The Healthy Gut Podcast Episode 15

Dr Mona Morstein podcast

the healthy gut podcast episode 15

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sibo, diabetes and gut health

In this week’s episode of The Healthy Gut Podcast, Rebecca speaks with Dr Mona Morstein about diabetes, insulin resistance and the role gut health plays on these conditions. Dr Morstein is recognised as an expert on pre-diabetes and diabetes, and also specialises in gastroenterology and hormonal disorders. Rebecca and Dr Morstein get into the detail about the importance of insulin and how our bodies use it, and why we can be predisposed to diabetes when we have SIBO. They also chat about the impact that the microbiome has on our gut health and how to protect it.

in today’s episode

In Episode 15 of The Healthy Gut Podcast, we discuss:

✓ The differences between Type 1 and Type 2 diabetes

✓  Why people with SIBO can be at risk of developing diabetes

✓  Why insulin is so important and the role it plays in our overall health

✓  Why gaining weight can be a sign that you are insulin resistant

✓  The link between fatty liver, poor microbiome health and SIBO

✓  How to test and diagnose pre-diabetes and diabetes and what you should do about it

resources mentioned in today’s podcast

connect with dr mona morstein

Dr Morstein
Dr. Morstein, ND is a naturopathic physician with a general practice at Arizona Integrative Medical Solutions.  She has specialised in gastrointestinal disorders and hormonal conditions for over 25 years. In particular Dr. Morstein is an expert on diabetes.
She is the Founder and Executive Director of the Low Carb Diabetes Association, a non-profit designed to educate patient with diabetes, care-givers, medical practitioners, and the world-wide community about using comprehensive integrative care to help prevent and successfully treat all types of diabetes. The LCDA’s unique message and what she teaches patients is the importance of “The Eight Essentials™” of Comprehensive Diabetes Care: low carb whole foods diet, exercise, sleep, stress reduction, healing the gut and microbiome, environmental detoxification, supplementation and medication. Basic membership is free.  

Her book, Mastering Diabetes: The Comprehensive Approach to Successfully Treating Type 1 and Type 2 Diabetes will be published this spring.
Dr mona morstein

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about the host

Rebecca Coomes

rebecca coomes

Rebecca Coomes is an author, entrepreneur, passionate foodie and intrepid traveller. She transformed her health after a lifetime of chronic illness, and today guides others on their own path to wellness. She is the founder of The Healthy Gut, a platform where people can learn about gut health and how it is important for a healthy mind and body and coaches people on how to live well with SIBO. Rebecca is the author of the world’s first cookbooks for people treating Small Intestinal Bacterial Overgrowth (SIBO) and the host of the SIBO cooking show and The Healthy Gut podcast.

Read more about Rebecca >>

podcast transcript

Today’s guest Dr. Mona Morstein has a BS in food and nutrition and earned her ND and did her family residency at natural college of naturopathic medicine in Portland Oregon. After running a successful private practice for 13 years, she joined Southwest College of naturopathic medicine and was chair of nutrition, gastroenterology professor and supervising physician of students in the outpatient medical clinic for 11 years. Dr. Morstein is back in private practice and is recognized as an expert on pre-diabetes and diabetes. And also specializes in gastroenterology and hormonal disorders. She is part of the Arizona diabetes coalition and the Crohns and Colitis foundation of America’s Medical advisory board in Phoenix Arizona. Dr. Morstein is the founder and executive director of the non-profit low carb diabetes association and her book Mastering Diabetes from Victim to Victor is due for release very soon.

Dr. Mona Morstein it is an absolute pleasure to have you on the healthy gut podcast.

[1:15] MONA:  Thank you so much Rebecca. I am really delighted to be here.

REBECCA:  It was lovely to meet you in person at the SIBO symposium in June earlier this year. And we did have a bit of a chat about diabetes and gut health at that time and it’s just great to now be able to share more of our conversation with our listeners.

[1:38] MONA:  Yeah I am excited to be here and fill in any blanks that you asked about.

REBECCA: Yeah wonderful. So I always ask this question to start with. And I would love to start with your story. How you ended up becoming such a well versed person who specializes in gastroenterology and diabetes.

[2:04] MONA:  Well after I did my  medical school training and residency in Portland, Oregon at National College, I moved out to Montana. And that’s where I had my private practice for 13 years and I saw a lot of  ranchers and farmers who had just water, septic tanks and cattle. And they wound up with a lot of parasites getting water that had been polluted by the urine and defecation of their cattle and they had a lot of food allergies and so I kind of was just brought into treating a lot of gastrointestinal conditions during my years seeing the farmers and ranchers there. And I really enjoyed it. And it really seems to be helpful to them. I also got very interested in diabetes during those years because I did not know much about it and when people started coming to me with diabetes I realized if I am going to be a responsible physician I really had to learn quite a bit about this condition.

And I actually flew back east and mentored with Dr. Richard Bernstein who has written a very famous book, Dr. Bernstein’s Diabetes Solution. I have worked with him and stayed friends with him. So those were kind of the two tangents that developed equally during my time in Montana when I got to Southwest College. They needed someone to teach neurology or gastroneurology and I felt very comfortable of then becoming the gastroenterology professor given my experience with the gut and how much I love treating it.  And I also of course continued my focus on working with pre-diabetic and diabetic patients.

[4:18] REBECCA: we are so lucky that you did good on that road because you  definitely brought a wealth of knowledge to people. I am particularly interested in diabetes. I have friends who have type 1 diabetes. But I am also fascinated by type 2 diabetes. Could you tell the listeners a little bit about the difference between type 1 and type 2 diabetes?

[4:$3] MONA:  Sure. Type 1 diabetes is classified as an autoimmune disease which means the body’s own immune system becomes imbalanced and starts attacking some aspect of the pancreatic beta cell and/or insulin itself. And as a result of that damage to the pancreatic beta cell it no longer really produces insulin and these people in general need to be injecting insulin. We have the childhood, the pediatric type of type 1 which actually tends to go into actually the twenties even though in medicine pediatrics and 18 years old, pediatric type 1 thus get into the twenties as well. And then we have what we call LAD or late autoimmune diabetes of the adult which is a slower onset type 1 diabetes that tends in general to start happening from age 35 and older.

Type 2 diabetes generally tends to happen to people who are overweight particularly with abdominal adiposity or that really means just a lot of fat in their midsection that produces insulin resistance. And that means that really even though they make insulin their body cells just don’t pay attention to it and don’t create the signals that tells them to take blood sugar from the serum into the cells. So they don’t do it. And so the blood sugar stays high and the serum when it reaches a certain point, a certain number then it is type 2 diabetes.

[6:44] REBECCA: And why is insulin so important? What is the role of insulin in our systems?

MONA:  That is a god question. Insulin is actually called the fat building hormone. Insulin drives storage of energy. And so insulin directs our cells to take the glucose in and if it’s in the muscles cells it’s good. We can burn it. But if it’s in the fat cells and in the liver it is designed to turn to fat and be stored as energy. And insulin actually reduces our metabolic capacity to burn our fat away. It’s really a storage hormone that says take your food, turn it into glucose, put it into your cells as fat and just keep it there, store it.

[7:35] REBECCA: and I would imagine that insulin has had a great place in human evolution at times of famine were we needed to store everything that we could so that we didn’t starve to death.

[7:47] MONA:  Well you know that it does… in times of famine or disease or barbarians coming in  whatever, obviously generally, the people that innately could store a bit more weight would survive versus say this skinny ectomores. So yes it does play a part in building up some extra storage of very high quality energy for those times when energy isn’t available for us to eat at amounts we need each day.

[8:30] REBECCA: I have always laughed that i would be one of those people that could survive the longest famine because my body has been one of those types of bodies that I just need to look at something that is highly calorific. Then I will put on pounds on the scales within minutes. So now that I have been going through this incredible journey of my own discovery toward health, I realized that perhaps it’s all around my insulin that is causing this problems not so much what I was eating. So  I would to sort of talk about why are we seeing.. is diabetes too on the increase. How does one now if they are suffering it or they are at risk of having it?

[9:11] MONA:  well diabetes is certainly a worldwide epidemic. 300 million people right now worldwide have diabetes and we are talking type 2 and it is still in a very significant elevating crisis. Yeah, many ideological factors involved in developing diabetes from obviously the simple of overeating and particularly overeating certain foods such as refined sugars and things like soda pop just completely useless things on the planet. And of course refined sugar in pastries and white bread and so forth. But also just overeating in general. Eating many more calories than a person really needs. Not getting exercise, just staying under your computer all day and not getting out and getting exercise.

Also, we have environmental toxins are a huge burden on the body and produce both insulin resistance and autoimmune disease. We have genetics of course also involve type 2 has a very genetic risk. We have  nutrient deficiency because of the crappy diet people are eating. They lose nutrients that help the body be better with insulin sensitivity. We also have inflammation. The diet… if it is very inflamed that can produce insulin resistance. We have the micro biome which I am sure you are interested to hear about. We have other hormonal imbalances that can play or exacerbate all of these other factors involved. So there are a number of factors now probably all of them may not be the main factor in all people but these are very common problems that we see in all really western societies.

[11:44] REBECCA: It is and I just lament over the fact that we have this enormous access to highly process, highly sugary foods at our disposal. Wherever we turn we can get these franken foods as I call them. And they are killing us. They are really killing the human population. We think we are doing so much better now that we have all this abundance of food but it’s not food and our poor bodies just are not coping with it.

[12:16] MONA:  I cannot disagree with anything you just said. I think it is right on target.

[12:20] REBECCA: so how can someone get a sense of whether they might be at risk of developing type 2 diabetes?

[12:29] MONA:  Well our fasting blood sugar now I will have to do a little math because the American Number System might be different Than yours. But generally a person should wake with a blood sugar of around 80-85. I think that is around 5 if you are on the Canadian type of scale. And if you are an American, if you are at above from 99, if you are 100, 125 I can do the math. To do the math you divide by 18 and then you get…I know the Canadian system. It’s probably your system as well. That’s pre-diabetes is 100 to 125 and hen above 125 is diabetes. There is also looking at the A1C but personally do not diagnose diabetes from a hemoglobin A1C. I prefer to use what the endocrinologist like which is to really make sure we have the blood sugars matching a diabetes diagnosis. Those are all fasting numbers. If after you eat your blood sugar is above 200, it will be 200/18. That is also considered a diabetic number.

[14:08] REBECCA: and are there symptoms that people can commonly feel without having to go and do a blood test that might be an indicator that, “Hey, things aren’t going so great.”

[14:17] MONA:  Well I think some of the main symptoms are you are overweight or even obese. You have low energy, you might have hypertension. In general unless the type 2 is really amazingly and dangerously out of control most type 2 patients are not going to be losing weight and urinating a lot like type 1 pediatric kids are. Although you can see it in some people that have been very bad diabetics undiagnosed for some time. But they might develop some thrush. There might be some vaginal yeast or in men what we call jock itch, genital yeast, toe nail fungus, wounds don’t heal well. If you get sick, you are not bouncing back. You are sicker for longer because high blood sugar’s really interfere significantly with the functioning of the immune system. So there would be these growing subtle and then more pertinent signs and symptoms in a person who has diabetes and isn’t yet aware of it.

[15:37] REBECCA: and if someone suspects that they might be at risk of developing type 2 diabetes or they might think, “Gosh I think I might even have it, what is your advice in terms of what they should do next?

[15:48] MONA:  Go right to their doctor and get some good blood work.

REBECCA: Sure. And is it really just around looking at the glucose levels in the blood that is the best diagnosis or you mentioned another type of test as well. Are they really the two common tests?

[16:07] MONA:  Glucose and A1C is the monitoring tool of diabetes. It measure how much of a red blood cell is covered in glucose. And it is our tool that we do every 3 months to see really how well has the patient been doing. But I mean there are a lot of other tests that we will want to do. There are tests to check how well people process sugar after meals, how’s there kidneys doing. It’s a urine test. We would want to test inflammation markers, how inflamed are they, how clotty are they since the number one reason diabetic patients die is from cardiovascular disease, heart attacks and strokes. We would wanna check  their vitamin D. you know we’ll want to do we want to check of course their lipids, their cholesterol and triglycerides, their liver functioning. Ferritin is our best early indication for fatty liver. So you’ll need to get a very complete blood panel and I hope it’s from a physician that is a little more progressive and has maybe a little more integrative mindset that knows to do more comprehensive analysis than just standard physicians might do.

[17:38] REBECCA: Definitely. And as your listing off some of those things that you want to look for in a patient, I could not help but think there is such great similarity….i don’t know the right word for this. But similarity between the things that are you are to look for when you’ve got disordered digestion. So if you are suffering something like irritable bowel syndrome or small intestinal bacterial overgrowth, what is the connection between a condition like diabetes and poor gut health?

[18:07] MONA:  well it’s interesting but we definitely know that micro biome changes and probably your listeners already understand the microbiome is the collection of bacteria, viruses and fungi in the gut, it’s supposed to look a certain way but there are all different kind of ways it can get imbalanced. We do know so that changes in the micro biome can produce more systemic insulin resistance. We certainly know changes in the micro biome seem to definitely be associated also with systemic autoimmunity from what is called molecular mimicry. But if we get certain bacteria in our colon and our immune system is attacking it and the protein on that bacteria looks similar to a protein on an organ in our body then we can start attacking that. we also know for example there is a condition that is oftentimes associated with type 2 diabetes in obese patients called fatty liver which is when the liver which is supposed to be 5% fat of content, it goes over 10% or even more. That’s when we call it fatty liver. And that is a very very bad thing for a body to have. And we know that SIBO causing leaky gut actually can lead to the development of fatty liver and actually be promoting the pro-inflammatory nature of it.

Leaky gut is also associated with autoimmunity. We know that a low carb diet, when you are not eating grains can actually be very very very unhealthy to the human micro biome because those particular fibers feed the beneficial bacteria. Those bacteria make short chain fatty acids and short chain fatty acids are the food for the colon cells. So we start seeing dysbiotic changes. And of course removing grains from both a SIBO patient and also type 2 diabetes very similar. But this is why it is so important when I put a type 2 diabetic on obviously a low carb diet. I put them on a lot of fiber powder. And this is also why I think for SIBO patients it is actually pretty important as soon as possible to get them on flax seeds or chia seeds and maybe start introducing quinoa or millet, non-grain type “grainy fibers.” They try to be keeping the micro biome in the colon healthy while we are dealing with the small intestine bacterial overgrowth and we are removing the grains.

[21:39] REBECCA: That is really interesting and I am thinking of the times that I have gone strictly grain free to try and heal my gut and I hear form so many people around the world who have been on these incredibly restricted diets for years for some of them and I just think, “Gosh what is it doing to their micro biome when they are literally eating five foods? They are left with five foods.

[22:06] MONA:  it’s true. You know it really is a problem for the gut. It’s a problem for digestive enzymes. You know digestive enzymes are what we call inducible in that the more variety of food you eat, the more they are gonna be making all of these different enzymes. And if you just don’t eat this or that food and especially say a macronutrient, the pancreas is gonna say, “You know what, forget it. You are not eating the food. I don’t want to waste any energy making this enzyme and then we start seeing people starting to put back in and it they can start having maldigestion sometimes not  because they really can’t…. because of the food but because this restriction of their diet intake has really inhibited the variety of digestive enzyme production.

[23:06] REBECCA: And I know with myself that as I came off with my SIBO diet and I was only strictly on it for 6 months, I just rejoiced in being able to increase my food again and I now eat… I really work hard every week to make sure I am getting a really broad variety if fruits and vegetables and different types of protein and other fibrous foods so that I can help replenish this little micro biome of mine that is living in my gut that is desperately trying to get well again.

[23:40] MONA:  that is obviously good but I also think remember we have this mind-body body-mind connection and the more I am sure you are enjoying your food and being happy, it actually makes a healthier biome and feeling depressed and restricted. And that goes from the gut, the gut also makes the mood… well it doesn’t make the mood but it has inculcating factors on just how we enjoy life. And you know when we are working with patients with real physical problems and we do have to do restrictive diets, just mean helping the micro biome and also just trying to do as comprehensive a program we can so they can start adding foods back in as expediently as possibly. It’s just a good mind body connection.

[24:47] REBECCA: It is totally and I remember back when I first got my SIBO diagnosis and I felt pretty angry at the entire world for putting me on this restricted diet and I felt unfair that it had happened to me and about 4 week sinto my treatment I really have a good stare and talking to myself. And I really checked my mindset because I realized I had become incredibly negative every time I sat down to eat. And I flipped it on my head and I started looking at my food and kind of thanking myself and the universe for giving it to me and for giving me the nourishing qualities that i had to eat and the fact that I had this beautiful healthy gorgeous food to consume.

And within days of changing that, my recovery felt like it sped up and now I really worked hard with myself and some of my clients that I work with who have SIBO themselves around that mindset piece. It is so important that we feel positive I believe in the food that we are consuming so that the body is getting those signals, “Hey guys this is great food. It’s gonna do some good work for us. Let’s all be happy that it is coming on board.”

[25:48] MONA:  Yeah I totally agree with that and I think it is very important and we have to, all of us individually, but also with our patients or clients, we can’t ever forget to work on that mental, emotional level. You know it is so easy to sit on a desk and say, “Hey stop easy this and this and this.” And you know it can be very devastating to people to have these restrictions and I think it is important to really work hard to show what they can and also to try to  put… you know if you break a leg, I mean it is not very happy but you have to be in a cast for two months because your body has to heal.

Telling patients that your gut is kind of broken and we kind of put a cast on it and have it heal. And just to get the mindset in a more positive or accepting way, I agree. I think that massively increases the healing and people don’t have to be in this diet for years and years and years.

[26:58] REBECCA:  No. and nor should they I believe or do they want to be. It’s not fun being in such a restricted state were you feel like you are missing out and that really helps to hinder the process I think psychologically. You know having that eye on the ball in terms of I’ve got a goal that I am working towards and I love that analogy of your gut. It’s like a broken leg, it just needs some time to heal. Let’s put a cast around it and make it the support.

Can we talk a little bit about the…just if there is a parallel between SIBO and diabetes or gut disorders and diabetes? Is there a connection?

[27:42] MONA:  well you know of course diabetes…we do have what I mentioned earlier fatty liver as a gut problem.  We do have a very unhappy, unhealthy and inflamed liver. Now in terms of diabetes, there are obviously we do know antibiotic use of course which I can be a main predicating factor SIBO patients. And also just in diabetes in terms of just changing the micro biome and making people more insulin resistance. You know one of the reasons, the main reasons  they got into giving cattle antibiotics because our agro industry in the united States is really just an awful awfully unhealthy whole you know corporation and their methodology. When they give antibiotics to cattle, the cattle become like insulin resistance, they gain weight, they gain fat, they marble. And this is why they like to give antibiotics to cattle because they got bigger and fatter. And here we have Americans for any little thing including virus conditions getting antibiotics that can ruin their micro biome. And I didn’t mean antibiotics cause SIBO.

Obviously, it’s a food poisoning. I think I might have misspoken there. Food poisoning as far as I know is not associated with diabetes. I think it is both just a general discomfort and disarray in the gut that leads to it and the similarities of foods particularly grains that have to be removed from both of them. Diabetics if they are very uncontrolled for a long time even thought their disease is centered in the beta cell which is part of the endocrine system, if they are uncontrolled for long there can be exocrine or digestive enzyme damage just like we can start seeing some with the slow migrating motor complex some slow digestion and also the loss of the disaccharide in the small intestine. So they can both have some digestive enzyme disarray as well.

[30:33] REBECCA: and you can just see how they can go hand in hand with each other. So one might not necessarily cause the other but they can work in parallel with each other from what that sounds like.

[30:46] Yeah I think we certainly know that SIBO is an ideological risk factor for developing that fatty liver specifically. Since most people with fatty liver have diabetes or at least are obese and are at a huge risk factor for developing it, I think that is a very close connection.

[31:13] REBECCA: So could a sign be for someone if they struggle to lose weight that this could be an indicator that their insulin resistance are on the road to type 2 diabetes even if they are eating a healthy diet or exercising and trying to do all the right things to lose weight?

[31:31] MONA:  Well they had to get obese. They probably could just have eaten really well and exercised to become obese to begin with. So, I mean just come back along those lines, insulin resistance is a frustrating medical condition because since so much insulin… when you are insulin resistant your body actually produces more insulin to hammer the cells into accepting the glucose. So when we are measuring insulin in pre-diabetic or diabetic patients take two. It’s not uncommon that we actually see higher levels of the insulin being produced because if a tiny bit of insulin isn’t working to get that glucose out of the serum, that pancreas is gonna be screaming insulin. There is a good test I do with pre-diabetics and I have them fast and I measure their glucose and insulin. Then I have them eat this meal at McDonalds which is one pancake with one syrup, one hash brown and water. And that’s saturated fat a and a hundred grams of refined sugar. And if you are gonna be insulin resistant, that meal is gonna do it.

And then I have them measure their glucose and insulin and hour and a half after the meal is over. And sometimes you can see that people secreted so much insulin as a result of that meal. Well let me put that in numbers. A non-diabetic whose generally has a normal, what we would call, leanish normal body type produces between 30 and 40 units of insulin a day to deal with all they eat. But I have seen patients on this test, they have produced… they secreted 240 units of insulin just to try and deal with that meal. Which means they produced a week’s worth of insulin just to get that blood sugar down because their body is so resistant to it. And often times their blood sugar numbers are still super high. I mean this how bad it can get in humans when they are really insulin resistant.

[34:21] REBECCA: Wow, they are really incredible numbers. And I am guessing that this takes some time to develop and am right in thinking that you don’t just wake up one day and suddenly become insulin resistant, that it takes time and poor diet to get you there.

[34:38] MONA:  yeah it takes time and poor diet and lack of exercise and maybe another thing is maybe you have obstructive sleep apnea. Maybe genetically you don’t detoxify the pesticides and herbicides. All of the chemicals and the heavy metals that are just rampant in the environment worldwide today. And so slowly you start gaining a little weight and you know your numbers start inching up year by year. And of course there is a kind of a negative feedback that if you keep eating this and keep eating toxins and you are not maybe sleeping well and you are not exercising, you know you do have less energy and maybe you are depressed and you do some emotional eating and so forth. It can just kind of snowball and over the years. Yes absolutely, it’s not some Tuesday to Wednesday.

[35:44] REBECCA: Something I hear from people a bit and that i have experienced myself was after years and years of disordered digestion and I suspect that I had SIBO from a very young age just undiagnosed that I have struggled to lose weight. I have always been that person that will put weight on very quickly but I won’t take it off easily. And to my surprise and sadness at the end of my SIBO treatment after 6 months of having the cleanest diet and such healthy food, I had barely lost any weight. I only lost 3 kilos. So what is that about 7 pounds which wasn’t very much given that I had stripped out any kind of what I consider naughty food. And I also noticed when I started to reintroduce carbohydrates and I attempted to eat sugar with honey and even if it was refined sugar that I felt it really quickly in my blood sugar I felt like I could feel a spike. I could feel kind of shaky and quite an intensity to that and I have spoken to other people who also have similar experiences. So that leave some wondering if that is a sign that you might be suffering from insulin resistance if you can actually feel the impact of sugar on your blood stream.

[37:08] MONA:  Well you know you are either reactive hypoglycemic or maybe you are having some hyperglycemic symptoms. that test would be great for you, the one I have mentioned. The before and after glucose and insulin with the meal challenge. That would give us a really good amount of information to learn how your body is processing foods in terms of blood sugar.

[37:45] REBECCA: What a  horror for me to walk back into a McDonalds after years

MONA:  The standard conventional test is just a drink, a bottle of glucose, straight glucose. And that’s an option obviously. But I like using food because that’s what the people are eating. They are eating this food and I like to see it what the effect is on the person. But if you are very weary then even the glucola could work for you.

[38:23] REBECCA: Yeah. Definitely. So what can people do, if they are listening to this podcast and I think my gosh that just sounds like me. It sounds like my story. How do you then work with your patients in terms of getting them back into better health?

[38:41] MONA:  Well, the way I set things up, my first office with a patient is an hour and a half. And that visit is just a very comprehensive intake and a physical exam. And then in that interview, I decide what test, like if it is a gut person, there is a three main triad test that I do. Obviously one is a SIBO breath. Another is a food sensitivity test. And then there is also a stool analysis to see what is going on with the micro biome more specific to the colon. Of course we know very clearly that a stool analysis has zero information about the small intestine. It’s only about the colon. And then of course I will send people home with a diet diary. I make all my patients record their diet for a week with symptoms and how their bowel movements are. And I don’t know maybe we will want to do blood or anything. But if it is a diabetic, I send them home with a diet and a glucose graph where they record their blood sugar for a week. I probably will want to do blood work with them.

And then in the second treatment visit when I have all the tests back, that is a whole hour and it is starting the whole… it sets up the entire treatment whether it is SIBO and the test was positive or whether it’s food sensitivities or a gut micro biome problem in the colon, or the diabetics going over the diet and exercise and medication. If they are on it, reducing. If they are on insulin for example we’ve gotta massively reduce it when they go on a low carb diet. I go over supplementation.

And then we have follow ups after that. But that’s how I set my clinic up. It seems to work really really well.

[40:49] REBECCA: And who are the types of people that commonly see coming in to your clinic?

MONA:  Well you know my clinic is full family practice. So I see kids and adult women and men. So since I am pretty good with diabetes, I do see a lot of type 1 diabetic patients. I do 2 day seminars on how to use insulin. So I feel very confident using insulin with all patients in all situations. But otherwise, there are a lot of men with SIBO, there are a lot of women with SIBO. So I see everybody along those lines.

[41:38] REBECCA: yeah sure. And in terms of the use of insulin, do you like using insulin for type 2 diabetes or do you try to keep that as a last resort?

MONA:  well of course insulin for type 2 diabetes is a terrible idea.  The problem with medications in type 2 diabetes, I don’t mind metformin. Nobody minds metformin, Glucophage. You know that helps reduce a little insulin resistance in the liver. And it doesn’t make people gain weight which is a big problem with many of the medications for type 2 diabetes. The problem is that no medication right now in clinical use actually treats the condition which is insulin resistance. We had some drugs called TZDs – Actos and Avandia and they did decrease insulin resistance but their side effects were so awful that they are just not in clinical use anymore.

So none of the drugs that we have now for type 2 diabetes aside from Metformin which is more specific to the liver and doesn’t really work with the fat cells or so forth, they don’t really treat the condition. And of course, we’ll start with oral medications if we need to. And then insulin is generally last resort even though there are studies showing using insulin right away in very poorly controlled initial type 2 patients can really get them under control very quickly. Nobody wants to do that. Doctors don’t want to do that. Patients don’t want to do that. And frankly if I put them in a low carb diet and they start going for some walks and we test them for sleep apnea and maybe get them on a CPAP machine if they need it. and we are doing stress relaxation and I am putting  them on in supplementation. And maybe I am helping their liver and getting them sweating so they can start detoxifying.

You have no idea. I mean you do have an idea but often times people don’t need any medications at all. This is the condition. We are going to get it under control just through comprehensive integrative medicine. And that’s why I form the low carb diabetes association at low carb diabetes.org. Although don’t check the website out yet. We hope to launch it in about three weeks. But this is because using comprehensive integrative medicine not just the diet but the diet and detoxification and supplementation and sleep and stress and healing the gut micro biome and then you know medications. These all have to be worked together to really get complete well reversal of type 2 diabetes.

[44:48] REBECCA: I am currently doing Doctor Michael Mosley’s 8 week blood sugar diet which is very much what you are talking about. So it’s a severe reduction of sugars and carbohydrates from the diet. And also restricting calories. So you do 800 calories a day for the 8 weeks. And I am doing it as a self-experiment really whether something like that supports my body to try and finally release some of this weight now that I have been actively healing my gut and getting rid of my SIBO. But it has been a really interesting process for me. I feel amazing on it and obviously I am eating very very healthy food, lean protein and lots of vegetables. But I wasn’t anticipating just how goo di would feel psychologically. And also that it’s made me realize that I don’t need to eat so much. I can feel really full and satisfied on a day with much less calories that I have eaten in the past. So it’s been an interesting journey. I am only at week 3. So I have still got 5 weeks to go. But it has helped me to lose some fat which is important and it will be interesting at the end of it to see what my blood glucose levels are at the end when I go back and retest.

[46:11] MONA:  I am glad that is working for you but I do have two caveats regarding that. One is when we eat less than a thousand calories a day you know slowly that’s going to decrease our metabolism to the extent that when we are off of that and go back to say 1400 normal amounts of calories we can have that sudden weight return. We also want to be aware and especially for people like you Rebecca with this, “I look at food and gain weight.” You know it would be interesting to insure…

Let me start again. Environmental toxins, the chemical ones tend to store in our fat cells and when we are losing fat, we are going to be releasing these toxins into our body and this is a scientific fact. I mean they have done studies where they measure serum levels of chemicals and then have people lose weight and the serum level of chemicals is significantly elevated. And so if the weight loss is not tied to a pretty serious program of detoxification, I think this was one reason some people start to lose weight and then they reach that plateau. Why can’t I lose more but even doing the same diet and so forth? And this is because all of these chemicals you have released into your system are now actually starting to make you more insulin resistant in shutting down your weight loss.

And so weight loss protocols are fantastic and you feeling great is fantastic. But I hope you are really working on a program supporting your liver with detox making sure you are sweating ideally every day and ensuring that you are urinating enough and having good bowel movements and so forth that you are just on a good protocol along those lines.

[48:27] REBECCA: I am and I am working with my  naturopath on this. I am not doing it alone and we are monitoring it closely and it’s something that we both agreed that I don’t necessarily need to continue to the full 8 weeks and if there are any signs that my body is not coping with it then we will stop it. So I am being very measured and careful in my approach to this. But I am definitely working on every day I get out and exercise. Not only does it make me feel good but you know for the sweating function that you have mentioned and I am drinking plenty of fluids as well to make sure that everything is well hydrated and flowing.

You have talked about people recording their blood glucose levels, how would someone do that? Is it the simple test that you can pick up from a pharmacy or how do you it? Is it possible to do it at home?

[49:25] MONA:  Yeah I mean, it just requires… Yes. A pharmacy sells glucose readers and you need then a glucose test strips and lancets, the little needles and by using that machine. And it all comes together. A glucose reader comes with a lancet, a few test strips but you can buy more at a pharmacy. And this is then how you can measure your blood sugars. Generally if you are type 2 or thinking you are insulin resistant, then we measure fasting. And then 1 and half hours after meals.

[50:13] REBECCA: Ok great. I would like to just, before we finish, just touch on your new book, Mastering Diabetes from Victim to Victor. Are you able to tell us a little bit about what the book is about?

[50:26] MONA:  yeah. Thank you. It’s at the publishers now. Well it’s a very long book teaching both people who have diabetes and their caregivers and medical practitioners pretty much everything about diabetes from what the different types are and the different labs and how to analyze it and ideological factors and how conventional medicine treats it. I go over all the medications that are available, the pros and the cons of them. I go over the different diets that are used and how they can be played out. I go over all the supplements, the main supplements that are used. I talk about what we call the…I talk about sleep and stress and the micro biome and detoxification and I talk about the challenges, how do you treat highs and lows. And then I go over pediatric and gestational. And then I also go over the complications of diabetes.

And why they occur, how conventional care treats them and what is the best ways to prevent and treat them with comprehensive integrative medicine. So pretty comprehensive book I hope.

[51:55] REBECCA: That sounds so interesting. And if somebody wants to grab a copy of the book or connect with you as a result of listening to this podcast, where is the best place for them to find you?

[52:10] MONA:  Well my website for my clinic is at AZIMSolutions.com which stands for Arizona Integrative Medical Solutions. AZIM Solutions.com. That is my clinic website and hopefully  maybe in three weeks or so, three weeks or a month no more to check out lowcarbdiabetes.org, the nonprofit that I have to educate people about comprehensive integrated care of diabetes. And I also would say another website Medicinetalkpro.com, I have done a 5 week webinar series on SIBO. And then I did a second one, another 5 week one on gastrointestinal reflux disorder, on gall bladder, everything about the gall bladder, on digestive enzymes and pancreatic insufficiency, on inflammatory bowel disease.  So you go to that website and go to CE which stands for continuing ed. You can see under the archive webinars if anybody is interested in listening to those.

[53:46] REBECCA: that sounds great and such wonderful resources. I will make sure that I have got the links for all of them in the show notes for anyone listening. Dr. Mona Morstein, it has been an absolute pleasure to have you on the Healthy Gut Podcast and I have personally learned so much about type 2 diabetes and I am sure my listeners have. So thank you so much for joining us today on the show

MONA:  thank you Rebecca it has been great. You are an excellent interview and I have really enjoyed myself. Thank you.

REBECCA: Wonderful. Thanks!

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