Here is the full transcript of functional nutritionist Dr. Sten Ekberg’s 2024 talk titled “#1 Absolute Best Way You Must Reverse Prediabetes.”
Listen to the audio version here:
TRANSCRIPT:
The Importance of Reversing Pre-Diabetes
Hello Health Champions! Today, I want to talk about why you must reverse pre-diabetes. Even if you don’t think that concerns you, you really want to pay close attention to this video because the vast majority of people with pre-diabetes do not know that they have it. Here’s why you need to understand this topic: 70% of people with pre-diabetes will become type 2 diabetic in the next 10 years. That is how consistent that progression is once it has started.
Type 2 diabetes is a causative factor, the strongest correlation and a causative factor, in cardiovascular disease, stroke, cancer, and even dementia. Just how common is this problem? Well, in the United States, we have 35 million people with type 2 diabetes, and around the world, that is now an astounding 540 million people—over half a billion people—already living with type 2 diabetes.
But then the question is, how many are going to become diabetic? Again, 70% of those with pre-diabetes will turn into diabetics in the next 10 years. That’s 100 million people in the United States. We don’t have really good numbers for the rest of the world because it’s not such a recognized problem.
Global Impact of Pre-Diabetes and Diabetes
Most countries are starting to recognize type 2 diabetes, but not so much the preceding stages. But if we use the same ratio here, there are probably somewhere around 1.6 billion people in the world who have pre-diabetes in addition to the half a billion who already have diabetes. As shocking as those numbers are, that’s not even the whole picture.
If we start looking at the whole world’s population—8 billion people—there’s a small percentage who are optimal and a rather small percentage that have type 2 diabetes. So this would be the 540 million. Then we said there is another 1.6 billion that have pre-diabetes.
So right here, we’re talking about 2 billion people. But what about all the people in between here? What about the people who are what we might call pre-pre-diabetic?
They’re the ones who are not really healthy, not really optimal, who have started developing some metabolic problems and are moving in the wrong direction. That is probably somewhere around another 4 billion people.
The Scale of the Problem
So we could make a case for 6 billion people not being really metabolically healthy. Not all of them are going to become diabetic, but we have a staggering number of people who are not optimal and are at risk for becoming diabetic at some point in the next 10, 20, 30 years. On one hand, we have the human cost and suffering; on the other hand, we also have a financial cost.
Diabetes care in the United States costs about $400 billion, and around the world, they estimate it at about $1 trillion for diabetes care. Now, in my opinion, based on what we just talked about, total sick care in the United States is at $4.5 trillion. If diabetes is associated with and a causative factor in most degenerative diseases such as cardiovascular disease, stroke, dementia, and cancer, then the vast majority—probably as much as 70 to 80%—of all healthcare costs are indirectly related to this problem.
If it’s $4.5 trillion just in the United States, I don’t even want to think about what the number is around the world. The real question is, we know there is suffering, but is this going to kill us or ruin us financially first?
Understanding Pre-Diabetes and Diabetes
We need to really understand what pre-diabetes and diabetes are. In a nutshell, it is called insulin resistance. What that means is that whenever you eat carbohydrates, your blood sugar goes up, and your body releases insulin to bring that blood glucose down, helping the glucose move from the bloodstream into the cells.
When that system is working, everything is fine. We have a certain capacity to tolerate and process carbohydrates, but if we abuse that system, overwhelm it, and break the machine, we become carbohydrate intolerant. That is what pre-diabetes and type 2 diabetes are.
We measure this along a continuum. It is not something you have or don’t have; it is not something that turns on or off. It’s a gradient—different degrees of how much you have.
Measuring Insulin Resistance
It is typically measured in hemoglobin A1C, which is a 3-month average of your blood glucose levels. If you’re very insulin sensitive, if your body is really good at processing carbohydrates and handling them quickly and efficiently, then you’ll be at the green end of the spectrum and your A1C will be 5.3 or less. But if you’re not perfectly insulin sensitive, if you start moving along this spectrum and get up even a couple of points to 5.5, now we are starting to move along this continuum and are becoming part of the 4 billion people, some of whom will become diabetics.
If we keep this going, then at 5.7, it is called pre-diabetes, and at 6.5, it is called type 2 diabetes. Here is the problem: when we only measure blood glucose as A1C, we don’t see a whole lot of change. From 5.5 to 5.3, there are significant metabolic changes, yet these numbers, these bars, look almost identical.
The same thing with pre-diabetes: now we have a significant problem, yet we can barely tell. These numbers are so similar. Even at 6.5, there is barely a noticeable change.
The Limitations of Blood Glucose Measurement
This is part of the problem: we don’t recognize this soon enough because we are only measuring blood glucose. If you look it up online, you find that it’s resistance to the hormone insulin resulting in high blood sugar.
That is the only thing they’re concerned with: the blood sugar.
All treatment for pre-diabetes is aimed at lowering blood sugar, not looking at the two components of the problem. One component is blood sugar; the other component is how much insulin it takes to keep that blood sugar there. If we measure insulin, we see that a healthy insulin-sensitive person would have an insulin level of about three—a fasting insulin of about three.
By the time the glucose, the A1C, has changed even just a few percent, we might see that the insulin has increased fourfold. By the time we get to pre-diabetes, it might have increased sixfold. By the time we’re diabetic, it could be eight times higher—800% higher—even though the glucose has only changed a little bit.
The Importance of Measuring Insulin
This is the problem. Glucose is a controlled variable; it is very important for the body to keep it in a very narrow spectrum. When we measure this glucose, we can only see results and changes when the body really fails because the body is working so hard at keeping it here.
If we measure this, we can’t see changes until it has failed. But if we measure insulin, we see how hard the body is working. With insulin, we could catch significant changes very early.
It’s not going to be a perfectly linear graph for everyone, but this represents on average what we tend to see. Here’s the other problem: eventually, the body is cranking out so much insulin, the pancreas is working so hard that at some point, it can’t make more insulin; it’s maxed out, it plateaus.
The Progression of Insulin Resistance
What happens now is the body is working this hard but can’t work any harder, yet our insulin resistance is progressing. This is where we see these blood sugar numbers get completely out of control, where the blood glucose gets into the 200s and 300s, your A1C gets into the 10, 12, 14 range, and that’s because we are becoming more and more insulin resistant but not making changes. We’ve reached the point where we’ve maxed out on insulin production.
Unfortunately, up to this point, up to the 6.5 range, most people can do well with something like Metformin, which just helps the body become more insulin sensitive. I’m not a huge fan of Metformin, but I think it is relatively harmless compared to many other things. However, once we reach this point and conclude that the body has maxed out and can’t make more insulin, we need to inject more insulin to control this blood sugar.
Now, they are forcing the blood sugar down at the expense of becoming even more insulin resistant. We already have eight times more insulin than we should have, yet we keep adding more, injecting it as a medication. Now, we’re controlling blood sugar to some degree but making the whole metabolic problem much worse.
Potential Complications
What can also happen at this point is that the pancreas, working so hard, struggling with inflammation and chaos in the body, can suffer an autoimmune attack. Now, it can’t maintain its function; it starts to fail, and the production of insulin goes down further. In many cases, where this progresses, it’s called Diabetes Type 1.5.
This is where a type 2 diabetic is in the process of becoming a type 1 diabetic. At that point, they definitely will need some insulin. The next question is, what causes it?
Causes of Insulin Resistance
There are some obvious answers, but we’re going to go through a list of 10 different things quickly so you can start seeing some patterns. The most obvious one is excess carbohydrate intake. Not all carbohydrates are alike; sugar and fructose are by far the worst because fructose, like alcohol, can only be processed through the liver.
The potential to overwhelm the liver is very high whenever we eat sugar. Next is high glycemic foods—things that raise blood sugar very quickly. This is primarily processed foods, which tend to be high in white flour and sugar.
Then we have starchy foods, like potatoes and rice. These could be okay, depending on your metabolic health. Sugar is horrible for anybody, but starchy food is really only a problem if you have already developed significant insulin resistance.
The Role of Diet and Lifestyle
If you are metabolically healthy, eat whole food, and cut out the sugar and high glycemic foods, you can probably eat quite a bit of starchy food and never develop a problem. What’s happening now in China and India is they eat a lot of starchy foods; their culture is based on rice, beans, and lentils. But now, things that they have eaten for a long time and done well with are becoming a problem because they are adding processed foods and sugar.
Number two is fatty liver, which causes insulin resistance because a fatty liver interferes with regulation—it interferes with insulin’s ability to regulate blood sugar. The liver is kind of like the metabolic center; it sets the tone for many things that go on in the body. Excess sugar is the primary cause of a fatty liver.
It used to be excess alcohol, but these days, the vast majority of fatty liver is caused by fructose. I put fructose and sugar ahead of alcohol, even though alcohol is a little more destructive to the liver. We don’t consume as much of it.
The Impact of Sugar and Processed Foods
Alcohol has certain restrictions; you can’t drink too much before you fall down. But sugar has no such limitations, and we give it to babies, toddlers, infants, and young people. Also, excess food can cause a fatty liver.
It’s like we’re stuffing the body full of food, and that’s going to end up in the liver. However, it is very difficult to eat excess food unless you eat a lot of sugar and processed foods because those drive up insulin, cravings, hunger, and appetite.
Number three is chronic stress. When we have chronic stress, we get elevated cortisol levels. Cortisol’s primary purpose is to raise blood sugar. When blood sugar goes up, insulin goes up, and therefore, insulin resistance increases.
The Role of Stress and Inflammation
It also increases inflammation—chronic low-grade inflammation from chronic stress—and interferes with sleep because cortisol shuts down the sleep hormone melatonin. Cortisol and stress also increase cravings. The purpose of cortisol is to put you in a fight-or-flight state, looking for emergency fuel—blood glucose.
You can get some of that from the liver by increasing gluconeogenesis, making more glucose, but the fastest way is to eat something sugary. That’s why, when you’re stressed, it is much more difficult to resist vending machines that sell junk.
Number four is inflammation. This interferes with the insulin signaling pathways. Processed seed oils contribute to inflammation because they are highly oxidized. When I talk about processed seed oils, I’m talking about all the things sold as vegetable oils in the store: soybean oil, canola oil, corn oil, safflower oil, etc.
The Impact of Processed Oils and Foods
Even though those foods aren’t terrible to start with, by the time we turn them into oil, we expose them to high heat, high pressure, and lots of chemicals, causing a lot of oxidation and damage. When we say vegetable oils or plant oils, we’re not including olive oil, coconut oil, or avocado oil because those can be made into oil with much less processing, so they’re much closer to their natural state.
Other sources of inflammation include processed food, chronic stress, lack of exercise, dysbiosis (an imbalance in your gut flora), and environmental toxins. This whole list shows how a lot of these items keep appearing on multiple lists, how there’s a huge overlap, and how one thing affects another and vice versa.
Number five is microbiome signaling. This is so interesting; we’re just learning more about how important the microbiome is and how much of your behavior and signaling in your body, hunger, cravings, and mood depend on the balance and health of your microbiome. Experiments with mice and to some degree humans have shown this. For instance, they’ve done fecal transplants from a skinny mouse to a fat mouse, and the fat mouse starts losing weight without changing anything else—feeding them the exact same thing.
It changes the body’s metabolic behavior, leading to weight loss.
The Microbiome and Health
It can work the other way too. With humans, this has been observed mostly with an infection called Clostridium difficile (C. diff). One out of 30 people have this bacterium, but it’s not a problem until you develop an imbalance in your microbiome. As long as you have enough healthy bacteria to keep the bad ones down, pathogens like C. diff are suppressed.
However, if we lose the good bacteria, these opportunistic organisms start overgrowing, which can be very serious and life-threatening, killing a large percentage of people over 65 when they get this infection. Here’s the thing: the number one cause of a C. diff infection is that you have been on a course of antibiotics, which killed off some of the good bacteria, allowing the bad ones to grow.
The second most common reason is being in the hospital, where you’re more likely to be exposed to this bacterial strain. Even though this was caused by an antibiotic, the first course of action to treat this is often another antibiotic. Eventually, we run out of effective treatments and develop stronger, more antibiotic-resistant strains of C. diff. This is where the fecal transplant and the microbiome come in.
Fecal Transplants and Their Impact
They have found that taking a fecal transplant from a healthy person with a strong microbiome and implanting it in the person with a C. diff infection heals 80 to 90% of people very quickly, within a few days. This is turning out to be a powerful resource as an alternative to antibiotics when they don’t work. One interesting thing with humans is that some people who receive a fecal transplant will start gaining or losing weight after the transplant.
They get healed from C. diff but experience metabolic changes because they received the transplant from someone with a different metabolism. I know what you’re thinking: this could be the next super treatment for obesity, but that’s not the way to go. This will not create optimal health or balance unless you rebuild the entire environment.
The fecal transplant is great for emergency intervention instead of an antibiotic, but for lasting good health, you need to do it the right way and rebuild the entire environment and feed your gut. Some causes of a microbiome imbalance include antibiotics, environmental toxins, processed foods (which feed pathogenic bacteria), and artificial sweeteners (which kill off some good bacteria).
The Impact of Lifestyle on Insulin Resistance
Number six is a sedentary lifestyle, which can also cause insulin resistance. Exercise, the opposite of a sedentary lifestyle, has several benefits: it reduces obesity and insulin resistance (though diet is far more powerful for this), reduces inflammation and chronic stress, improves microbiome balance (benefiting good bacteria and managing bad ones), and improves sleep in many people.
Number seven is genetics. You can have a genetic predisposition to insulin resistance, but we must remember that it is just a predisposition; it doesn’t mean you have to get it. Your genetics can’t be changed, so focus on epigenetics—how you express your genes.
The Role of Genetics and Aging
You have a certain genetic makeup, but you can express your genes well or poorly, and this is all about lifestyle—everything we’re discussing in this video and most of my videos. They’re all about your genetic expression, your epigenetics.
Number eight is aging. We tend to get more insulin resistant as we age, and again, there’s nothing you can do about this. However, epigenetics come back into play—how you express aging. You can’t do anything about your chronological age, but your expression determines your biological age.
The Importance of Sleep and Medication Effects
Number nine is poor quality or insufficient quantity of sleep. They have found that after a night of poor sleep, you wake up with higher cortisol levels—in other words, you are more stressed already. This increases inflammation, blood sugar, insulin, and cravings. Anytime you sleep poorly, you have a higher tendency for cravings and eating more of what you shouldn’t.
Number ten is medications. Corticosteroids, which are synthetic forms of cortisol, are incredibly powerful in causing insulin resistance and weight gain.
Medications That Affect Insulin Resistance
Other medications include antipsychotics, beta-blockers (often given for blood pressure, which is associated with insulin resistance), thiazide diuretics (often given for high blood pressure, which is already associated with insulin resistance), statins, and hormonal contraceptives. Insulin itself can cause insulin resistance. If you’re already insulin resistant and your body can’t make more, the treatment becomes insulin, even though you already have too much.
Steps to Address Insulin Resistance
Here’s what you can do about this: measure your baseline. You want to measure insulin and get some blood work to know where you are. Measure some inflammatory and cardiovascular disease markers like an NMR (a detailed cholesterol panel that measures the size and number of LDL particles), lipoprotein (a genetic marker indicating a greater tendency to lay down plaque), CRP (C-reactive protein, an inflammatory marker), and homocysteine (an intermediate metabolite; if you have a genetic variant called MTHFR, you can’t convert homocysteine, which builds up and poses a heart disease risk).
If you’ve tried a lot of things and your body is still stubborn, not responding well, and you’ve done whole food, intermittent fasting, and different diets, you probably want to dig deeper into root causes. This is where analyzing your microbiome is crucial.
Advanced Testing Options
In my office, we now perform DNA sequencing of your complete microbiome to see exactly how different strains relate, the balance, which ones are pathogenic, and which good ones are missing or not enough. Another test to consider is measuring your omega-3 to omega-6 fatty acid ratios.
If this is within your means, I strongly recommend it because you can address it with much better specificity and create a detailed plan with a greater probability of success. I’ll put some links down below where you can contact us for more information.
Lifestyle Changes for Better Health
If this is not within your means, there are still a lot of things you can do, though it may not be as specific. Here’s what you want to do: exercise regularly, practice relaxation and stress management techniques like meditation and breathing exercises, and eat real food. Give up processed and packaged foods, sugar, and white flour. Processed foods are the number one cause of insulin resistance and poor health, so stop eating them.
Eat no more than one to three meals per day. Many people hear they’re supposed to eat three meals and three snacks, but that’s not how the body works. Your body knows how to make energy from the food you eat; you do not need to top it off with snacks and breaks everywhere.
Dietary Recommendations
If you’re very insulin resistant, one meal a day can increase your body’s ability to burn fat. If you’re maintaining or reversing a slight imbalance, two to three meals should be fine. Eat low to moderate carbohydrates. If you start eating real food and cut out processed and packaged foods, you’ve probably already cut your carbohydrate intake by half, maybe even down to a third, putting you in the low to moderate range.
If you’re diabetic or very insulin resistant, go low-carb or even ketogenic, meaning all your carbs will be leafy greens and non-starchy vegetables. Eat a moderate amount of quality protein, whether plant or animal protein. The body is made to eat animal protein, and as long as it’s good quality (grass-fed meat, wild-caught fish, pastured chicken), it shouldn’t be an issue.
Importance of Healthy Fats and Food Variety
The rest of your calories should come from natural fats. Do not be afraid of fats, but avoid commercial oils. There is nothing wrong with the fat in grass-fed meat, wild-caught fish, nuts, seeds, extra virgin olive oil, or mildly processed avocado oil. All of those are fine, but avoid commercial oils.
Constantly work on getting a wide variety of foods. Different foods have different nutrients and properties. The more variety, the more you’ll support your body. Some foods you eat for your human cells (to make energy and build tissue), but more and more, we learn you also need to feed your bacteria.
Get a variety of leafy greens and non-starchy vegetables. There are thousands of options, but most of us eat only a few types even if we eat a lot of vegetables. Expand your horizons, try new things, and your body will thank you for it.
Here is the YouTube video link: https://www.youtube.com/watch?v=HD26SI0tvx8