Diet and Diabetes: Carbohydrate Consensus vs. Controversy | Christopher Gardner, Ph.D. | 13.04.2022

This webinar recording is from April 13, 2022, with Christopher Gardner, Ph.D. This webinar is part of the webinar series "A Taste of Healthcare" hosted by the Physicians Association for Nutrition which took place in spring 2022.
About the event
Diabetes cases and their respective health complications have been on the rise globally for decades. Food plays a huge role in the prevention and treatment of diabetes, and dietary interventions should be part of every diabetes therapy. At the same time, the role of carbohydrates in the development and treatment of the disease remains controversial, leading to uncertainty among health professionals and patients.
Professor Gardner from Stanford University shares his insights from landmark trials he conducted on these topics. He will cover relevant human intervention trials with an engaging blend of science and humour. Thereby, the emphasis is on consensus and controversy in the area of dietary carbohydrates.
About the speaker
Christopher Gardner holds a PhD in Nutrition Science from UC Berkeley and is the Rehnborg Farquhar Professor of Medicine at Stanford. He is the incoming chair of the American Heart Association Nutrition Committee. For over 30 years his research has examined what to eat and what to avoid for optimal health. This includes more than 20 nutrition intervention trials conducted with over 2,000 participants. Relevant to this presentation are the two landmark Low-Fat vs. Low Carb weight loss diet trials: A TO Z (JAMA 2007) and DIETFITS (JAMA 2018). A recently completed trial contrasted a Ketogenic Diet to a Mediterranean Diet among adults with type 2 diabetes or prediabetes. The outcomes in these trials are typically cardiometabolic factors (e.g., lipids, insulin, glucose, blood pressure, inflammation/immune function, body composition).
About the series
“A Taste of Healthcare” webinar series covered the links between nutrition and some of our most pressing global health threats. We were extremely happy to welcome a selection of leading international researchers in their fields to share their knowledge. The 5-part series took place in March and April 2022 and provided medical students and healthcare professionals with the knowledge, motivation, and tools to implement optimal nutrition in clinical practice and healthcare systems.
Did you find this talk interesting? 50+ high-quality recordings with expert speakers on all kinds of nutrition-related topics are available for PAN Members on our website here: pan-int.org/webinar-recordings/
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Disclaimer: Any views, thoughts, and opinions expressed by guest speakers in our webinar recordings are solely that of the speaker and do not necessarily reflect the views, opinions, policies, or position of the Physicians Association for Nutrition.
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Copyright: © 2022, PAN International. All rights reserved. This presentation is copyright of PAN International and any unauthorised use is prohibited. Written consent must be requested via [e-mail]. All sources referenced in this educational presentation are the copyright of the original creators (please refer to the information shown on the presentation slides).

[@sectionalsofa]

I LOVE Dr Gardner's charts. They're SO clear. I wish I could have all of them at my fingertips.

[@k.h.6991]

Practical summary: - everybody needs to stop eating added sugar and refined grains (aka anything made of white wheat flour), that is: most of our packaged foods, also don't go to McDonalds. - most people eat too few fruit and vegetables. Adding plant foods will feed not only you, but also your gut microbiome. This is health promoting in all kinds of ways. - meat should be a small part of your daily calories: too much protein gets converted into carbs (and potentially fat). If you do eat meat, eat the non-processed stuff (no added salt etc) - Gardner's food pyramid has beans as a foundational food: something to eat daily. (from me:) This is, as the title suggests, aimed mostly at diabetes. For heart disease, the saturated fat in meats are a problem. One would also stress the salt in (ultra-) processed foods as an issue.

[@annam2483]

thanks for giving us the information for free, very useful!

[@pan_international]

You're very welcome Anna, we're glad you appreciate it

[@chewiewins]

Excellent lecture, thank you. As Borderline diabetic now normal after Keto, finding high non-HDL and LDL means I need switch to more Mediterranean. You study shared confirms it for me.

[@pan_international]

Thanks, we're glad you like the lecture and that you found the information useful. All the best for finding the optimal diet that works for you and your health.

[@Herkimerdiamond]

You are jeito now and sick tomorrow. In long term you may have a stroke, diabetes, and many diseases. It’s better if you search for Cyrus Khambata and Robby Barbaro at mastering diabetes. If you want to live. That’s my advice.

[@terry2346]

@@Herkimerdiamond Jeito??? Are you saying that high carb (50-60% or so) Is okay? That would lead to T2, stroke, etc but not sure if that is what you are saying??

[@Herkimerdiamond]

@@terry2346 dear Terry, I was saying “you are good now but sick tomorrow.” Please, search for Cyrus Khambata and Robby Barbaro, they have a channel on KZbin called MASTERING DIABETES, and they explain everything you need to know about the diet people with type 1 and 2 should eat. What you possibly don’t know yet is that the strokes and cardiovascular disease and all diseases don’t come from whole carbohydrates but only from fat. The keto diet works in a few weeks but it will create insulin resistance, that’s why there are people with type 2 who still have a pancreas creating insulin but the diet they eat full of fat don’t let the insulin play their part in the metabolism of glucose. I am diabetic type 1 for 20 years and I can tell that these two guys, Cyrus and Robby, have saved my life. Please if you want to live longer, with no stroke no nothing, change your diet to whole food plant based diet the fastest you can. You guys eating keto and paleo are killing yourself and you don’t know… I am saying this to you to save your life. Check These two guys. With all my love…Joana

[@gregorygreene1940]

I like the balanced approach at the end. I'm T2 and definitely have a lower carb diet but I don't go to extremes. The most important thing for me is losing weight and that is dependent on being in a calorie deficit. Doesn't matter what I eat if I'm not in a deficit I'm not losing weight. CICO

[@pan_international]

Thanks for sharing your experience. Finding what works is an individual journey and every step made towards a balanced diet can be beneficial for personal health. Good luck!

[@davidb3070]

I live in the uk and i think carbs are ok as a balanced diet with plenty of fibre. I went keto once i got type 2. 3 months latter no diabeties but i now eat carbs no problem

[@todd8155]

I appreciate your videos and enjoy having a reputable source of diet information as there is so much misinformation in the diet world :-/ A small criticism, and that is that your polls are lacking important details. For example, when you ask what percentage of fat and protein in a keto diet, do you mean as commonly practised, as designed by the originator of the diet, or as a well designed keto diet? One can't really answer the question without this additional info. A small point, but I have seen this elsewhere too. For example, you asked what percentage of energy from carbs in the diet. Once again, according to whom? Conventional wisdom, latest research, diet info from the last 60 years like the American Food Pyramid. Not super critical, but if I was taking a test with these questions I would be frustrated and feel that that it wasn't possible to really answer the questions.

[@pan_international]

Hi Todd, thanks for your comment. We can't speak on behalf of the speaker, Dr. Christopher Gardner, however, I'm sure that he would acknowledge the fact that the questions in the polls are quite broad and more info would be needed to be able to fully and accurately answer the questions. In this context, the polls serve more to illustrate the presentation points rather than to define absolutes. In any case, we're glad you enjoy learning about this fascinating topic and thanks for watching!

[@doddsalfa]

The massai diet isn’t a low carbohydrates diet.Massai woman expect 2 meat meals a week

[@rinohunter6190]

Optimal means avoiding metabolic syndrome 100%

[@stevestephens8925]

you cited populations from very high carb and and very low carb populations demonstrationg similar health outcomes but you land more heavily on plant based high carb as the preferred way to go. just your preference?

[@realfoodcures]

The ldl goes up in keto in order to move triglycerides out of cells to the muscles. Normal physiology, not pathos.

[@jwatkins672012]

Interesting start. When I dropped HFCs from my diet my wrestless leg syndrome disappeared. In fact, I noticed when I had HFCs shortly thereafter a distinct ants in my pants energy feel occurred. Haven't had any for decades, thankfully.

[@dorianphilotheates3769]

I just found The Messiah 😇 - subscribed.

[@kardste8114]

I wonder about best diet for cancer. Whole food plant based, with low oils, only necessary protein, lots green leafy veggies and fermented foods?

[@gillc9773]

Adjust to your body as fermented foods are no good if you have histamine issues. But yes lots of vegetables and some fruit and lean protein are meant to be good. ❤

[@deekap8387]

So for diabetics is it better to go on Metformin rather than eating high fat low carbs? I am very skinny, vegetarian and ate lot lot of simple carbs as growing up. My dr advised me to go on Metformin but not sure long term side effects. What’s your take on it.

[@yangtse55]

Perhaps you aren't skinny ENOUGH yet ? Look up Roy Taylor "personal fat threshold" - a short sharp diet to clear the liver and pancreas of fat. I was labelled ""diabetic" at a BMI in the 30s when I'd been flattened by flu and they were testing for various things... But cycling every day probably kept me safe for years. at that size - 50 to 100 miles a week.. I lost 10 kilos in 3 months and tested fine at a BMI of 29 - though I was also cycling ... But without taking a glucose challenge test - which the UK NHS does not routinely do, I can't swear that I was "cured" at that weight because I was cycling every day... My brush with T2 inspired me to avoid spiky carbs ... if only because I still had weight to lose and such foods are not satiating ... I dropped grain for more beans .. if I increase my exercise I will fuel it with slow carbs... My diet has become vaguely "mediterranean" because I eat a LOT of tahini - so unsaturated fat takes the edge off readily-available carbs...

[@deekap8387]

@@yangtse55 maybe. But My bmi is 19 now. I don’t have any more to lose. I am back to my fat threshold when I was young. I am at 117 pounds now. Maybe I can lose a couple more pounds. If I go below that I am malnourished. I think my diabetic might be coming from my genes. My dad was very skinny but diabetic. He was Very active but had no symptoms of diabetes. Just like me.

[@terry2346]

@@deekap8387 It would be interesting to see what would happen if you switch to a Keto diet! Hard to do on a Vegetarian diet but not impossible from what people say. Easier if you eat meat. Just wonder what would happen to your diabetes as a result.

[@deekap8387]

@@terry2346 true, so I am going to eat more eggs and cut down on grains and see how that works. Hope that works for me. Metformin gave me gut issues. So I am going to take a break w Metformin.

[@notesfromleisa-land]

Maybe seek another opinion regarding your medication and perhaps a nutritionist to review your diet profile.

[@Caladcholg]

24:01 so eat fermented, avoid fiber until the jury reconvenes, got it. Sure don't want the risk of being one of those inflammatory subgroups while waiting for the sonnenburgs hypothesis.

[@rolandparks4318]

Gardner Gardner he is the best... He puts doctors on a test!!!! You da man!!! - - - Feed the Mit (ocondria) - - - . Bacteria´s life's matter - Biom matters. Pass the frijoles.

[@reason3581]

Lifetime exposure to LDL seems to be the main factor for atherosclerosis (plack) in your arteries. (See mendelian randomization studies) If you include animal products like eggs, chicken and dairy I don’t believe there is evidence you can avoid plack buildup in the later decades of your life. Consuming any animal products will make it very hard to keep LDL levels low enough.

[@arambarsamian6312]

I didn’t know this. Very interesting. Do you have links to any studies that speak to this claim?

[@lenguyenngoc479]

@@arambarsamian6312 LDL and Heart Disease. Mendelian randomization studies on ldl and heart disease. give links to studies Sure, here are a few Mendelian randomization studies on LDL and heart disease that you might find helpful: Ference, B. A., et al. (2017). Mendelian randomization study of ACLY and cardiovascular disease. The New England Journal of Medicine, 377(13), 1307-1317. www.nejm.org/doi/full/10.1056/nejmoa1612790 Ference, B. A., et al. (2015). Variation in PCSK9 and LDLR genes and LDL cholesterol and myocardial infarction. The New England Journal of Medicine, 372(19), 1790-1792. www.nejm.org/doi/full/10.1056/nejmc1501964 Ganna, A., et al. (2014). Reassessing the association between circulating LDL cholesterol, triglycerides, and cardiovascular risk through Mendelian randomization. European Heart Journal, 35(15), 1171-1179. academic.oup.com/eurheartj/article/35/15/1171/496766 Swerdlow, D. I., et al. (2015). HMG-coenzyme A reductase inhibition, type 2 diabetes, and bodyweight: evidence from genetic analysis and randomized trials. The Lancet, 385(9965), 351-361. www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61183-1/fulltext I hope you find these studies informative! ChatGPT is so good at this 🚶‍♂️

[@4nyumerzik]

Our direct ancestors have been eating animal foods for at least 3 million years; but it's bad for your health?

[@lenguyenngoc479]

@@4nyumerzik Our ancestors have drunk water to survive for more than 1 billion years. How come too much water is harmful 🙄 don't u see the obvious fact? "too much"?? Seriously, eating meat for millions years? that's your point even children can come up with better arguments how much is too much? "u eat saturated fat and raise ldl above 70" then that's too much easy

[@lpodverde]

The question i have is will replacing animal fats with seed, nuts and oils make a difference or do you need to go no fat. Nuts, seeds and their butters, oils and avocados have a lot of fat and a part saturated fat (lower that animal products, but still there). Will the non-animal fat still cause heart disease, i can't find and answer to that.

[@soundstormdubai]

6:00 : And how long do they live ? to 40yo ?

[@edsedlak6827]

The USDA recommendation or recipe for diabetes 300 g is ridiculous.

[@dorianphilotheates3769]

21:00 - Quod est demonstratum! (x.I.MMXXIII).

[@chrismartin7579]

Interesting that @3:00 on your food pyramid, no mention of eggs or fish, two foods that I would think would make up more than 0%.

[@Caladcholg]

To be fair it was a carb pyramid.

[@Appleblade]

This is the least plausible eating imaginable. Our 3 million years ancestors would be puking at the idea... big juicy animals all around and we're supposed to eat fucking beans?

[@Caladcholg]

Not just beans, but a bunch of simply indigestible crap. I don't think we got here by padding our blood sugar spikes with fiber. We just hardly ate sugar. Or fiber.

[@annam2483]

28:00: why is an vegan diet not effecting HDL-C? I thought this is definitely the case…

[@kasasenkootut]

HDL is needed to clear LDL out of the blood vessels. When LDL lowers with diet, also HDL may get lower, but it in this case, ain`t a bad thing. HDL is a secondary marker of metabolic syndrome including insulin resistance, which can be cured with WFPBD. It is shown, that HDL as a risk marker, has a J-shaped curve meaning, that both low and high numbers reflect non-ideal risk profile. Hope this helps!

[@pan_international]

Hi Anna, this is a great question. It seems that there is no clear consensus yet (so perhaps the cell in the table is left blank in Prof. Gardner's presentation because of the absence of evidence, such as he points out for low carbs and risk reduction of diabetes). We took a quick look at a Cochrane Meta-Analyses and found this abstract: “The very small changes in HDL and triglyceride levels are in the opposite direction to that expected[...]There is currently insufficient information to draw conclusions about the effects of vegan dietary interventions on CVD risk factors.” Here's the link to the paper if you'd like to read more pubmed.ncbi.nlm.nih.gov/33629376/. Professor Gardner, I’m sure, would be able to give a more detailed answer on this topic. However, we hope this helps clarify your question. Thanks again, the PAN Team

[@annam2483]

@@pan_international Oh, this helps a lot! Thanks for answering my question and giving more information about this topic. As you said, maybe the cell is blank in Prof. Gardner´s presentation because of the absence of evidence (so that it means there is also no negative effect as well). Makes sense.. I will definitely read the paper this evening. Greetings, Anna

[@kasasenkootut]

Hi! This meta-analysis might interest you. There defenately is information about vegan diet to vascular health. Termannsen AD Clemmensen B, Nørgaard TJ, et al. Effects of vegan diets on cardiometabolic health: A systematic review and meta-analysis of randomized controlled trials. Abstract presented at: European Congress on Obesity (ESO); May 4-7, 2022; Maastricht, Netherlands

[@pan_international]

@@annam2483 Great, we're glad to have helped out. If we find out any more information on this topic, we'll let you know. Thanks!

[@dorianphilotheates3769]

NOTA BENE: 25:40- 40:40

[@kencarey3477]

The guys that wrote the book Mastering diabetes have cured typ 2 diabetes with a high fruit vegan diet!

[@dans5595]

a rule i follow: don't believe anything on a package label.

[@soundstormdubai]

7:50 : why are you not presenting the McDougall true high carb diet (80 to 90% of carbs)

[@knockingseeker]

His diet is too extreme. It’s almost religious in it’s views and promotes carbs that are not the best like white potatoes. A high carb intake take is fine but not mostly high glycemic starch. For most people they need more good fats and protein. 60-15-15 is better maybe even to much carb for lots of people.

[@drewbuffington]

Because this dude is government shill. 100%

[@dorianphilotheates3769]

ΠΑΝ is right!

[@pedroinspain]

So, Dr Gardner, at approximately 29:00 you conclude that low-carb diets increase the risk of Type-II diabetes. These are the same diets that have allowed diabetics to significantly reduce their medication ... right? Why do I sense something illogical in that? I presume that you are discounting this, but giving importance to the Zurich mouse studies (note - early in the diet). "In a study by ETH Zurich and University Children's Hospital Zurich, mice were put on one of two different diets - the ketogenic diet or a high fat diet." WAIT!!! What? "Metabolic tests showed that abnormal glucose levels and insulin resistance developed in the livers of mice fed a keto diet to a greater extent than in mice fed a high fat diet. As the liver was unable to deal with normal levels of insulin for glucose control, the risk of type 2 diabetes also increased." I have clearly lost the plot - or have I? Because a keto diet (protein fixed) IS BY DEFINITION a high fat diet. Oy vey!!

[@gillc9773]

Maybe the keto diet reduces sugar initially because the sugar and carbs are limited. But it seems as if this affects the adverse heart markers. So whole food plant based with some protein may be better 🎉

[@poerava]

This doctor is demonstrably wrong. Shocking.

[@JohnDoe-uw9nq]

Let's see your CV and your arguments.

[@lindapestridge3073]

I agree.

[@mazza712]

I followed keto diet , low carb verges no wheat no bread or grains , my protein was legumes and eggs fats olive oil advocado butter I put on 10 kg , ldl high , hba1c 5.3 Diabetes good rest awe full keto went out door , even fasted 16 -18 hrs day

[@oanairani41]

What legumes did you eat? Keto is mostly healthy fats, like butter, some low carbs nuts, fatty fish, meats, avocado, and 20% protein...or so. If you had legumes like lentils , beans, that's a mediteranian diet. Your carbs intake cannot be more than 20- 40 grams a day.

[@gillc9773]

You must adjust to your body. ❤

[@RC-qf3mp]

Get a Ketomojo, test your blood glucose and ketones, see what foods are causing spikes. Add more fat. Are you get 75% of your calories from fat? If not, you’re not on a well formulated ketogenic diet. If you are, and still not getting into ketosis, then increase the fat.

[@JL-yv3qv]

So basically all that’s left is the obvious… eat less (fewer overall calories) per meal and u will lose weight and with it the associated benefits.

[@wojtek1582]

Nope. Eating less while eating just one product or one type of products instead balanced rich diet will make you sick or even dead.

[@NoirHammer]

Fish is also a good source of toxins and microplastics.

[@RC-qf3mp]

Microplastics are everywhere, including tap water. So good like avoiding that one. Small fish like sardines are less likely to have toxins. Super nutritious, tasty, very long shelf life with no artificial preservatives (just salt and the can are what preserve them), but have the side effect of providing glowing skin, better mood, great brain boost and will save you money (most bang for your buck when it comes to fat, protein and very high nutrients). Incidentally, fruits are a great source of water, sugar and pesticide. So pick your poison.

[@myopenmind527]

This is way too much sugar and way too much carbohydrates. There is zero requirement for carbohydrates or sugar in the diet. I’ve lost 32lb on an ultra low carb diet in 4 months. I still eat plenty of green veg, tomatoes, peppers just no startch veg. I’ve already stopped taking half my diabetic medication so now only take metformin. My blood glucose is very well controlled and my lipid profile has improved.

[@themaingujdek1]

People just don't get it, lack of diabetic symptoms on keto doesn't mean you've cured them, you are cured if you eat carbs and don't have a reaction anymore. This is entirely possible and thousands of people have done it, just look how people get CURED of type2 on whole food plant based low fat diet

[@doddsalfa]

B*

[@larsnystrom6698]

Explan this: For older people, the higher LDL-C the less mortality. The quote between Triglycerides and HDL is 5 times more signifiant as the LDL-C level for cardiovascular events. Yes, LDL-C is somewhat significant. Probably because those particles get damaged in diabetes type 2, and no longer recognized by the liver. That creates a correlation between LDL-C and cardiovascular events. But is LDL-C a cause? I doubt that because older people with higer levels have less mortality. Any story that doesn't take that into account is delusional. Any researcher who see a paradox should really see a counter example. Remember the French Paradox!

[@reason3581]

Cholesterol tends to go down in old people who are frail and underweight or have cancer or other diseases. Reverse causation. On the other hand people who have super low LDL their whole life due to their genes (see mendelian randomisation) do not have increased mortality.

[@gillc9773]

The flaw in the French Paradox is the bureaucracy. They do not report deaths from heart issues like the UK. They call it death from natural causes. Although the French generally eat better I.e. more fresh foods.

[@yangtse55]

You are probably just trolling, but the U-curve has been widely explained - the higher LDL in longer-living elderly is not causal - but symptomatic of undernourishment and illness - the same curves are spotted in BMI, waist circumference and blood glucose... This is the problem generally with population studies - certainly when cynically cherry-picked.

[@gillc9773]

@@yangtse55 Thank you for explaining. Very informative. I didn't know any of that.

[@robertmorgan000]

I've lustened to you before as a guest on other people's channels...and you are very engaging and interesting.....but... i couldnt listen to this... because you are chatting too much... the balance was all wrong for me...too many words ... too much commentary... less info (than previous experiences listening to you)

[@Caladcholg]

40:15 .... are you actually using a pasta company's idea of what's good for the environment, and not documents like Holistic Management, to make an ecological point? What do you think the age of your audience is, 9? We aren't going to get fooled by that type of shit again. #regenerativeagriculture

[@mikewatkins1725]

The optimal amount of carbs for a diabetic is ZERO!

[@knockingseeker]

That is a band aid solution. One cause of insulin resistance is intercellular fats. A high saturated fat diet will actually worsen insulin sensitivity but blood sugars improve due to carb avoidance. It’s not solving the problem unless large amounts of fat is lost. To cure the type 2 diabetes one must lose lots of fat clear out fats in cells and lose liver fat. This can be done on keto low fat balanced diet long water fasts. But for long term health it’s better to do it on a healthy diet not high in saturated fat or a lot of animal protein. Keto with mostly fatty fish and avocados il and good fats is fine.

[@wocket42]

Optimal carbohydrate intake per day: zero grams.

[@YuraL88]

With ZERO evidence😂

[@terry2346]

@@YuraL88 If so then please name for us ONE essential carbohydrate! Just one please.

[@YuraL88]

@@terry2346 glucose is essential for brain. Technically it's non-essential because your liver can convert proteins to glucose, but it's only because your brain require glucose over any other macros.

[@terry2346]

@@YuraL88 Actually it has been shown that the brain can be fueled by ketones as well but it is correct that the body can make the required amt of glucose for the brain from a keto or carnivore diet. So the Carbohydrates are not essential as are proteins and fats. You CAN live without them and many people would benefit with a restricted carb diet. The Incidence of T2 diabetes would go back to the levels of the 60's and 70's quite quickly. And the health benefits would be astounding!

[@YuraL88]

@@terry2346 only partially by ketones. Glucose is still needed. Glucose is mainly made not from ketones, but rather from amino acids, so the body converts proteins to glucose to save the brain from shutting down if enough amino acids are available.

[@wocket42]

The minimum amount of fibre per day for optimal health: zero grams.