to a new fuel source and a new fuel source of these ketone bodies that are manufactured by your liver. Your liver has to basically ramp up its production of ketone bodies by taking fatty acids and then degrading them into a seal Colet and then making, these ketone bodies to distribute the tissues all throughout your body and send up to your brain so your brain can switch over from using glucose as a fuel to using ketone body.

                        Your central nervous system has to adapt. Your liver has to adapt to a new manufacturing process. Your muscles have to adapt to a new fuel source. It forces multiple tissues throughout your body to be changing their fuel supply. As a result of that, it takes a little bit of time. In the same way that you know somebody who's transitioning towards a ketogenic diet might want to do it and stick with it so they can get through the symptoms of the keto flu and eventually get to a point where they are, using predominantly ketone bodies as a fuel and predominantly fatty acids as a fuel. I would argue the same thing for people who are switching towards a higher carbohydrate intake. It may feel weird at first, it may feel strange, you might have digestive problems, you might have a difficult time thinking properly. Your energy levels might be weird.

                        Over the course of a week, two weeks, three weeks, four weeks, if you truly do keep your total fat intake low and you truly are eating a significant quantity of carbohydrates that are whole carbohydrates, they're not refined coming from packaged process, you know, cookies, crackers, chips and the like. Then I'm very confident that even if it feels weird at first, you're going to start to feel dramatically better. Your energy levels will go up; your blood glucose will be more controllable. Your medication use will likely come down and you might even lose a significant amount of weight in a short period of time. 

Melanie Avalon:           I love it. I think people think they'll gain weight when actually I think if you basically just ate carbs, it would be almost, not impossible, but gaining weight would be very difficult just from like a pure perspective of how that is formed in the body. Listeners, this is not just adding back carbs, it's the low fat context, the whole foods context also important. The last question I ask every single guest on this podcast, it's really quick. It's just because I know how important mindset is surrounding everything. It's not just diet; it's not just all of that stuff. What is something that you're both grateful for? 

Robby Barbaro: I'll tell you what I'm grateful for right now. I kind of like a broken record if anybody follows me on Instagram or whatnot, but I'm just obsessed with fruit and I'm grateful. I'm grateful for the amazing fruit that is coming into season right now. I just got some white peaches over the weekend and some really delicious cherries, so I'm excited about all that summer has to bring when it comes to high quality fruit. 

Melanie Avalon:           Do you like pineapple? 

Robby Barbaro: You know what's funny, pineapple is one of the fruits, I do not like it. I mean I've had it in Hawaii and I've had like white pineapple and when it's tree ripened or plant ripened, whatever you want to call it, pineapples don't grow on trees. When it's like it comes straight from the plant and it's ripe in there, it's good and it doesn't really cut my mouth, but some of the, you know ones you buy at the grocery store, it's just, I don't know, it just doesn't, it doesn't work out for me. 

Melanie Avalon:           The diet I thrived on that I've tried to get back to was actually really high lean protein and high pineapple. It was basically the pineapple would digest the protein, but then it was like high carb, low fat. It did really well for me. 

Robby Barbaro: You truly are the ultimate biohacker. These nuances are really fun. I love it. 

Melanie Avalon:           How about you Cyrus? 

Cyrus Khambatta:         I'm actually super grateful that… I'm actually, I'll be honest with you, I'm pretty damn grateful that Robby is my business partner, he's a great guy and you know he brings a lot of energy, enthusiasm and a ton of experience to the table. You know, the two of us have been able to build a business that's truly changing the lives of people around the world. We started out early where we literally want to change the conversation in the world of diabetes and affect one million people and we're well on our way to doing that and I would not be able to do without him. Robby you're stuck. 

Robby Barbaro: Thanks a lot man. I appreciate that. The feeling is mutual, read and acknowledge what is in our book everybody out there.

Melanie Avalon:           Well, thank you guys so much. You really are changing the world. It's amazing. Listeners, check it out and maybe we can come back for a part two in the future because I could talk to you guys for so much longer. Thank you so much. 

Cyrus Khambatta:         Yeah, we’re just scratching the surface right here. I love it. Thank you. Thank you for all that you do and thank you for putting in the time. Really understand this stuff. Just like Robby was saying, very few podcasters really, really, really understand diet to a really super nerd detail, and clearly you do. It’s, always fun to talk with you and geek out on a lot of the things that actually do matter. 

Melanie Avalon:           Awesome. I love it. Well, thank you both so much. I'll talk to you again. Bye.

Cyrus Khambatta:         Bye.


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