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Prediabetes is reversible. Here's exactly how. — Transcript

by Seth Capehart MD · 3,504 words · 586 segments · language en · Watch on YouTube

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0:00I had a patient recently come into the
0:01ER for something completely unrelated to
0:03what I'm about to talk about, but their
0:05routine labs came back and showed that
0:07she was now diabetic. When I told her,
0:10she cried. She told me her doctor had
0:12warned her years earlier that she was
0:14pre-diabetic. She said, through her
0:16tears, "I knew that this would happen
0:18someday." And I asked her, "Why didn't
0:21you fix it then?" And she looked at me
0:23completely confused and said, "What do
0:25you mean, fix it?" She had no idea that
0:28pre-diabetes was something you could
0:29actually reverse. Nobody had ever told
0:31her that. She thought it was just a
0:33waiting room before the inevitable
0:35happened. And I explained to her exactly
0:38what I'm about to explain to you. And by
0:39the time she left that conversation, she
0:41was one of the most motivated and
0:43grateful patients I've ever had. If you
0:45haven't met, I'm Seth, I'm an ER doctor
0:47and former special ops guy. If you or
0:49someone you love has been told that
0:51they're pre-diabetic, this video might
0:52be the most important thing that you or
0:54they watch all year. So please send it
0:57to them or anyone else you love that's
0:59on their way towards pre-diabetes or has
1:01diabetes. All right, let's get into it.
1:03So let's start with the basics because
1:05most people who hear pre-diabetic walk
1:08away with a vague sense of dread and
1:09almost no actual understanding of what
1:11it really means. So pre-diabetes means
1:13your blood sugar is higher than normal,
1:15but not yet high enough to be classified
1:17as type 2 diabetes. Specifically, a
1:20fasting blood glucose between 100 and
1:22125 or a hemoglobin A1C of between 5.7
1:26and 6.4. A1C is essentially a 3-month
1:30average of your blood sugar, which makes
1:32it one of the most useful numbers on a
1:33standard lab panel. Here's the scale of
1:36this problem I'm talking about. 115
1:39million American adults, 42.6%
1:43have pre-diabetes right now. That's
1:45nearly half of the adult population, and
1:47we're just talking about adults here.
1:49The pediatric conversation is completely
1:51separate, but very, very serious. And
1:53here's the part that should genuinely
1:54alarm you. Only about one in 10 people
1:58with prediabetes actually know that they
2:00have it. Now, let me actually explain
2:02what's happening inside your body
2:04because almost nobody walks out of a
2:06doctor's appointment with this explained
2:08clearly and has an understanding of the
2:10actual mechanisms that will make the
2:12rest of this video make sense.
2:14When you eat food, specifically
2:15carbohydrates or sugar, it gets broken
2:17down and enters your bloodstream as
2:19glucose.
2:21Your blood sugar then rises. Glucose
2:23floating around in your body at high
2:25levels is actually somewhat toxic to
2:27your body. So, your body wants to clear
2:29it out as quickly as it can and so it
2:31does that by getting it into your cells
2:33where it can be used as energy. That's
2:35where insulin comes in. You probably
2:36heard the word insulin before. Your
2:38pancreas produces insulin specifically
2:40for this job. The pancreas is an organ
2:42that sits right here in the middle of
2:44your abdomen.
2:45Think of insulin as a key. Your cells
2:47have locks on them like door locks, also
2:50known as receptors, on their surface.
2:51Insulin is the key that fits into that
2:54lock and opens the door allowing glucose
2:56to move out of your bloodstream and into
2:58the cells where it can be used for fuel.
3:01In a healthy, well-functioning system,
3:03this works beautifully. You eat, blood
3:05sugar rises, insulin is released, the
3:07key opens the lock, glucose moves into
3:09your cells, blood sugar comes back down.
3:11Smooth process repeated multiple times
3:13per day for most of human history
3:14without issue.
3:16Here's where this breaks down then.
3:18When you chronically eat more
3:20carbohydrates and sugar than your body
3:21actually needs day after day, year after
3:24year, the blood is constantly flooded
3:26with too much glucose. Your pancreas
3:28responds the only way that it knows how,
3:31and that is to pump out more and more
3:33insulin to keep unlocking those cellular
3:34doors and pushing glucose inside and out
3:37of the bloodstream where it becomes
3:39toxic at high levels. But, your cells
3:41start to push back. They're already full
3:44of glucose. They don't need any more
3:46glucose being shoved into it. So,
3:48essentially, they start changing the
3:50locks on the doors. The receptors become
3:52less responsive to insulin. This is
3:54what's known as insulin resistance or
3:56insulin insensitivity. The key doesn't
3:59turn as smoothly anymore in the lock.
4:01Your pancreas, sensing that blood sugar
4:03is still elevated because glucose isn't
4:05getting into the cells efficiently, does
4:07what it knows how to do, which is
4:08produce even more insulin. More keys
4:11trying harder to force into those
4:13increasingly stubborn locks that won't
4:14open.
4:16For a while, this brute force approach
4:17actually works. Your pancreas produces
4:19enough excess insulin to overcome that
4:22resistance and your blood sugar numbers
4:24stay in a relatively normal range, even
4:26though behind the scenes your insulin
4:28levels are already significantly
4:30elevated and your system is working far
4:32harder than it should have to.
4:34This is actually the earliest stages of
4:35metabolic dysfunction, often happening
4:37years before blood sugar ever rises high
4:40enough to show up as diabetes or
4:41prediabetes on standard tests, which is
4:43exactly why fasting insulin, not just
4:47fasting glucose, is one of the labs I
4:49always talk about on this channel. It
4:51catches the problem years before you are
4:54diagnosed with prediabetes. So, that's a
4:56test that you can order with your
4:57doctor, a fasting insulin. Eventually,
4:59though, the pancreas, the organ, can't
5:01keep up anymore with this pace. It's
5:03been working in overdrive for years.
5:05Insulin production starts to decline
5:07because the pancreas is basically
5:09failing, the resistance has gotten
5:11worse, and now blood sugar climbs
5:13because neither the insulin supply nor
5:15the cellular response can compensate
5:17anymore. And that's the moment you cross
5:19from prediabetes into type 2 diabetes.
5:22Prediabetes is not a diagnosis. It's
5:24basically a warning. It's your body
5:26telling you, with as much clarity as a
5:29lab test can offer, that this lock and
5:31key system has been under certain for
5:32too long. And that you still have a
5:35window to fix it before the locks change
5:38permanently.
5:39The tragedy of this is how few people
5:41are told that fixing it is actually an
5:44option. So, the real question is, why
5:46does any of this matter? Why is high
5:48blood sugar dangerous in the first
5:50place?
5:51So, let me explain it the way I explain
5:52it to my patients because once you
5:53understand what excess glucose is
5:55actually doing to your body at the
5:56tissue level in real time, this stops
5:58being some abstract lab number and
6:00starts feeling like exactly what it is,
6:02a very slow
6:04very quiet, very unseen emergency.
6:06So, think of glucose molecules in your
6:08bloodstream kind of like tiny shards of
6:11glass, okay? In normal amounts moving
6:13efficiently into your cells, we'll
6:15consider them pretty harmless. They're
6:16just fuel for your cells. I know glass
6:18being fuel doesn't exactly make sense,
6:19but stick with me here.
6:22When the blood sugar stays elevated for
6:23extended periods of time, that excess
6:25glucose in your bloodstream starts
6:27essentially battering the inside of the
6:29linings of every blood vessel in your
6:30body. It's called glycation. Glucose
6:33molecules binding to proteins and
6:34damaging their structure, including the
6:36proteins that make up your blood vessel
6:38walls.
6:39Imagine sandpaper, like very fine grit
6:42sandpaper, running continuously over the
6:44inside of your arteries, your veins,
6:46your capillaries in your body. Not once,
6:47but continuously every minute, every
6:49hour for years.
6:51That damage triggers inflammation, and
6:53inflammation triggers scarring and
6:54stiffening of the blood vessel walls.
6:56And stiff, damaged, inflamed blood
6:58vessels are the foundation for nearly
7:00every catastrophic complication of
7:02diabetes.
7:03For instance, your eyes. The tiny,
7:05delicate blood vessels in your retina
7:07are some of the most vulnerable in your
7:08entire body to this glucose damage. So,
7:11diabetic retinopathy is the leading
7:13cause of blindness in working age adults
7:15in this country. Not old age, not
7:16injury, sugar quietly destroying the
7:19blood vessels to your eyes over years
7:21until your vision starts to fail.
7:23And then there's your kidneys. Your
7:24kidneys are essentially a massive
7:26filtration system built from millions of
7:29tiny blood vessels. Chronically elevated
7:31glucose shreds these microscopic vessels
7:33over time just like it does in the eyes.
7:35Diabetic nephropathy is one of the
7:37leading causes of kidney failure in the
7:38entire world. That means dialysis
7:41multiple times per week for the rest of
7:43your life, hooked up to a machine doing
7:45what your kidneys used to do for free.
7:47Absolutely devastating and life-altering
7:50diagnosis. And then there's your nerves.
7:52High glucose is directly toxic to your
7:54nerve tissue. That's why people get
7:55diabetic neuropathy, if you've ever
7:57heard of that. It typically starts in
7:59the feet with numbness, tingling,
8:01burning pain that creeps upwards over
8:02years.
8:04And the part that should really disturb
8:05you is this. Because of that nerve
8:07damage, people with advanced diabetes
8:09often can't feel injuries to their feet
8:11cuz they can't feel their feet at all.
8:13So, a small cut, a blister, a stubbed
8:15toe, something that should be trivial,
8:17except their circulation is also damaged
8:19from the same glycation process
8:20happening in their blood vessels that we
8:21already talked about. So, that small
8:23wound doesn't heal properly. It gets
8:25infected. The infection spreads because
8:27blood flow can't deliver enough immune
8:28response to the to fight it off. And in
8:30advanced cases, that wound ends in
8:33amputation. I've watched this happen a
8:35lot. I see it every day in the ER.
8:37People who lost a toe, a foot, a leg
8:40because of a blister, a simple blister
8:42that never healed. They never even knew
8:45that it was there or felt it forming.
8:47And then there's your heart and blood
8:48vessels. Diabetes dramatically
8:50accelerates atherosclerosis, or the
8:51buildup of plaque inside your arteries.
8:53People with diabetes have two to four
8:55times the risk of heart disease and
8:57stroke compared to people without it.
8:59The same glycation damage that we've
9:00been talking about happens inside your
9:01coronary arteries, or your heart
9:03arteries, and inside the vessels inside
9:05your brain. It's not a separate problem.
9:07It's the exact same mechanism, just
9:09showing up in different places in your
9:10body. So, for your brain, emerging
9:13research has started referring to
9:14Alzheimer's disease as type 3 diabetes
9:17because of how strongly chronic high
9:18blood sugar and insulin resistance
9:20correlate with chronic decline in
9:22dementia risk. Your brain runs on
9:24glucose, but it needs it delivered in a
9:26controlled and regulated way, not
9:28flooding it chaotically because the
9:30entire system basically broke down.
9:32And acutely, when blood sugar spikes
9:34extremely high, which happens in poorly
9:36controlled diabetes, you can develop
9:38what's called diabetic ketoacidosis, or
9:39another one that's related called HHNS,
9:42a genuinely medical emergency. Your
9:45blood becomes dangerously acidic. People
9:47come into my ER in this state confused,
9:50vomiting, breathing in strange labored
9:52patterns as their body desperately tries
9:54to correct their blood chemistry. Left
9:56untreated,
9:57it is absolutely fatal.
9:59I've stabilized patients in this exact
10:00condition. It is not rare. It happens
10:03regularly. We see it in the ER all the
10:04time.
10:06This is what's actually sitting at the
10:07end of a road that starts with a
10:09diagnosis of prediabetes, and nobody
10:11explained this to you. Blindness, kidney
10:13failure, amputation, heart attacks,
10:15strokes, dementia, a medical emergency
10:18that can kill you in a matter of hours
10:20if it goes far enough.
10:22That sandpaper has been running the
10:23entire time, quietly, while you felt
10:26completely fine.
10:28Before I get into how this actually gets
10:29reversed, if you're watching this and
10:31you're already worried about your own
10:32numbers, or you've been told that you're
10:34prediabetic, and you want help building
10:35a plan around it, that's exactly the
10:37kind of thing I work with people on
10:38directly. Check the links below if
10:40that's something that you want help
10:41with. Now, let's get into the part that
10:43actually matters for this video because
10:45this is fixable, and this is what you
10:46came here to see.
10:48This is the thing that nobody told my
10:49patient, and the part most people with
10:51pre- prediabetes never are actually
10:53told, either.
10:54This is reversible.
10:56Genuinely, scientifically,
10:58well-documented, reversible.
11:00So, let's talk about medication first
11:02because I want to be clear about where I
11:04stand on this.
11:05Metformin is the most commonly
11:06prescribed medication for prediabetes
11:08and early type 2 diabetes. It works
11:10primarily by reducing how much glucose
11:12your liver releases into your
11:13bloodstream, and improving your cells'
11:15sensitivity to insulin somewhat. It's a
11:18genuinely useful medication. I prescribe
11:20it occasionally. It is not the enemy
11:22here.
11:23But, here's what the actual research
11:25shows when it's compared directly to
11:26lifestyle interventions.
11:28The Diabetes Prevention Program, one of
11:30the most important clinical trials ever
11:31conducted on this topic followed over
11:333,000 people with prediabetes and
11:35compared three groups. A placebo group,
11:37a Metformin group, and an intensive
11:39lifestyle intervention group focused on
11:41modest weight reduction and 150 minutes
11:43of weekly activity. And the results,
11:46Metformin reduced progression to full
11:48diabetes by 31%.
11:51The intensive lifestyle intervention
11:52reduced it by 58%.
11:56Lifestyle nearly doubled the
11:57effectiveness of medications. And in
11:59participants over age 60, lifestyle
12:02intervention reduced progression by 71%.
12:06Just let that sit for a second. The
12:08thing most doctors reach for first, the
12:09pill, is meaningfully less effective
12:12than the thing most doctors don't have
12:13time to fully explain. And that is not a
12:15problem with the doctor, that's a
12:16problem with the system, and we've
12:17talked about this before. A physician
12:19does not have enough time to go through
12:21an entire lifestyle and dietary and
12:24weight loss plans with you.
12:26But, the best thing they can do for you
12:27at the time is to give you a band-aid
12:29until you can do the lifestyle
12:30intervention to fix the underlying
12:32problem. And now, I am here as a
12:34physician telling you what the
12:36underlying problem is and that you can
12:37fix it.
12:39And here's a statistic that genuinely
12:40troubles me.
12:41Despite this evidence being available
12:43for over two decades, fewer than a half
12:46of 1% of the 88 million Americans alone
12:50with prediabetes have ever enrolled in a
12:52structured lifestyle program designed to
12:55reverse it.
12:56Less than half of a percent.
12:590.4%
13:01to be precise. The information gap here
13:03isn't a small oversight. It is a massive
13:05systemic failure to communicate
13:07something that could change millions of
13:09lives.
13:11Now,
13:11I want to go even further here because
13:13some of you watching aren't prediabetic.
13:15You already have type 2 diabetes.
13:17And I don't want you to think that this
13:18conversation doesn't apply to you
13:20either.
13:21There was a trial, the Direct trial is
13:23what it was called. It was a rigorous,
13:24well-designed study conducted across
13:26dozens of primary care practices took
13:28people who already had established type
13:302 diabetes some for as long as 6 years
13:33and put them through an intensive weight
13:34loss and lifestyle program.
13:36The results,
13:3746% of participants achieved diabetes
13:40remission within 12 months
13:43compared to only 4% in the control group
13:46and remission was strongly correlated
13:48with how much weight they lost. The more
13:50weight lost, the higher the likelihood
13:51of putting the disease into genuine
13:53remission off medication with normal
13:56blood sugars. This is not a fringe
13:58claim. This is published, peer-reviewed,
14:00rigorously studied medicine. Type 2
14:02diabetes, a disease most people believe
14:04is a one-way street, can for a
14:06meaningful percentage of people be put
14:08into complete remission through
14:09aggressive lifestyle change. Not
14:11managed, absolutely reversed.
14:13And I want to be fully honest about the
14:14limits here, too. Remission isn't
14:16guaranteed for everyone. The earlier you
14:18intervene at the pre-diabetes stage or
14:20in the first few years of type 2
14:22diabetes diagnosis, the higher your odds
14:24are of remission.
14:26The longer the disease has been
14:27established, the harder full remission
14:29becomes. Though even then, lifestyle
14:31changes consistently slow progression
14:33and reduce complications. This isn't an
14:35all-or-nothing thing. Every step you
14:37take towards reversing this moves you
14:39away from blindness and kidney failure
14:41and amputation and heart disease at any
14:43stage, even if you don't reach full
14:45remission.
14:46Medication, when it's needed, is a
14:48bridge, a band-aid. It buys you time and
14:51protects you while you do the work that
14:53actually changes the underlying problem.
14:54It was never meant to be the only
14:56intervention.
14:57So, let's get into exactly what the
14:59research-backed approach looks like. And
15:02this is what I walk my patients through,
15:03as well. This is what actually moves the
15:05needle.
15:06One, fix the food. This is the single
15:08biggest lever. The Direct trial and the
15:09Diabetes Prevention Program both center
15:11on the same core principle and that is
15:13the
15:13to reduce the constant glucose flooding
15:15into your bloodstream that's been
15:17overwhelming your system for years. Cut
15:19out processed carbohydrates and added
15:21sugars dramatically. Not because carbs
15:23are evil, your great great great
15:24grandparents ate carbohydrates, but
15:26because refined processed versions hit
15:28your bloodstream fast and hard
15:29repeatedly all day every day. That
15:31sandpaper we talked about. Every spike
15:34is another pass.
15:35Build your meals around real foods,
15:36proteins, vegetables, healthy fats, and
15:38whole food carbohydrate sources like
15:40tubers and fruits, which digest much
15:42slower and don't create the same
15:43dramatic glucose spikes. This is exactly
15:45the primal eating approach we talk about
15:47constantly on this channel and is
15:49directly specifically supported by the
15:50diabetes reversal research. Number two,
15:53lose the excess weight particularly
15:55visceral fat. The direct trial showed
15:57direct correlation. The more weight
15:59participants lost, the higher their
16:01remission rates.
16:02The diabetes prevention program achieved
16:04its 58% risk reduction with participants
16:06losing just 5 to 7% of their body
16:09weight. That's not extreme. That's about
16:1010 to 15 lb for a lot of people.
16:12Visceral fat specifically is the fat
16:14around your organs. It's metabolically
16:16active and directly worsens the insulin
16:18resistance. Losing it is one of the most
16:20powerful things that you can do to
16:21reverse this process.
16:23And number three, move your body
16:25consistently. The research protocol was
16:27150 minutes per week of moderate
16:29activity, which is about 20 minutes per
16:31day. Movement does something remarkable
16:33for insulin sensitivity. Your muscles
16:35can pull glucose out of the bloodstream
16:38without needing as much insulin to do
16:39it. Essentially creating a second
16:41doorway into your cell that doesn't
16:43require the same broken lock. Walking
16:45after meals is particularly effective
16:47for blunting blood sugar spikes.
16:49Resistance training builds muscle, which
16:51increases your overall capacity to store
16:53and use glucose effectively.
16:55Both matter. Together they matter even
16:57more. Number four, sleep and stress
16:59matter more than people realize. Poor
17:01sleep directly worsens insulin
17:03resistance, sometimes dramatically. Even
17:05after we just one or two nights of
17:06inadequate sleep, chronic stress
17:08elevates cortisol and cortisol raises
17:10blood sugar directly. You can be doing
17:12everything right with food and exercise
17:13and still be undermining your progress
17:15if you're sleeping only four or five
17:16hours a night and running constantly
17:18high levels of stress.
17:19And number five, know your numbers and
17:21then retest. Don't just guess. Get a
17:22fasting insulin, fasting glucose, and
17:24A1C at the start. Make the changes
17:26seriously for 90 days and then retest.
17:28The direct trial showed meaningful
17:30results within 12 weeks for many
17:32participants. You don't have to wait a
17:34year to know if this is working for you.
17:36This is exactly what I told my patient.
17:38This is exactly what I do with my
17:39clients. Real food, lose the excess
17:41weight, especially around the
17:42midsection, move daily, sleep, and
17:43manage your stress. Get retested in 3
17:45months.
17:47My patient left that conversation with
17:48something she hadn't had in years,
17:50genuine hope backed by something real.
17:53Science.
17:54If any of this hit home for you, if
17:55you've been told you're prediabetic or
17:57even diabetic, and nobody walked you
17:58through what that actually means or what
18:00you can do about it,
18:02I want you to leave this video with the
18:03same thing my patient left that
18:04conversation with. Hope backed by real
18:07evidence and a desire for change. This
18:10is reversible for most people at the
18:11prediabetes stage almost entirely, and
18:14even for established type 2 diabetes,
18:16real meaningful remission is achievable
18:18for a significant percentage of people
18:19who do the work. Real food, lose the
18:21excess weight, move daily, sleep, manage
18:23your stress, retest in 90 days. That's
18:25it. That's the whole protocol. No magic,
18:27just biology given its conditions it
18:29needs to heal itself. If you want help
18:31putting this into action, please check
18:33the links below. I run a Primal 60
18:35Challenge every month. It will put this
18:36into action for you. If you want to work
18:38directly with me one-on-one, there is a
18:41link to a quiz that you can take below
18:43that'll kind of guide you along to get
18:44there. Until next time.
18:46Keep moving.

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