Stay Off My Operating Table

Harriet Verkoelen Unravels the Insulin-Obesity-Diabetes Knot - #111

• Dr. Philip Ovadia • Episode 111

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How come weight gain remains a common struggle for individuals with type 2 diabetes, despite maintaining a restricted diet? Harriet Verkoelen sheds light on the misconceptions surrounding insulin and type 2 diabetes, underscoring the importance of insulin resistance testing, and discussing hyperinsulinemia which could be a far more severe risk factor than high glucose levels.

The mainstream understanding and treatment of type 2 diabetes could be flawed, but there's not enough attention given to it in medical education. With the potential damage caused by high insulin levels, including coronary heart disease and other chronic diseases, why are we foregoing insulin testing?

Harriet's insights on the early signs of insulin resistance, different treatments for type-2 diabetes patients, and the need to cut down on carbs just prove to us there's no question about her dedication to promoting a greater understanding of our body's metabolic health.

Get to know our guest
Harriet Verkoelen, with her background in nursing and nutrition, has specialized as a diabetes nurse. She advocates a low-carb lifestyle as a solution to reversing type-2 diabetes.

“We need to work together and show doctors what the results are so we can work all together. And dietitians need to understand that they also have to change something in their advising. Because as I told you, the test always tells you that you need to eat less carbohydrates. ”

Connect with her
Instagram: https://www.instagram.com/harrietverkoelen/
Facebook: https://www.facebook.com/harrietverkoelen.dietist/
Website: https://www.harrietverkoelen.nl /  https://www.meetins.nl
LinkedIn: https://www.linkedin.com/in/harriët-verkoelen-1023bb13/
Amazon:

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Jack Heald:

All right, folks, it's the staff, my operating table podcast, as you just heard, and we are joined today by a woman whose commitment I'm kind of astonished by. We are recording this. Local time for me is 2 pm. Local time for Phil. Are you in Chicago or are you in Florida right now?

Dr. Philip Ovadia:

Yeah, Illinois 4 pm.

Jack Heald:

So it's 4 pm where Phil is, but where our guest is it's 11 at night. He's committed. Phil, tell us about this woman and let's get to know her.

Dr. Philip Ovadia:

Yeah, well, that probably just gives a little bit of insight into how amazing a guest we have today and I'm really excited to have this discussion with her. So we've gone well across the pond again and into our international reaches to have this conversation with the Harriet Verkulin. Harriet is really doing some very interesting stuff around nutrition and metabolic health testing, and once I kind of learned what she was doing, I immediately needed to get her on the podcast to talk about it. But, harriet, why don't you introduce yourself to our audience, give a little bit of your background, and then we can kind of start talking about all the fun stuff you talk about.

Harriet Verkoelen:

Yeah, well, first of all, thank you very much for having me on your podcast. I'm very excited about that. Well, to talk a little bit about me, first of all, I'm a mom of two and a stepmom of two, and my daughter is 27 and I became a mom at 33. So that's an introduction about revealing my age. But prior, before I became a mom, I did a course on nurse free. I'm a nurse, but when I finished that there were no jobs for nurses. So I took a course in nutrition and when I finished that course to be dietitian, there were no jobs for dietitians. And then I took a job in a hospital for a diabetes nurse specialist and I did that for 15 years and after that I was a diabetes nurse specialist in a GP practice, but all the time I also was a dietitian and I didn't practice to be dietitian all those years. But the first few years I started that job in 1989.

Harriet Verkoelen:

And in the first few years working in the hospital and meeting diabetes patients, some things did strike. I started to ask myself questions because I noticed that type two diabetes patients often needed much more, seemed to need much more insulin than type one diabetes patients did, and also we always told them to lose weight, but what they did, they always gained weight, always. And the most funny thing was, sometimes it happened that a type two diabetes patient forgot to inject his long-term insulin at night and nothing seemed to be happening. So nothing happened about the blood glucose. So that was very odd, I thought. So I started to ask these questions and I dove into insulin resistance.

Harriet Verkoelen:

At that moment the Adkins diet had a revival. Well, and then there was one patient that was my eye opener. She was discussing her own weight and she only ate rice, cracker, apple, not much. She said I'm always hungry, I don't eat much because I don't want to gain more weight. But then I saw that when she ate those things, her blood sugar levels rose a lot. She needed a lot of insulin and, to say it bluntly, it couldn't get much worse For her. She already had heart failure, she couldn't move, she couldn't exercise. So I told her try something different, try to cut those carbs. And then the funny thing happened her blood sugar levels dropped so her insulin could lower a lot and then she started to lose weight. So that was my eye opener, and this was well early 1990s or something.

Harriet Verkoelen:

So I started to practice this more and it worked. So I studied a lot more about that and then in 2009, I wrote my first book from four and in that book about low carbohydrate lifestyle, I didn't dare to go lower than 50 grams of carbohydrates because it was very controversial at that moment and everybody got angry. What was I thinking? To advise people diabetes patients to don't eat much carbohydrates. So I wrote three books more and in 2014, I started to educate, to train further other colleagues, dietitians, to get to know more about this lifestyle.

Harriet Verkoelen:

And then in 2020, I published an article about the results in my practice. I wrote about 35 patients in my practice because I came to work as a dietitian, of course, after my first book, 35 patients I saw in my practice type two diabetes patients who injected insulin and 33 came off insulin. So that's more than 90%. When they eat very little carbs, they don't need any insulin and they can lose weight and they do much, much better. So to me it's still something odd that there's not much attention to this in medical education.

Dr. Philip Ovadia:

Yeah, let's set the stage a little bit. Talk about the relationship between insulin and weight gain.

Harriet Verkoelen:

Well, since insulin is the fat storage hormone and insulin makes sure that you cannot burn your fats. So your metabolism we have a hybrid metabolism. I don't know if that's the right word in English, but we can get energy from burning sugar and from burning fat. But when your insulin is high in your body, then you're not able to burn any fat, you only will burn sugar. And then you eat all those carbs. Your insulin rises, you burn carbs, but not enough. So the rest of the carbs and the sugar, your body will store that as fat. And then the funny thing is that most type two diabetes patients there's no lack of insulin. They are insulin resistant, which means that they have hyperinsulin, a lack of insulin, like type one diabetes patients. So that's a huge difference in the cause of their high blood sugar levels. So different people can have high blood sugar levels, but the cause of that might be very different. So you need to treat them in a different way and not prescribe insulin injections to all of them. That's a wrong treatment, I think.

Dr. Philip Ovadia:

Yeah, and just to kind of bring that into focus for our audience type one diabetics who can't make insulin don't make insulin. They used to die prior to us being able to administer exogenous insulin. They would die because they basically wasted away, they couldn't store any fat and, despite eating huge amounts of food, they wouldn't be able to keep up with the energy demands because they basically had no way of storing energy and they would have exceedingly low body fat percentages. And then what you see in a type one diabetic who then starts treatment with insulin is basically they'll get fat. I mean, that's what, like you said, that's what insulin does.

Dr. Philip Ovadia:

And the unfortunate place that we've gotten to is because we're so focused on the glucose, we ignore the insulin part and we try and treat type one and type two diabetes in similar ways, because we're just focused on bringing the glucose down and we're not thinking enough about what the underlying insulin picture is. And, like you said, we often have type two diabetics who have very high insulin levels, if you measure it, and then we go and prescribe insulin for them on top of it, because the insulin that they're making, their body isn't responding to the insulin and the thought is, well, if we just overload the system with insulin, we'll be able to kind of get it to respond better.

Harriet Verkoelen:

Yes, this is the first time I've ever heard this.

Jack Heald:

We've been doing this for two years and I mean I'm not saying nobody ever said it, I'm just saying it didn't sink in. Type two diabetics don't have an insufficiency of insulin in their system and yet the solution is to give them more. I mean, the solution I'm in air quotes.

Harriet Verkoelen:

Because nobody ever measures this. Yeah, when you think about it and you see how the logic of it, then your flabbergasted.

Jack Heald:

There isn't logic. That doesn't make sense, right?

Harriet Verkoelen:

Right, yes.

Dr. Philip Ovadia:

Yeah, it's a deficiency of our system that only focuses on the glucose and doesn't routinely measure insulin levels.

Harriet Verkoelen:

That's right and that's what I. Last year I started to do these insulin measurements and that's what I see. When I measure somebody who has type two diabetes, you see that there's no lack of insulin. They have hyperinsulinemia, but so the insulin doesn't function the way it should in your body, so your body keeps on producing more and then you get hyperinsulinemia, which is the diagnosed of insulin resistance.

Jack Heald:

And insulin is what allows us to store fat. So if you've got an excess of insulin, the natural result is your body just holds on to keep storing fat, just keeps packing it away. Yeah, yeah, and then you Phil, have we heard this? I mean, I know you've heard it, you're a doctor, but have I heard this before?

Dr. Philip Ovadia:

I think we've gotten into it, perhaps more superficially, with some of our past guests, but we probably haven't gone into this detail and, quite frankly, it saddens me to say this, but most of my doctor colleagues probably don't know this detail and don't think about this detail of the disease that they're treating.

Jack Heald:

I have a friend who was a type 2 diabetic and I remember he literally carried around a cooler with his insulin in it because he needed so much so often and he must be close to death and he's got to carry out. He eventually discovered the ketogenic diet and got well, but I remember him carrying around this.

Jack Heald:

And the funny thing is he didn't carry a water bottle, he carried a cooler of insulin. It blew my mind, but now I get it. Now it's all clicking, okay, sorry, I hate to keep it interrupting, but I'm just-. I'm astonished, I am Okay, okay, okay, okay, okay, okay, okay, okay, okay, okay, okay, okay, okay, okay Okay.

Harriet Verkoelen:

Yeah, if you get to think about it and you see that type 2 diabetes patients often inject much more than type 1 diabetes patients, and they don't even have a lack of insulin, so it's so not logical at all.

Jack Heald:

Yeah, so it sounds like they're really two utterly different dysfunctions.

Dr. Philip Ovadia:

They are Like what?

Jack Heald:

in type 2.

Dr. Philip Ovadia:

Yeah, they are.

Jack Heald:

For some idiotic reason, they've been given the same name.

Dr. Philip Ovadia:

Well, and again that goes back to the original sort of discovery was the glucose? Diabetes was described in ancient medical texts and they were detected by excess sugar that was spilling into the urine. So the disease became framed by excess glucose and insulin, Even as a therapy was discovered. In 1920s was really when we developed insulin as a therapy, but the focus was always on the glucose part of the equation. It never really was on the insulin part. There were some clinicians and scientists who focused on it, like Dr Kraft and Dr Grieven for instance, but their discoveries never really made it into the mainstream, I would say.

Harriet Verkoelen:

So I think that the definition of diabetes put you in a wrong focus, because we say that diabetes is an absolute or relative shortage of insulin, but the relative shortage of insulin is more its focus. You on the shortage, but you can still have hyperinsulinemia. When you look at the need there is in a body for insulin, if you're insulin resistance, then the need of insulin seems to be much higher. But there is no shortage, it's hyperinsulinemia still. So we're making it much worse and that's what Kraft proved in his research. Hyperinsulinemia is much worse for your veins than blood glucose is. So we're treating out type 2 diabetes patients exactly the wrong way, because we make sure that blood glucose levels are really low, but they give them so much insulin. So it's completely the wrong treatment.

Jack Heald:

I want to make sure I understood what you just said. Too much insulin in the system. Hyperinsulinemia in our system is worse than too much glucose.

Harriet Verkoelen:

That was the conclusion of the research that Joseph Kraft did. He looked at almost 15,000 Canadian people and he did his Kraft testing, which means that he measured fasting glucose and fasting insulin, and then he gave them 100 grams of glucose to drink and then in five hours after that, every hour, he measured again glucose and insulin and what he found out is that people who had high insulin levels had the same damage in their veins as people. I have to say a little bit on different People who have low glucose levels and high insulin levels had the same damage as people who had high glucose levels and high insulin levels. So the blood glucose didn't do this.

Jack Heald:

The blood glucose was not the culprit.

Harriet Verkoelen:

Right, that's what he wrote down in his book. So it's the hyperinsulinemia that's much worse, for that damages your blood veins.

Jack Heald:

What's the damage, what's the effect of the high insulin?

Harriet Verkoelen:

I think that Dr Ovedia can explain that. But you get your coronary heart diseases and all these chronic diseases.

Dr. Philip Ovadia:

Yeah, exactly, A damage to your blood vessels is one of the primary ones and that can manifest in a number of different ways, but other end organ damages as well. And again, we know that hyperinsulinemia and insulin resistance is associated with most of the chronic disease that we see cardiovascular disease, many forms of cancer, Alzheimer's disease, chronic kidney disease All of these things have a root cause of hyperinsulinemia and insulin resistance. And what Dr Kraft really opened people's eyes to was that the high insulin occurs well before the high glucose does, so you can detect the disease at its earliest stages if you're looking at insulin. We only detected at the late stages when we're looking at glucose. So I think that was really probably the most important finding of Dr Kraft's work and unfortunately it's largely been forgotten and or ignored by the medical community.

Harriet Verkoelen:

I think that even Kraft would say that people who have low blood sugar levels but have hyperinsulinemia, he said they are diabetics anyways, because that's what the damage does. So you're diabetic when you're hyperinsulin as well. Yeah.

Dr. Philip Ovadia:

And I believe it was Dr Kraft in one of his papers looking at the relationship between hyperinsulinemia and heart disease and basically said all heart disease patients are diabetic or hyperinsulinemic. You just need to test for it, which, again, is not something that we typically do. So talk about. I know you said when you first put this out there, when you wrote your first book, there was a lot of pushback against it. Now you've written a number of books and articles and what would you say is the acceptance of these concepts today in the dietician community. And then I don't know if you see a difference, sort of regionally, looking at perhaps the US versus Europe on this front.

Harriet Verkoelen:

It's a big difference between countries because here in the Netherlands there are several dieticians who also practice advice in low-carbohydrate lifestyle, even ketogenic, the carnivore diet lifestyle. I'm not so sure about that's a bridge too far, I think, for most of them. But the dieticians who have a little bit more experience they start to advise more often the low-carbohydrate lifestyle, but still not all of them. But in the Netherlands it's even more than in Belgium. I spoke to Jack a little bit about Belgium. There it's not done the dieticians over there maybe just a few, but less than in Holland and in other countries. I don't know too much. So it's still not in the course of dieticians. They still don't learn anything about this. Like doctors they don't learn anything. All these medical professionals, they know about the term insulin resistance but they don't actually learn what it means, what it means in a medical way, and I think that's a pity. I don't know. That's a fail, yeah.

Dr. Philip Ovadia:

And I think one of the challenges around that is the testing, and glucose is something that we can test for very easily. These days, patients have home monitors. We have continuous glucose monitors. Every time your doctor orders blood work on you, practically you're going to get your glucose level checked. But we don't test insulin in the same way and there are some challenges around testing for insulin. We certainly don't have a continuous insulin monitor as of yet, so I know you have a lot of experience with that. Talk a little bit about the testing of insulin.

Harriet Verkoelen:

Yeah Well, I started last year. I think I tested 200 people. At this moment, the essay I use is like a COVID test. You might say that's how it looks like. I do it similar to what Kraft did, but I don't test for five hours but two hours. So I'm out of one fingerprint, one drop of blood from your finger. I measure the blood, glucose and insulin. Then they drink 75 grams of glucose. I don't know if that's the standard here in the Netherlands. I don't know if that's the standard because Kraft did this with 100 grams of glucose and then, after they drank the glucose, I measure three times more 40 minutes after they drink this one hour, so that's 20 minutes in between, and two hours, so up until two hours I test their glucose and insulin.

Jack Heald:

These are all just the fingerprint. A fingerprint.

Harriet Verkoelen:

Yes, only from a fingerprint. And for the insulin I need a little bit more blood, so I use a little pipette to take up the blood and put it on the essay. Yeah, there is a test that's called a HOMA IR to find out if somebody is insulin resistant, but that's only done with the fasting insulin level, and with lots of people I tested I saw that the fasting insulin and glucose level was perfectly fine, but in two hours they were completely out of all the lines. They got very high insulin levels. So the HOMA IR doesn't do anything for me anymore, so that you need to do at least two hours to see what the pancreas produces about insulin.

Harriet Verkoelen:

And also, after two hours your system has to lower everything. So your glucose has to be almost like the same thing as in fasting state and insulin as well. And if that's the case, then your metabolism seems to be recovering very well from that attack of 75 grams of glucose. But lots of people don't do this. After two hours they have the highest levels, so their metabolism is very unhealthy. It isn't able to recover anymore. So you cannot see that. Sometimes you see that when you measure it in the fasting state, but lots of people have nice numbers measured at fasting state.

Dr. Philip Ovadia:

Yeah, and again going back to Dr Kraft's work, I forget the exact numbers but I think of the 15,000 patients, roughly half of them were overtly diabetic and had elevated glucose at baseline. But then if you looked at the other half, I believe it was about three quarters of those people had hyperinsulinemia either. There's a couple of different patterns that he describes, but basically three quarters of the remaining half that weren't overtly diabetic were hyperinsulinemic, and he was doing this now almost 40 years ago. I would say if you took 15,000 people today, especially here in the US, you'd probably struggle to find 10% of them that were truly metabolically healthy and not either diabetic or hyperinsulinemic.

Harriet Verkoelen:

From all of those people I tested the 200 by now only four had a good graphic, good numbers, but all the others they had symptoms like 2% of 200 people were not Hyper-insulinemic.

Jack Heald:

holy smokes.

Harriet Verkoelen:

But all those who had wrong numbers, they had symptoms. So if you test everybody also who have no symptoms, then probably they're not insulin resistant, although some people found out that they were and didn't have any symptoms. But most of them have, like hypoglycemia, they have very low blood glucose levels after they ate something or they have apnea, or women with PCOS or, of course, diabetes patients. So they had symptoms and when I measured them and then I found out that they were insulin resistant. But the funny thing is I also measured a six year old. He was insulin resistant.

Harriet Verkoelen:

And also I saw a few people who had BMI of 19. So that's not overweight at all. They were very insulin resistant as well. So you cannot talk about weight only, so you have to measure. And also what I find out is that lots of diabetes patients type two diabetes patients who are diabetics for like 10 years or something they have the posture and all the symptoms of insulin resistant, but they produce, they are not hyperinsulinemic anymore. They have very low insulin levels and they even can get into keto acidosis at that point. So you need to measure.

Dr. Philip Ovadia:

Yeah, exactly, we kind of refer to that now as type one and a half diabetes, or it will be called the MODE or LADA late adult onset. But yeah, basically a type two diabetic will eventually become basically a type one because their pancreas just fails essentially and is now no longer able to produce insulin and they're insulin resistant on top of it, which is a big problem. And the other side of that as well, we see where we have people who are type one diabetics for long periods of time injecting high amounts of insulin and they become insulin resistant over time and they need more and more insulin now to keep their glucose levels down. So here in the US, one of the issues we have is that the training of dieticians is very heavily influenced by the food industry, and so is that similar to what you see in Europe. And the.

Dr. Philip Ovadia:

Netherlands.

Harriet Verkoelen:

Yes, unfortunately, they learn that you need more unsaturated fatty acids, which is always processed oils, processed fats, and they don't know what they're advising. They're away from natural, real food and that's kind of a shame. That's all. Yeah, it's done by the food industries and they don't know the difference between mechanically processed fats or chemical processed fats, which is, I think, a huge difference, like making coconut oil yourself. It's not a chemical way, it's a mechanic. I don't know if that's right English words. That's the youth. It's unrefined, but most of the plant oils are refined and they don't know exactly the difference. I didn't know. I didn't learn it in my dieticians education, so I had to learn that later on. In fact, lots of things I learned in my education I had to let go and found out that it was in a different way. So those educations are not really the real food you learn. It's food industry. Yeah, that's a problem, I think. Yeah.

Jack Heald:

I don't know why this is hitting me so hard, other than for over two years you and I have been having these conversations, and this may be the problem with being a layperson and a professional is you might be suffering from the curse of knowledge that I'm not suffering from, and it's hitting me like a ton of bricks. Type two diabetes is not a problem with glucose. It's a problem with too much insulin.

Harriet Verkoelen:

Yeah, yeah.

Jack Heald:

And I know we've never heard this the earliest detection is to test insulin levels, not blood glucose levels. I know we've never heard that, and that's I'm thinking of our listeners out there. There's folks out there who are probably dealing with the early, maybe even lack of symptoms, but they're having symptoms that if we knew what their insulin levels were, we could say yep, you're heading that direction.

Dr. Philip Ovadia:

Yeah, and certainly I have advocated now for quite a while that patients get their insulin level checked. As we were kind of touching on. There are some challenges around that. It may not be as easy as it is to get your glucose level checked, but it's certainly feasible and one of the advantages we have here in the US is in the vast majority of the country, with one or two exceptions statewide you can order your own blood work and you can order an insulin level on yourself and it's usually pretty affordable.

Dr. Philip Ovadia:

I know some websites like ownyourlabscom, where I believe an insulin level will cost you $8. Check. You will have to go get a blood draw. Unfortunately we don't have the technology that Harriet was referring to with a finger stick measure of insulin. We're hopeful it's going to come soon, but you'll have to go get your blood drawn. But it's going to be well worth it to see that. And that doesn't even get into the fact, like you mentioned, harriet and I want to get into this a little bit more that looking at fasting levels of insulin still may miss this problem for some people, but at least it's going to be an improvement over just looking at your glucose levels.

Harriet Verkoelen:

Yes, there's lots of people who have very nice blood glucose levels, but then when you measure insulin then they're way too high and sometimes it's already in a fasting state, but most of the times it's later on.

Harriet Verkoelen:

So you just have to measure that and it would be my wish that every single person from 16 or 25 would do this test every two years. So you would do so much more for health. And no, it costs a little, but it's so much less than all those medications you people prescribe later on and the damage in your body, the unhealthy metabolism which is caused by the insulin resistance. So it would be much, much better if we knew more about this test, if it would be largely available for everybody to do this. It gives a lot of insight for people themselves and it gives a lot of motivation to do something about it with your lifestyle. Because that's what I see in people who are doing this test that they are so motivated to do something about it because lots of people don't want to take more and more and more medications and now you can get rid of them at least lots of diabetes medication and lots of others also. So I think it's cheaper this way if we test a lot of people, we can prevent a lot of chronic diseases.

Jack Heald:

What would be some of the early symptoms that you could self-diagnose. You say, hey, I've got that, I've got this thing, I've got that thing. Maybe I'm dealing with too much insulin.

Harriet Verkoelen:

I think there are symptoms that people don't relate to insulin resistance, because some are universal, like being tired, having mood swings, not be able to lose weight easily, hypoglycemia so when you're shaking after a meal, or people who have apnea, or women with PCOS who don't have regular periods or anything all those things or when your hair gets thinner on top of your head lots of symptoms, but we don't relate them to insulin resistance. So I think there needs to be more awareness about this and symptoms in an early phase and then get this test done. That gives you a lot of insight in your own metabolism. But we are not used to that and lots of these symptoms we think like they start when we get older. Well then, it's normal.

Harriet Verkoelen:

When you get older you have these symptoms, but they don't need to. It doesn't need to be because of the age. It might be insulin resistance, but you don't know if you don't measure and it's just one morning people come to me, I measure, they drink and at the end of the morning we know the results and we know what's going on.

Jack Heald:

So Okay, so let's take the next step. You've tested. You found out that you're hyperinsulinemic. Did I say that right?

Harriet Verkoelen:

You got it, I guess so.

Jack Heald:

Now what.

Harriet Verkoelen:

You always have to eat less carbs and natural food.

Jack Heald:

Always I kind of knew that's what it was going to be.

Harriet Verkoelen:

But Some people. I asked them because I want to know what the BMI, I want to know what medication and four diabetes they have. But I also asked them do you have any idea about how many carbs you eat a day? And sometimes it's 200 and sometimes it's 40 grams. But if you eat 40 grams and still have a very unhealthy metabolism, then you have to get lower. You still have to get lower because you have to reverse this insulin resistance. The funny thing is that when people have lactose intolerance we don't tell them you need to drink your milk and here is a little pill to help you digest this milk. But in diabetes patients we say you need to eat your carbs and here is insulin to inject to lower your blood sugar level. That's not logical at all.

Jack Heald:

That's a really good analogy.

Dr. Philip Ovadia:

Yeah, no, it really is kind of crazy when you think about it and yet it's still the most widely held dogma and belief that diabetics need to consume carbohydrates, like you said. And then you balance it out. So how low do people need to go on their carbs? Because this is always a discussion. Do you need to go kind of carnivore, zero carb? Can you stay sort of keto, low carb-ish atkins? There are all these different kind of approaches to carbohydrate reduction, so talk a little bit about your perspective and experience with that. Yeah, yes.

Harriet Verkoelen:

Well, I focus on weight. Most of people are overweight and I think you only can reverse insulin resistance when you lose weight, when you lose your belly fat. So if you eat like I always start with around 30 grams of carbohydrates especially when people already have chronic diseases like diabetes I go very low and I start around 30, sometimes around 20 grams of carbohydrates and then I look at results. If they are losing weight, then everything is fine. If they're not losing weight, then I try something different and I ask them to run two or three days a week, get lower like super keto, which is almost carnivore, or try to fast more. Four times a year I organize a 40 hour fasting challenge so that people can learn and practice how to fast a little bit under my guidance, and after those 40 hours, most of the times they say, well, it wasn't too bad to do this, whereas before they thought, well, I can never do this. But once experienced they say, well, okay, it's doable. So they need to fast, learn to fast more and also they need to have more inspiration and tips what they can eat.

Harriet Verkoelen:

When you eat like super keto, only 10 grams of carbohydrates a day. And what they always ask is when I don't eat carbs. I have to work higher. I need energy. Where does my energy come from when I don't eat carbs? So they don't know that we can also and it's meant to be to burn our fat, our body fat, and we only have 800 grams of glycogen in storage and that gives us less than 4,000 calories. But if you're burning fat, one kilo of fat gives you 9,000 calories. So if you're in fat burning mode, you get much more energy than when you are in the sugar burning mode. That's. People don't realize this.

Jack Heald:

Real quick. Can you translate grams to American for us?

Dr. Philip Ovadia:

Well, so yeah, we use grams. I think people will be familiar with a kilogram of fat, it's going to be 2.2 pounds of fat and, like Harriet said, that's going to contain about 9,000 calories of energy.

Jack Heald:

And this is just the fat we're carrying around our belly.

Dr. Philip Ovadia:

This is just the fat we're carrying around and most of us don't realize we're walking what becomes sort of what people don't understand Obese people will be hungry all the time and yet they're walking around with essentially unlimited supplies of energy. But the problem again and we mentioned it earlier but didn't really hone in on it is insulin. Besides telling your body to store fat, it also blocks your body from pulling fat, from breaking down fat, from pulling that energy out. So when you have high insulin levels, you can't access that body fat for energy, and this is why people will be hungry all the time, even though they have lots of energy around with them.

Dr. Philip Ovadia:

One of the best analogies I've heard to describe that is if you're the trucker that was driving the tanker full of gasoline around, you can still run out of gas and be stuck on the side of the road because you can't use that gas. That's in the storage tank that. You can only use what's in the gas tank of your truck. But that's one of the other issues that we run into with hyperinsulinemia. And so, as Harriet was saying, the first step is you've got to bring down your insulin levels, and the most effective way to do that is by stop eating carbohydrates.

Jack Heald:

Yeah, this is even more alarming than I'd ever realized, even more screwed up than I thought it was. And, believe me, I thought it was seriously, seriously screwed up, and yet it all comes back to eat whole real foods. Yes, and when you're Keep your carbs down.

Harriet Verkoelen:

Yes, keep your carbs down, and when your metabolism is healthy, then you don't per se need to keep your carbs that low. But first to reverse your diseases, then you need to do that.

Jack Heald:

And when I hear this is something I didn't understand until I've asked Phil this question many times when I hear healthy metabolism, my understanding now of what that means is your body is in a state where it efficiently converts the glucose and the fat that you take into your system into energy. That's what it means to have a healthy metabolism.

Harriet Verkoelen:

Yes. I can see that when I take the measurements, because then I see nice glucose levels. Even when you drink this 75 grams of glucose but also your insulin levels it rises a little bit but then it lowers again and at the end at the two hours your levels are the same as in the fasting state. So your metabolism recovers very nicely from those glucose you drink. Then you can see that you have a healthy metabolism.

Dr. Philip Ovadia:

Yeah, you kind of asked about this earlier, jack, to give people an idea about what 75 grams of glucose is. That's roughly two cans of soda. It's going to be 75 grams of glucose. Yes, the point of the test is you're sort of stressing the system. Most people won't.

Dr. Philip Ovadia:

Well, I shouldn't say this, but a lot of people don't drink two cans of soda back-to-back and they may not be getting 75 grams of glucose at every meal, but over the course of the day, like Harry had said, most people are taking in that much glucose spread out throughout the course of the day. And one of the other issues and I'd love to hear your perspective on this as well, harriet that we get into is there's the issue of taking in too much sugar at once. But then there's the issue of the frequency with which we eat sugar basically throughout the day, and the average person now eats, consumes calories, about six to eight times a day, and if you're asleep for eight hours, that kind of works out to essentially every two hours. So you get this insulin response and then you never give your body the chance for the insulin level to come back down.

Harriet Verkoelen:

Yes, that's right, because first of all, we thought that we need to have breakfast. As soon as you get up, you need to have your breakfast, which always is a lot of carbs, so because that's what makes our metabolism going. But it's always going, so you don't have to artificially do anything about that. But okay, we're taught that we need our breakfast and then we need to have something two, three hours later. But then with my testing I see that in lots of people their metabolism hasn't recovered yet, so insulin levels are still high, and then you're getting another shot of carbohydrates and sugars.

Harriet Verkoelen:

So you build that up during the day, so you'll never be able to get in fat burning mode, so you will only store this extra energy as fat. So your body fat is most of. It is not fat that you ate, but fat that your body makes itself because of the insulin that turns sugar into body fat. So if you eat all day six, seven times a day and for diabetes patients, we advise them to eat an apple before they go to sleep so they won't have hypoglycemia at night, so they're eating carbs all day long and that's quite the different thing they need. They need to lower their carbs, so we're advising them wrong.

Jack Heald:

I think I get it All this time. I've thought the root cause problem was I mean even saying it out loud now I realize how poor my thinking has been, but it was. Oh, you got to keep your blood sugar down.

Harriet Verkoelen:

Yes, but it's not the blood sugar.

Jack Heald:

That's a symptom. It's not a cause.

Harriet Verkoelen:

Yes.

Jack Heald:

Yes, the cause is I guess it's a combination, they're related the amount of insulin in your bloodstream combined with the ability of your body to make use of the insulin. But I've never heard that too much insulin in your system was damaging your vein. No, but I never heard that.

Harriet Verkoelen:

Well, doctors need it Doctors haven't heard this either.

Jack Heald:

I feel less mad about it.

Dr. Philip Ovadia:

Most of my colleagues don't think about that or are unaware of that as well. And, to be clear, having high blood sugar is also damaging. It's just that having this high insulin is damaging as well and occurs much earlier. So that's really where the missed opportunity is. If we measured insulin levels routinely, we would pick up on this a lot earlier and we would have a much different approach to this, I think, because, again, if you're trying to lower insulin, there isn't a medication that does that, which may be why we don't focus on it, but the only way to really do that is to stop eating the stuff that's causing your insulin to go up, and that's carbohydrates. And where's the money in that? Yeah, exactly, exactly. So that's the challenge.

Harriet Verkoelen:

Poor urns, when people are fasting or when people are not using any processed foods anymore. Who's earning from that? Nobody, only the patient.

Jack Heald:

I mean, it's blindingly obvious to me in a way it never was before. I'm just stunned. I shouldn't I realize this is dumb. I should have gotten this a long time ago, but holy cow.

Dr. Philip Ovadia:

So just to one more thing to kind of talk about and circle back to the insulin testing. What are the barriers to that being more widely available?

Harriet Verkoelen:

Well, it takes a lot of time because you're testing all morning. They have to come to you. In fasting, you measure, I'm fasting and I myself can only have five patients at the same time. So it takes a lot of time and I think it's not known enough and we don't know what to do with it. So, like you are known in this field, you know a lot about insulin resistance and yet lots of people are talking about insulin resistance but yet we don't measure, and so one way or another, I don't know, it's time consuming, but it gives so much insight I don't know.

Harriet Verkoelen:

We need to do something about this, that it gets more known in professionals and that we can do this for an easy access for all people to do this.

Harriet Verkoelen:

It would be nice if insurance companies, at least in Holland and the Netherlands, would cover for this, because it saves a lot of money. But well, I'm trying to get it known more in the Netherlands. I'm trying to work with other dieticians colleagues to do these measurements at their location or trying to get them to also do these tests. It doesn't have to be dieticians, it might be something easily is accessible for people in villages or in towns, I don't know, but we need to work together and show doctors what the results is, so we can work all together. And dieticians need to understand that they also have to change something in their advising because, as I told, the test always tells you that you need to eat less carbohydrates, so there's a lot going on. I don't think it changes easily. It won't go fast, unfortunately, but we need to do something about this to get this more known and more accessible for everyone. But I don't have the answer yet.

Jack Heald:

Well, that's one of the things we're working on here. I want to make sure I was clear on this. There's an insulin test. That is the one time. It's only your fasting insulin levels and that's not the test you want. You want the test, what's the test called? So if somebody's listening to this, they say what test do I ask my doctor for?

Harriet Verkoelen:

Yes, well here, if people ask their doctor, can you measure my insulin, the doctor responds with why do you want to know? So there is the test, as I call it. It's an insulin response test combined with an oral glucose tolerance test, and an oral glucose tolerance test might be known by pregnant women because that's how gestational diabetes is diagnosed. So I combine that test with the insulin response test. That's what I call it, but it's not covered by insurances, so that might be a problem.

Jack Heald:

But people are very interested, the folks who are going down this particular road. Many of them have already accepted the reality that they cannot depend on the traditional health care system to get them healthy, and if they've got to pay for their own labs, they'll pay for their own labs. It will save them money, they'll get the right thing, yeah, yeah.

Dr. Philip Ovadia:

So here in the US, similar. If you ask your doctor to check your fasting insulin level, they're probably going to tell you there's no reason to do that, or we don't do that, or it's too expensive, or whatever the excuses are. You can easily do that. Like I said, in most states here in the US you can order your own lab work and there are many websites to do it.

Dr. Philip Ovadia:

I'm particularly fond of one Ownyourlabscom. I have no financial interest in it, but it's a great site and it will cost you $8 to check your insulin level and you can do that fasting and you could even sort of run this experiment on yourself if you want to. If your fasting insulin level is normal but you're still concerned about this, then you can drink 75 grams of glucose and, like I said, you could do that with two cans of soda and then go get your insulin level checked two hours later and it's not perfect but it's a bit of a workaround. And here in the US, if you're asking your doctor for the test, yeah, it's going to be called a glucose tolerance test with insulin levels and the moniker again is the Kraft test KRAFT for Dr Joseph Kraft. No relation to Kraft, the food company, but again very difficult to get a Kraft test done here in the US because of those logistics that Harriet was talking about.

Jack Heald:

A glucose tolerance test, insulin response yeah.

Harriet Verkoelen:

If you would like to know more than you would do this one hour and two hours after you drank the glucose, and what I found out, because there are no numbers about what is the normal level, what are normal levels. But I found out that the fasting level would be maximum two and after the meal at 10. But almost everybody has higher levels, because I read something in your book about 10 or 20, what should it be? But I think that up to 10 after a meal for your insulin. That is what it's supposed to be.

Dr. Philip Ovadia:

And that's going to be in molar units, right? So here in the US we use different units for insulin as well as glucose, and so the usual numbers here in the US is you want your fasting level to be less than 10. And then your host brand deal a two hour insulin level with this challenge. I think most people will say 25 or 30 is going to be the cutoff there. But yeah, and you can look up Kraft testing and see all the different patterns that Dr Kraft described as well.

Harriet Verkoelen:

Yeah, and I looked at those patterns and I saw the numbers that he uses. But there's a difference between his research, because he did research about damage in veins and I research about insulin resistance, so that's slightly different. Can I show one graph about? Yeah, sure, I can show you the graph I took and there you see, the glucose is in millimole per liter, which is in US it's milligram per deciliter.

Jack Heald:

So for our listeners, we're looking at a graph that shows insulin and glucose.

Harriet Verkoelen:

All right, yes, at the right side you see the YX about the glucose which is in millimole per liter. You see the five. That would be 100 milligrams per deciliter in US. At the left side you see the YX and that's insulin, and I don't know if I pronounced this rightly, but it's micro units insulin per milliliter. I don't know if that's the same you use in US, but this is a graphic, that's yours.

Harriet Verkoelen:

Yes, this is mine. I was surprised, because I think it's a right one. My blood sugar in the blue line, as you see, was a little bit less than 100.

Jack Heald:

And then it rose until 40 minutes after you took the glucose, it rose.

Harriet Verkoelen:

Yes, it rose until 180. And that's 11 in millimoles. And then it lowered again. The insulin, that's the red line, was in fasting state less than two, and then it went up until 8.7. And then it lowered again and after two hours it was the same as in the fasting state. So the metabolism recovered very well from that attack of glucose. And then you can see another. Oh no.

Jack Heald:

I was hoping you were going to offer another view.

Harriet Verkoelen:

Yes, I have a little bit of problems with the no, I cannot share the screen. You can see. No, I have to stop this. Well, what happens is that lots of people the red line at 40 minutes rises a lot and then it might lower again after two hours. But lots of times I also see that in a fasting state the glucose and insulin is really very well, but then at two hours it only rises, rises, rises. So in two hours there's no recovering of the metabolism. So you're not getting to see any lowering.

Dr. Philip Ovadia:

You get a higher response, a higher peak, and it also stays elevated for a longer period of time. Yes, are the two sort of abnormalities that we start to see in this insulin response.

Jack Heald:

So the takeaway for me from that is just because your fasting insulin looks good doesn't mean you're not dealing with insulin resistance, correct? What I'm going to tell is what happens at least two hours after you've ingested the glucose. How have you recovered? Yeah?

Harriet Verkoelen:

Yeah, wow.

Dr. Philip Ovadia:

Well, yeah, this has been a fascinating discussion. I think, like Jack, many people in our audience will have been enlightened by it, and maybe it helped to clarify a lot of these concepts that they may have heard about but didn't kind of fully comprehend the implications of it. So if people want to learn more about your work I don't know how much of an audience we have over in the Netherlands, but I think we certainly have some and so if people want to work with you, why don't you tell them where they can connect?

Harriet Verkoelen:

Well, my website is my name harrietverkudennl, or they can email me with info at harrietverkudennl or contact me at LinkedIn or Facebook. So hopefully that works.

Jack Heald:

Very good. Well, we've got all that information available and it will be in the show notes both on the podcast and the video version. So wow, harriet, thanks.

Harriet Verkoelen:

Thank you, thank you, love talking to you.

Jack Heald:

My brain is sparking. Wow, one of the things that happens with me when I have these kinds of little revelations. I'll go hang out with some friends and I'll go hey, did you know Guess what I just found out? I just heard this thing and I know sometimes they get you know I'm easily enthused, but they're going to get this one. They're going to go oh my God, they're going to get this one.

Dr. Philip Ovadia:

This is significant All right, Call it a day. Phil Sounds good. Another great one.

Harriet Verkoelen:

It's midnight already here, so yes, call it a day. Let's let her hear it in a good bed.

Jack Heald:

So for Harriet Foukoulin, I'm Jack Heald. This is Dr Philip Ovedia's podcast. Stay off my operating table. Thanks for tuning in. You know where to find us next time and we'll talk to you next time.

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Dr. Philip Ovadia

Host
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Jack Heald

Host